Contrast-enhanced magnetic resonance (MR) T1 mapping with low-dose gadolinium-diethylenetriamine pentaacetic acid (Gd-DTPA) is promising in identifying clear cell renal cell carcinoma histopathological grade and differentiating fat-poor angiomyolipoma

Abstract

Background: This study aimed to identify clear cell renal cell carcinoma (ccRCC) histopathological grade and differentiate it from fat-poor angiomyolipoma (AML). This was achieved through contrastenhanced magnetic resonance (MR) T1 mapping with intravenous low-dose gadolinium-diethylenetriamine pentaacetic acid (Gd-DTPA).Methods: In total, 56 consecutive patients received MR scanning between January 2016 and December 2018 using the pre-and post-contrast-enhanced T1 mapping sequences with low-dose Gd-DTPA (0.036 mmol/kg). RCCs were pathologically proven in 40 patients after surgery and graded according to the International Society of Urological Pathology (ISUP) classification system. Ten AMLs were pathologically proven by surgery histopathology and six AMLs were diagnosed by magnetic resonance imaging (MRI).Patients were followed up for more than half a year. The mean T1 values of the renal lesion and ipsilateral normal renal parenchyma were measured before and after Gd-DTPA administration (T1p and T1e). The reduction of T1 value (T1d) and the ratio of its reduction (T1d %) were calculated and compared.Results: In 40 ccRCCs, higher-grade [International Society of Urologic Pathology (ISUP) grade 3 and 4] and lower-grade (ISUP grade 1 and 2) ccRCCs were noted in 13 and 27 patients, respectively. The mean T1p was 1,514.8±139.4 ms and the mean T1d was 907.7±193.7 ms in the higher-grade ccRCCs, which were significantly higher than in the lower-grade ccRCCs (T1p =1,251.7±151.5 ms and T1d =648.5±218.2 ms, respectively; P<0.001). Fat-poor AMLs had higher T1p (1,677.3±104.8 ms) and T1e (865.6±251.5 ms) as compared to ccRCCs (P<0.001). Combined T1p + T1d showed the highest area under the curve (AUC) (0.912) in the differentiation of higher-grade ccRCCs from lower-grade ccRCCs (P=0.010). Combined T1p + T1e had the highest AUC (0.956) in the differentiation between ccRCCs and fat-poor AMLs (P=0.010).All T1 mapping metrics could discriminate between normal renal parenchyma and renal lesions (P<0.001).No significant difference was found in the T1p and T1e at different parts of the ipsilateral normal renal parenchyma. Interobserver agreement for quantitative longitudinal relaxation time in the T1 maps was excellent.Conclusions: Contrast-enhanced T1 mapping with low-dose Gd-DTPA may provide a more reliable and accurate approach in identifying ccRCCs histopathological grade and differentiating ccRCCs from fat-poor AMLs.

B1‐Corrected T1 Mapping in Lung Cancer: Repeatability, Reproducibility, and Identification of Histological Types

“…Studies of hepatocellular carcinoma and clear cell renal cell carcinoma have similarly shown that high-grade tumors, presented as a high degree of malignancy, have higher native T1 values. 12,13,38 However, the result was different from the study of Wu et al, 22 in which ADC values were positively correlated with native T1 values in the assessment of myocardial fibrosis in hypertrophic cardiomyopathy patients. This may be because the high water content of inflammatory and fibrotic tissues leads to high ADC and T1 values.…”

“…In this study, the T1 values of patients with SCLC were significantly higher than those of patients with NSCLC; thus, T1 values may also potentially distinguish between SCLC and NSCLC. The possible reasons may be that higher degrees of micronecrosis and incomplete necrosis may occur in SCLC because of rapid growth, which is below the spatial resolution of MRI and is therefore difficult to exclude in ROI delineation 12,13,25 . Meanwhile, SCLC is characterized by poor adhesion, loose nests, and infiltration along the intercellular space, inducing more extracellular matrix (ECM), and, thus, yielding larger T1 values 12,25 …”

“…[4][5][6][7][8] Additionally, it has been shown that T1 mapping is potentially able to differentiate benign and malignant pulmonary lesions and lymph nodes due to differences in their water content. [9][10][11] Other studies have suggested that T1 mapping could also be used to determine histopathological grade 12,13 and to monitor the treatment response of tumors. 14 Thus, T1 mapping may be a promising imaging strategy for assessing the intrinsic properties and underlying pathological changes of tumors.…”

A CT-Based Radiomics Nomogram Integrated With Clinic-Radiological Features for Preoperatively Predicting WHO/ISUP Grade of Clear Cell Renal Cell Carcinoma

“…CT diagnosis is superior to percutaneous biopsy because of its noninvasiveness; however, it is inferior in terms of diagnostic accuracy (20,21). Novel imaging techniques, such as magnetic resonance imaging (MRI) and dual-energy spectral CT, are capable to assess the grading level of CCRCC, however, their predictive performance do not match that of percutaneous biopsy, and the diagnostic results depend on the experience of radiologists (22)(23)(24). By quantifying tumor heterogeneity through the spatial arrangement of image voxels with signal-intensity variations and detecting the imperceptible differences of the intensity distribution in medical images, CT radiomics can noninvasively predict the pathological grade of tumors with satisfactory performance (25)(26)(27).…”

Associations between brain volumetry and relaxometry signatures and the Edmonton Frail Scale in frailty

“…Therefore, relaxometry characteristics have been investigated in several brain imaging studies (11)(12)(13)(14). Relaxometry studies have also been conducted on other organs, such as the cartilage (15), kidney (16), etc. However, the application of relaxometry in clinical practice is limited by several factors.…”