Differentiation of solid and friable tumour thrombus in patients with renal cell carcinoma: The role of MRI apparent diffusion coefficient

Paweł Kowal ¹, Krzysztof Ratajczyk ¹, Wiktor Bursiewicz ¹

⁰Department of Urology, Regional Specialist Hospital, Wroclaw, Poland.

Advances in Medical Sciences +

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September 16, 2024

View abstract on PubMed

Summary

MRI texture analysis of apparent diffusion coefficient (ADC) maps can differentiate solid from friable renal cell carcinoma (RCC) thrombus. This imaging technique aids in better characterizing tumor thrombus in patients with RCC and inferior vena cava (IVC) involvement.

Area Of Science

Radiology and Oncologic Imaging
Medical Physics
Nephrology

Background

Inferior vena cava (IVC) involvement in renal cell carcinoma (RCC) signifies advanced disease and poorer prognosis.
Differentiating solid from friable tumor thrombus is crucial for treatment planning and predicting outcomes.

Purpose Of The Study

To evaluate the utility of apparent diffusion coefficient (ADC) MRI 3D texture analysis in distinguishing solid from friable tumor thrombi in RCC patients.
To assess the diagnostic performance of radiomic features derived from ADC maps.

Main Methods

Retrospective analysis of 27 RCC patients with renal vein or IVC tumor thrombus who underwent preoperative MRI with diffusion-weighted imaging (DWI).
Calculation of first-order radiomic features from ADC maps of the entire thrombus volume.
Histological classification of thrombi as solid or friable.

Main Results

No significant differences in texture parameters like range, kurtosis, or variance were found between solid and friable thrombi.
ADC mean, median, and entropy showed moderate differentiation capability (AUC 0.808 for entropy).
Skewness threshold of 0.09 achieved high sensitivity (86%) and specificity (92%) for differentiating thrombus types.

Conclusions

3D texture analysis of ADC maps is a precise method for differentiating solid from friable tumor thrombi in RCC patients with IVC involvement.
Radiomic features, particularly skewness, show promise in non-invasively characterizing tumor thrombus consistency.

Keywords:

Diffusion-weighted imaging Renal cell carcinoma Texture analysis Thrombus