Renal Cell Carcinoma: Diffusion-weighted MR Imaging for Subtype Differentiation at 3.0 T

Wang, Haiyi; Cheng, Liuquan; Zhang, Xu; Wang, Dianjun; Guo, Aitao; Yuangui, Gao; Ye, Huiyi

doi:10.1148/radiol.10092396

Cited by 199 publications

(150 citation statements)

References 36 publications

(34 reference statements)

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“…A potential alternative to increased use of biopsy might lie in the use of diagnostic imaging to characterize renal cortical tumors on the basis of their tissue composition, morphologic features, and/or contrast enhancement patterns (21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32). Doppler ultrasonography, contrast material-enhanced computed tomography, and magnetic resonance (MR) imaging have shown potential for enabling differentiation of clear cell renal carcinomas (which show increased vascular flow and enhance avidly) from papillary and chromophobe carcinomas (which show reduced vascular flow and less enhancement) (21)(22)(23)(24)(26)(27)(28)).…”

Section: Discussionmentioning

confidence: 99%

“…A study by Wang et al (31) showed that clear cell carcinomas had significantly higher apparent diffusion coefficients than did papillary or chromophobe carcinomas. Taouli et al (30) reported that in the differentiation of benign and malignant renal lesions, DW MR imaging (area under the receiver operating characteristic curve, 0.85) was less accurate than qualitative assessment of dynamic contrastenhanced MR imaging (area under the receiver operating characteristic curve, 0.94).…”

Section: Genitourinary Imaging: Renal Cortical Tumorsmentioning

confidence: 99%

“…The potential value of diffusionweighted (DW) MR imaging for characterizing renal lesions has also been investigated (29)(30)(31)(32). A study by Wang et al (31) showed that clear cell carcinomas had significantly higher apparent diffusion coefficients than did papillary or chromophobe carcinomas.…”

Section: Genitourinary Imaging: Renal Cortical Tumorsmentioning

confidence: 99%

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Renal Cortical Tumors: Use of Multiphasic Contrast-enhanced MR Imaging to Differentiate Benign and Malignant Histologic Subtypes

Vargas

Chaim²,

Lefkowitz³

et al. 2012

Radiology

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Purpose:To investigate the use of quantitative multiphasic contrast material-enhanced magnetic resonance (MR) imaging in differentiating between common benign and malignant histologic subtypes of renal cortical tumors. Materials and Methods:The institutional review board waived informed consent and approved this retrospective HIPAA-compliant study of 138 patients who underwent preoperative contrastenhanced MR imaging during the period of January 2004-December 2008. At surgery, 152 renal tumors were identified (77 clear cell, 22 papillary, 18 chromophobe, and 10 unclassified carcinomas; 16 oncocytomas; nine angiomyolipomas). Three readers independently identified and measured the most-enhanced area in each tumor and placed corresponding regions of interest in similar positions on images from the precontrast, corticomedullary, nephrographic, and excretory phases. The percentage change in signal intensity (%SI change) between precontrast imaging and each postcontrast phase was calculated.Interreader agreement was evaluated by using the overall concordance correlation coefficient (OCC). A linear mixed-effects model was used to estimate and compare the trajectories of the means of log %SI change across all phases between the six histologic subtypes. results:Interreader agreement was substantial to almost perfect (OCC, 0.77-0.88). The %SI change differed significantly between clear cell carcinomas and papillary and chromophobe carcinomas in all phases of enhancement (P , .0001-.0120). In addition, %SI change was significantly higher in angiomyolipomas than in clear cell carcinomas, but only in the corticomedullary phase (P = .0231). Enhancement did not differ significantly between clear cell carcinoma and oncocytoma in any phase (P = .2081-.6000). conclusion:Quantitative multiphase contrast-enhanced MR imaging offers a widely available, reproducible method to characterize several histologic subtypes of renal cortical tumors, although it does not aid differentiation between clear cell carcinomas and oncocytomas.q RSNA, 20121 From the Departments of Radiology (H

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Section: Discussionmentioning

confidence: 99%

Section: Genitourinary Imaging: Renal Cortical Tumorsmentioning

confidence: 99%

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Renal Cortical Tumors: Use of Multiphasic Contrast-enhanced MR Imaging to Differentiate Benign and Malignant Histologic Subtypes

Vargas

Chaim²,

Lefkowitz³

et al. 2012

Radiology

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“…DWI provides quantification of the Brownian motion of water molecules in tissues, which depends on tissue organization, cellularity, the integrity of cell membranes, and extracellular space tortousity (21). Qualitative and quantitative information are obtained regarding tissue characterization without the need for gadolinium chelates and alternative imaging for renal lesion characterization in patients at risk for nephrogenic systemic fibrosis (21)(22)(23)(24). Few studies have evaluated the correlation of apparent diffusion coefficient (ADC) values with nuclear grade, histological subtype, and cellularity of RCC.…”

Section: The Role Of Mri In Renal Imagingmentioning

confidence: 99%

Subtypes of renal cell carcinoma: MRI and pathological features

Gürel¹,

Narra²,

Elsayes³

et al. 2013

Diagn Interv Radiol

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Renal cell carcinoma (RCC) is the most common malignant tumor involving the kidney. Determining the subtypes of renal cell carcinoma is among the major goals of preoperative radiological work-up. Among all modalities, magnetic resonance imaging (MRI) has several advantages, such as inherent soft tissue contrast, detection of lipid and blood products, and excellent sensitivity to detect small amounts of intravenous contrast, which facilitate the discrimination of subtypes of RCC. In this article, we review MRI and pathological features used for determining the main histologic subtypes of RCC, including clear cell, papillary, collecting duct, chromophobe, multilocular cystic, and unclassified RCC. Renal cell carcinoma (RCC) is the most common malignant epithelial tumor of the kidney, accounting for 85%-90% of all solid renal tumors in adults and comprising 1%-3% of all malignant visceral neoplasms (1). Approximately 40% of patients with RCC eventually die from progression of this disease, making it the most lethal urologic malignancy (2). Today, most RCC instances are incidental masses identified on imaging studies performed for nonurological reasons.Percutaneous biopsy is a minimally invasive method, and its accuracy for identifying renal tumors ranges from 70% to 90% (3, 4). However, widespread use of percutaneous biopsy remains controversial due to the potential complications of biopsy, the possibility of sampling errors, the dependence on an adequate biopsy sample for analysis, and concerns about how the biopsy information might alter the treatment plan (5). Therefore, histopathological characterization of renal masses with magnetic resonance imaging (MRI) compared with percutaneous biopsy becomes more advantageous.Determining subtypes of RCC has significant prognostic and theraupeutic implications for patients who are poor surgical candidates, for patients who have a metastatic disease, for surgical planning in patients who are surgical candidates, and for immunotherapy and use of the tyrosine kinase inhibitors "sunitinib" and "sorafenib" for clear cell RCC and "temsirolimus" for papillary RCC (6-9).The need for a different approach to the management of RCC among classical surgical procedures has arisen. Nephron-preserving surgical methods, cryoablation, radiofrequency ablation, targeted molecular therapy or follow-up, and MRI are believed to surpass other modalities both in the diagnosis of RCC and determination of its subtypes (10,11).In this article, we review MRI findings and pathological features used for determining the main histologic subtypes of RCC, including clear cell carcinoma, papillary, collecting duct, chromophobe, multilocular cystic, and unclassified RCC. The role of MRI in renal imagingThere are three indispensable components of renal MRI: breathhold imaging, three-dimensional (3D) gradient echo pulse sequence, and fat detection techniques.Breathhold imaging is one of the essential techniques in renal mass MRI protocols. Suspended expiration eliminates respiratory motion artifacts an...

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“…To date, only 2 studies, which examined only RCC but not benign renal tumors, have used MRI at 3T. 21,22 The purpose of this study was to assess the usefulness of the apparent diffusion coefficients (ADCs) for differentiating different types of solid renal tumors with DWI at 3T.…”

Section: Introductionmentioning

confidence: 99%

Utility of Apparent Diffusion Coefficients in the Evaluation of Solid Renal Tumors at 3T

Sasamori

Saiki

Suyama

et al. 2014

MRMS

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Purpose: We assessed the usefulness of apparent diffusion coefficients (ADCs) for solid renal tumor imaging using diffusion-weighted magnetic resonance imaging (DWI) at 3T.Methods: This retrospective study assessed ADCs of 31 patients with renal tumors that were imaged using preoperative DWI. DWI was performed with the b values of 50, 500, and 1000 s/mm 2 , using a 3T magnetic resonance imaging (MRI) system (MAGNETOM Trio, 3T, Siemens Healthcare, Erlangen, Germany). The ADC map was calculated using the b values of 50 and 1000 s/mm 2 . ADCs of the different tumors were compared according to the Tukey-Kramer test.Results: The tumors were diagnosed as clear cell renal cell carcinoma (RCC; n = 20), papillary RCC (n = 1), infiltrating urothelial carcinoma (UC) of the kidney (n = 4), cystic RCC (n = 1), poorly differentiated carcinoma (n = 1), and angiomyolipoma (AML; n = 4). The mean ADC of clear cell RCC was significantly higher than that of infiltrating UC of the kidney (1.423 vs. 0.931 © 10 ¹3 mm 2 /s; P < 0.05), and the mean ADC of AML was significantly lower than that of clear cell RCC (0.674 vs. 1.423 © 10 ¹3 mm 2 /s; P < 0.01). Conclusion: ADCs used in DWI at 3T may be useful for differentiation of different types of solid renal tumors.

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Renal Cell Carcinoma: Diffusion-weighted MR Imaging for Subtype Differentiation at 3.0 T

Abstract: DW imaging with b values of 0 and 800 sec/mm(2) allows sensitive and specific differentiation of clear cell, papillary, and chromophobic RCCs, suggesting that DW imaging may be useful in the preoperative characterization of RCC.

Cited by 199 publications

References 36 publications

Renal Cortical Tumors: Use of Multiphasic Contrast-enhanced MR Imaging to Differentiate Benign and Malignant Histologic Subtypes

Renal Cortical Tumors: Use of Multiphasic Contrast-enhanced MR Imaging to Differentiate Benign and Malignant Histologic Subtypes

Subtypes of renal cell carcinoma: MRI and pathological features

Utility of Apparent Diffusion Coefficients in the Evaluation of Solid Renal Tumors at 3T

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