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Renal lesions: characterization with diffusion-weighted imaging versus contrast-enhanced MR imaging
Bachir Taouli1, Ravi K Thakur, Lorenzo Mannelli
1Department of Radiology, New York University Langone Medical Center, 560 First Ave, New York, NY 10016, USA. bachir.taouli@nyumc.org
Purpose:
To compare the diagnostic performance of diffusion-weighted (DW) magnetic resonance (MR) imaging with that of contrast material-enhanced (CE) MR imaging and to assess the performance of these examinations combined for the characterization of renal lesions, with MR follow-up and histopathologic analysis as the reference standards.
Materials And Methods:
The institutional review board waived the requirement of informed patient consent for this retrospective HIPAA-compliant study. One hundred nine renal lesions in 64 patients (46 men, 18 women; mean age, 60.7 years) were evaluated with CE MR imaging and breath-hold DW imaging performed with various b values. Renal lesions were characterized with use of CE MR criteria, and apparent diffusion coefficients (ADCs) were measured. The ADCs of benign and malignant lesions were compared at Mann-Whitney testing. Receiver operating characteristic (ROC) analysis was performed to assess the accuracy of DW imaging and CE MR imaging in the diagnosis of renal cell carcinoma (RCC).
Results:
The 109 renal lesions--81 benign lesions and 28 RCCs--had a mean diameter of 4.2 cm +/- 2.5 (standard deviation). The mean ADC for RCCs (1.41 x 10(-3) mm(2)/sec +/- 0.61) was significantly lower (P < .0001) than that for benign lesions (2.23 x 10(-3) mm(2)/sec +/- 0.87) at DW imaging performed with b values of 0, 400, and 800 sec/mm(2). At a cutoff ADC of less than or equal to 1.92 x 10(-3) mm(2)/sec, the area under the ROC curve (AUC), sensitivity, and specificity of DW imaging for the diagnosis of RCCs (excluding angiomyolipomas) were 0.856, 86%, and 80%, respectively. The corresponding AUC, sensitivity, and specificity of CE MR imaging were 0.944, 100%, and 89%, respectively. Combined DW and CE MR imaging had 96% specificity. The AUC for the DW imaging-based diagnosis of solid RCC versus oncocytoma was 0.854. Papillary RCCs had lower ADCs than nonpapillary RCCs.
Conclusion:
DW imaging can be used to characterize renal lesions; however, compared with CE MR imaging, it is less accurate. DW imaging can be used to differentiate solid RCCs from oncocytomas and characterize the histologic subtypes of RCC.
Insights
Diffusion-weighted (DW) magnetic resonance (MR) imaging is less accurate than contrast-enhanced (CE) MR imaging for characterizing renal lesions. However, DW imaging aids in differentiating renal cell carcinoma (RCC) from oncocytomas and identifying RCC subtypes.
Area of Science:
- Radiology
- Oncology
- Medical Imaging
Background:
- Renal lesion characterization is crucial for diagnosis and treatment planning.
- Magnetic resonance (MR) imaging, including diffusion-weighted (DW) and contrast-enhanced (CE) techniques, offers valuable insights into renal pathology.
Purpose of the Study:
- To compare the diagnostic performance of DW MR imaging versus CE MR imaging for renal lesions.
- To evaluate the combined diagnostic performance of DW and CE MR imaging.
- To establish histopathology and MR follow-up as reference standards.
Main Methods:
- Retrospective analysis of 109 renal lesions in 64 patients.
- Evaluation using both CE MR imaging and breath-hold DW imaging with various b values.
- Measurement of apparent diffusion coefficients (ADCs) and receiver operating characteristic (ROC) analysis for diagnostic accuracy.
Main Results:
- Mean ADC was significantly lower for renal cell carcinomas (RCCs) (1.41 x 10(-3) mm(2)/sec) compared to benign lesions (2.23 x 10(-3) mm(2)/sec).
- DW imaging achieved an area under the ROC curve (AUC) of 0.856 for RCC diagnosis, while CE MR imaging achieved an AUC of 0.944.
- Combined DW and CE MR imaging demonstrated 96% specificity for characterizing renal lesions.
Conclusions:
- DW imaging is a useful tool for characterizing renal lesions, differentiating solid RCCs from oncocytomas, and identifying RCC subtypes.
- CE MR imaging exhibits higher diagnostic accuracy than DW imaging alone for renal lesions.
- Combined DW and CE MR imaging enhances specificity in characterizing renal lesions.
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