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Apparent Diffusion Coefficient Distinguishes Malignancy in T1-Hyperintense Small Renal Masses.

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Apparent diffusion coefficient ratio (ADC ratio) can distinguish malignant from benign small renal masses, even those with T1 hyperintensity on MRI. Lower ADC ratios indicate malignancy, offering a reproducible diagnostic tool for these challenging lesions.

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Area of Science:

  • Radiology
  • Oncology
  • Medical Imaging

Background:

  • Small renal masses (< 4 cm) pose diagnostic challenges, especially when T1 hyperintense on MRI.
  • T1 hyperintensity may be due to hemorrhage, complicating diffusion-weighted imaging (DWI) analysis.
  • Accurate differentiation between benign and malignant small renal masses is crucial for appropriate management.

Purpose of the Study:

  • To evaluate the efficacy of apparent diffusion coefficient (ADC) measurements in differentiating malignant from benign small renal masses.
  • To assess the reproducibility of ADC measurements in T1-hyperintense renal lesions.

Main Methods:

  • Retrospective study of patients with T1-hyperintense renal masses (< 4 cm) on MRI.
  • Pathological confirmation for malignant lesions; benign status established by pathology, ultrasound, or stable imaging for >5 years.
  • ADC measurements normalized to the ipsilateral kidney (ADC ratio) were independently performed by two radiologists.

Main Results:

  • The study included 95 patients with 58 benign and 37 malignant lesions.
  • ADC ratio was significantly lower in malignant lesions (0.65 ± 0.29) compared to benign lesions (1.03 ± 0.32; p < 0.001).
  • ADC ratio remained a significant predictor of malignancy even after controlling for lesion size, demonstrating high interrater agreement (κ = 0.836-0.934).

Conclusions:

  • ADC ratio is a highly reproducible metric for small renal masses with T1 hyperintensity on MRI.
  • Lower ADC ratios effectively distinguish malignant from benign renal masses.
  • ADC ratio shows promise as a non-invasive tool for characterizing small, T1-hyperintense renal lesions.