Apparent diffusion coefficient as it relates to histopathology findings in post-chemotherapy nephroblastoma: a feasibility study

Abstract

Background Nephroblastomas represent a group of heterogeneous tumours with variable proportions of distinct histopathological components. Objective The purpose of this study was to investigate whether direct comparison of apparent diffusion coefficient (ADC) measurements with post-resection histopathology subtypes is feasible and whether ADC metrics are related to histopathological components. Materials and methods Twenty-three children were eligible for inclusion in this retrospective study. All children had MRI including diffusion-weighted imaging (DWI) after preoperative chemotherapy, just before tumour resection. A pathologist and radiologist identified corresponding slices at MRI and postoperative specimens using tumour morphology, the upper/lower calyx and hilar vessels as reference points. An experienced reader performed ADC measurements, excluding non-enhancing areas. A pathologist reviewed the corresponding postoperative slides according to the international standard guidelines. We tested potential associations with the Spearman rank test. Results Side-by-side comparison of MRI-DWI with corresponding histopathology slides was feasible in 15 transverse slices in 9 lesions in 8 patients. Most exclusions were related to extensive areas of necrosis/haemorrhage. In one lesion correlation was not possible because of the different orientation of sectioning of the specimen and MRI slices. The 25% ADC showed a strong relationship with percentage of blastema (Spearman rho=−0.71, P=0.003), whereas median ADC was strongly related to the percentage stroma (Spearman rho=0.74, P=0.002) at histopathology. Conclusion Side-by-side comparison of MRI-DWI and histopathology is feasible in the majority of patients who do not have massive necrosis and hemorrhage. Blastemal and stromal components have a strong linear relationship with ADC markers.

Renal Tumors of Childhood—A Histopathologic Pattern-Based Diagnostic Approach

“…Finally, through digitalization of traditional H&E slides, so-called whole slide images can now be analyzed by machine learning techniques. This has already resulted in automated recognition of specific tissue components, such as lymph node metastases in breast cancer [7]. It is certainly conceivable that such automated recognition will also lead to computer-assisted classification of tumor types, including pediatric renal tumors.…”

“…Distribution of pediatric renal tumors in children <15 year of age according to the National Registry Childhood Tumors (UK). While imaging techniques are continuously improving, they are still unable to reliably diagnose and distinguish the most relevant pathology based risk groups, although some new techniques (like MRI-Diffusion Weighted Imaging) might be helpful in the near future [7]. The clinical characteristics of children with renal tumors are similar, although some (like age distribution) may be helpful in the differential diagnosis [8].…”

Comparison of 3-Dimensional and Augmented Reality Kidney Models With Conventional Imaging Data in the Preoperative Assessment of Children With Wilms Tumors

“…Diffusion-weighted imaging in MRI already shows the increasing potential to discriminate tumor from healthy tissue. 17 To further objectify these data with scientific accuracy to convert them into 3-D prints or AR holograms, more research about standardized algorithms is needed. In addition, high-quality conventional imaging (MRI or CT) is key for obtaining useful preoperative 3-D imaging.…”

“…Coronal 3-D, T2-weighted imaging along with fat-suppressed T1-weighted imaging before and after the administration of gadolinium-based contrast medium was acquired. 17 Computed tomography was performed with the 16-row multiple detector CT (Brilliance 16P; Philips Medical Systems). All patients received 1.5 mL/kg of contrast medium, with a maximum of 120 mL scanned in the arterial phase (injection rate of 2 mL/s, with saline solution pushed through the injection line immediately after the injection of the contrast bolus [injection rate of 2 mL/s and a volume of 8-10 mL depending on the age of the patient]) in accordance with standard protocol.…”

European Society of Paediatric Radiology 2019 strategic research agenda: improving imaging for tomorrow’s children

“…It is for this reason that the standardization of technical parameters is paramount going forwards, but also perhaps the largest hurdle to overcome. This challenge occurs on many levels, includes the standardization of imaging approaches (e.g., the use of ultrasound [US] in cystic kidney disease [18]), imaging protocols (e.g., the use of gadolinium for joint disease activity assessment in juvenile idiopathic arthritis [19]), and further specific sequences within imaging protocols (e.g., the use of diffusion-weighted imaging in oncology assessment as routine [20]).…”