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Xu Y, Wan Q, Ren X, Jiang Y, Wang F, Yao J, Wu P, Shen A, Wang P. Amide proton transfer-weighted MRI for renal tumors: Comparison with diffusion-weighted imaging. Magn Reson Imaging 2024; 106:104-109. [PMID: 38135260 DOI: 10.1016/j.mri.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 12/07/2023] [Accepted: 12/10/2023] [Indexed: 12/24/2023]
Abstract
OBJECTIVE To investigate the potential of amide proton transfer-weighted (APTw) MRI in identifying benign and malignant renal tumors and to evaluate whether APTw MRI can add diagnostic value to diffusion-weighted imaging (DWI). MATERIALS AND METHODS Participants with renal tumor underwent preoperative multiparametric MRI, including APTw MRI and DWI. The APTw and apparent diffusion coefficient (ADC) of malignant tumors and benign tumors were calculated independently by two radiologists and compared. The value of the mean APTw and the mean ADC for differentiating malignant and benign tumors was evaluated by receiver operating characteristic analysis. RESULTS In total, 65 participants (mean age, 59 years ±14; 41 men) were evaluated: 54 with malignant and 11 with benign renal tumors. Malignant renal tumors showed higher mean APTw values [2.03% (1.63) vs 1.00% (1.60); P < 0.01] and lower mean ADC values (1.22 × 10-3 mm2/s ± 0.37 vs 1.51 × 10-3 mm2/s ± 0.37; P < 0.05) than benign renal tumors. The area under the receiver operating characteristic curve (AUC) of APTw, ADC and the combination of them for the identification of benign and malignant renal tumors was 0.78(95% CI: 0.66, 0.87; P < 0.001),0.70(95% CI: 0.54, 0.86; P < 0.05) and 0.79 (95% CI: 0.67, 0.88; P < 0.001). The optimal cutoff value for mean APTw was 2.14% (sensitivity, 74%; specificity, 73%). There was no difference between these three parameters for differentiating malignant from benign renal tumors (P > 0.05). CONCLUSION The APTw MRI has the potential use as an imaging biomarker for renal malignant and benign tumors.
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Affiliation(s)
- Yun Xu
- Department of Medical Imaging, Tongji Hospital, School of Medicine, Tongji University, Shanghai 200065, China; Institute of Medical Imaging Artificial Intelligence, Tongji University School of Medicine, Shanghai 200065, China
| | - Qingxuan Wan
- Department of Medical Imaging, Tongji Hospital, School of Medicine, Tongji University, Shanghai 200065, China; Institute of Medical Imaging Artificial Intelligence, Tongji University School of Medicine, Shanghai 200065, China
| | - Xihui Ren
- Department of Medical Imaging, Tongji Hospital, School of Medicine, Tongji University, Shanghai 200065, China; Institute of Medical Imaging Artificial Intelligence, Tongji University School of Medicine, Shanghai 200065, China
| | - Yutao Jiang
- Department of Medical Imaging, Tongji Hospital, School of Medicine, Tongji University, Shanghai 200065, China; Institute of Medical Imaging Artificial Intelligence, Tongji University School of Medicine, Shanghai 200065, China
| | - Fang Wang
- Department of Medical Imaging, Tongji Hospital, School of Medicine, Tongji University, Shanghai 200065, China; Institute of Medical Imaging Artificial Intelligence, Tongji University School of Medicine, Shanghai 200065, China
| | - Jing Yao
- Department of Medical Imaging, Tongji Hospital, School of Medicine, Tongji University, Shanghai 200065, China; Institute of Medical Imaging Artificial Intelligence, Tongji University School of Medicine, Shanghai 200065, China
| | - Peng Wu
- Philips Healthcare, Shanghai 200072, China
| | - Aijun Shen
- Department of Medical Imaging, Tongji Hospital, School of Medicine, Tongji University, Shanghai 200065, China; Institute of Medical Imaging Artificial Intelligence, Tongji University School of Medicine, Shanghai 200065, China.
| | - Peijun Wang
- Department of Medical Imaging, Tongji Hospital, School of Medicine, Tongji University, Shanghai 200065, China; Institute of Medical Imaging Artificial Intelligence, Tongji University School of Medicine, Shanghai 200065, China.
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MRI Characteristics of Pediatric and Young-Adult Renal Cell Carcinoma: A Single-Center Retrospective Study and Literature Review. Cancers (Basel) 2023; 15:cancers15051401. [PMID: 36900194 PMCID: PMC10000563 DOI: 10.3390/cancers15051401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/09/2023] [Accepted: 02/17/2023] [Indexed: 02/25/2023] Open
Abstract
Pediatric renal cell carcinoma (RCC) is a rare malignancy. Magnetic resonance imaging (MRI) is the preferred imaging modality for assessment of these tumors. The previous literature has suggested that cross-sectional-imaging findings differ between RCC and other pediatric renal tumors and between RCC subtypes. However, studies focusing on MRI characteristics are limited. Therefore, this study aims to identify MRI characteristics of pediatric and young-adult RCC, through a single-center case series and literature review. Six identified diagnostic MRI scans were retrospectively assessed, and an extensive literature review was conducted. The included patients had a median age of 12 years (63-193 months). Among other subtypes, 2/6 (33%) were translocation-type RCC (MiT-RCC) and 2/6 (33%) were clear-cell RCC. Median tumor volume was 393 cm3 (29-2191 cm3). Five tumors had a hypo-intense appearance on T2-weighted imaging, whereas 4/6 were iso-intense on T1-weighted imaging. Four/six tumors showed well-defined margins. The median apparent diffusion coefficient (ADC) values ranged from 0.70 to 1.20 × 10-3 mm2/s. In thirteen identified articles focusing on MRI characteristics of MiT-RCC, the majority of the patients also showed T2-weighted hypo-intensity. T1-weighted hyper-intensity, irregular growth pattern and limited diffusion-restriction were also often described. Discrimination of RCC subtypes and differentiation from other pediatric renal tumors based on MRI remains difficult. Nevertheless, T2-weighted hypo-intensity of the tumor seems a potential distinctive characteristic.
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Baio R, Molisso G, Caruana C, Di Mauro U, Intilla O, Pane U, D’Angelo C, Campitelli A, Pentimalli F, Sanseverino R. "To Be or Not to Be Benign" at Partial Nephrectomy for Presumed RCC Renal Masses: Single-Center Experience with 195 Consecutive Patients. Diseases 2023; 11:diseases11010027. [PMID: 36810541 PMCID: PMC9945135 DOI: 10.3390/diseases11010027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 01/21/2023] [Accepted: 01/31/2023] [Indexed: 02/11/2023] Open
Abstract
In daily medical practice, an increasing number of kidney masses are being incidentally detected using common imaging techniques, owing to the improved diagnostic accuracy and increasingly frequent use of these techniques. As a consequence, the rate of detection of smaller lesions is increasing considerably. According to certain studies, following surgical treatment, up to 27% of small enhancing renal masses are identified as benign tumors at the final pathological examination. This high rate of benign tumors challenges the appropriateness of surgery for all suspicious lesions, given the morbidity associated with such an intervention. The objective of the present study was, therefore, to determine the incidence of benign tumors at partial nephrectomy (PN) for a solitary renal mass. To meet this end, a total of 195 patients who each underwent one PN for a solitary renal lesion with the intent to cure RCC were included in the final retrospective analysis. A benign neoplasm was identified in 30 of these patients. The age of the patients ranged from 29.9-79 years (average: 60.9 years). The tumor size range was 1.5-7 cm (average: 3 cm). All the operations were successful using the laparoscopic approach. The pathological results were renal oncocytoma in 26 cases, angiomyolipomas in two cases, and cysts in the remaining two cases. In conclusion, we have shown in our present series the incidence rate of benign tumors in patients who have been subjected to laparoscopic PN due to a suspected solitary renal mass. Based on these results, we advise that the patient should be counseled not only about the intra- and post-operative risks of nephron-sparing surgery but also about its dual therapeutic and diagnostic role. Therefore, the patients should be informed of the considerably high probability of a benign histological result.
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Affiliation(s)
- Raffaele Baio
- Department of Medicine and Surgery “Scuola Medica Salernitana”, University of Salerno, 84081 Baronissi, Italy
- Correspondence:
| | - Giovanni Molisso
- Department of Urology, Umberto I, Nocera Inferiore, 84014 Salerno, Italy
| | | | - Umberto Di Mauro
- Department of Urology, Umberto I, Nocera Inferiore, 84014 Salerno, Italy
| | - Olivier Intilla
- Department of Urology, Umberto I, Nocera Inferiore, 84014 Salerno, Italy
| | - Umberto Pane
- Department of Urology, Umberto I, Nocera Inferiore, 84014 Salerno, Italy
| | - Costantino D’Angelo
- Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy
| | - Antonio Campitelli
- Department of Urology, Umberto I, Nocera Inferiore, 84014 Salerno, Italy
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Liu W, Liu H, Xie S, Masokano IB, Bai Y, Wang X, Zhong L, Wu Y, Nie J, Zhou G, Pei Y, Li W. Comparing the clinical utility of single-shot, readout-segmented and zoomit echo-planar imaging in diffusion-weighted imaging of the kidney at 3 T. Sci Rep 2022; 12:12389. [PMID: 35859112 PMCID: PMC9300617 DOI: 10.1038/s41598-022-16670-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 07/13/2022] [Indexed: 12/04/2022] Open
Abstract
We compared the clinical utility of single-shot echo-planar imaging (SS-EPI) using different breathing schemes, readout-segmented EPI and zoomit EPI in the repeatability of apparent diffusion coefficient (ADC) measurements, cortico-medullary contrast to noise ratio (c-mCNR) and image quality. In this institutional review board-approved prospective study, some common clinically applicable diffusion-weighted imaging (b = 50, 400, 800 s/mm2) of kidney on 3.0 T MRI were performed on 22 volunteers using SS-EPI with breath-hold diffusion-weighted imaging (BH-DWI), free-breathing (FB-DWI), navigator-triggered (NT-DWI) and respiratory-triggered (RT-DWI), readout-segmented DWI (RS-DWI), and Zoomit DWI (Z-DWI). ADC and c-mCNR were measured in 12 anatomic locations (the upper, middle, and lower pole of the renal cortex and medulla), and image quality was assessed on these DWI sequences. A DWI with the optimal clinical utility was decided by systematically assessing the ADC repeatability, c-mCNR and image quality among the DWIs. For ADC measurements, Z-DWI had an excellent intra-observer agreement (intra-class correlation coefficients (ICCs): 0.876–0.944) and good inter-observer agreement (inter-class ICCs: 0.798–0.856) in six DWI sequences. Z-DWI had the highest ADC repeatability in most of the 12 anatomic locations of the kidneys (mean ADC absolute difference: 0.070–0.111 × 10−3 mm2/s, limit of agreement: 0.031–0.056 × 10−3 mm2/s). In all DWIs, Z-DWI yielded a slightly higher c-mCNR than other DWIs in most representative locations (P > 0.05), which was significantly higher than BH-DWI and FB-DWI in the middle pole of both kidneys and the upper pole of the left kidney (P < 0.05). In addition, Z-DWI yielded image quality that was similar to RT-DWI and NT-DWI (P > 0.05) and superior to BH-DWI, FB-DWI and RS-DWI (P < 0.05). Our results suggest that Z-DWI provides the highest ADC reproducibility, better c-mCNR and good image quality on 3.0 T MRI, making it the recommended sequence for clinical DWI of the kidney.
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Affiliation(s)
- Wenguang Liu
- Department of Radiology, Xiangya Hospital, Central South University, No. 87 Xiangya Rd., Kai Fu District, Changsha, 410008, Hunan, People's Republic of China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, People's Republic of China
| | - Hui Liu
- Department of Radiology, Xiangya Hospital, Central South University, No. 87 Xiangya Rd., Kai Fu District, Changsha, 410008, Hunan, People's Republic of China
| | - Simin Xie
- Department of Radiology, Xiangya Hospital, Central South University, No. 87 Xiangya Rd., Kai Fu District, Changsha, 410008, Hunan, People's Republic of China
| | - Ismail Bilal Masokano
- Department of Radiology, The Third Xiangya Hospital, Central South University, Changsha, 410013, Hunan, People's Republic of China
| | - Yu Bai
- Department of Radiology, Xiangya Hospital, Central South University, No. 87 Xiangya Rd., Kai Fu District, Changsha, 410008, Hunan, People's Republic of China
| | - Xiao Wang
- Department of Radiology, Xiangya Hospital, Central South University, No. 87 Xiangya Rd., Kai Fu District, Changsha, 410008, Hunan, People's Republic of China
| | - Linhui Zhong
- Department of Radiology, Xiangya Hospital, Central South University, No. 87 Xiangya Rd., Kai Fu District, Changsha, 410008, Hunan, People's Republic of China
| | - Yi Wu
- Department of Radiology, Xiangya Hospital, Central South University, No. 87 Xiangya Rd., Kai Fu District, Changsha, 410008, Hunan, People's Republic of China
| | - Jilin Nie
- Department of Radiology, Xiangya Hospital, Central South University, No. 87 Xiangya Rd., Kai Fu District, Changsha, 410008, Hunan, People's Republic of China
| | - Gaofeng Zhou
- Department of Radiology, Xiangya Hospital, Central South University, No. 87 Xiangya Rd., Kai Fu District, Changsha, 410008, Hunan, People's Republic of China
| | - Yigang Pei
- Department of Radiology, Xiangya Hospital, Central South University, No. 87 Xiangya Rd., Kai Fu District, Changsha, 410008, Hunan, People's Republic of China. .,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, People's Republic of China.
| | - Wenzheng Li
- Department of Radiology, Xiangya Hospital, Central South University, No. 87 Xiangya Rd., Kai Fu District, Changsha, 410008, Hunan, People's Republic of China. .,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, People's Republic of China.
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Mori T, Kato H, Kawaguchi M, Hatano Y, Ishihara T, Noda Y, Hyodo F, Matsuo M, Furui T, Morishige KI. A comparative analysis of MRI findings in endometrial cancer: differentiation between endometrioid adenocarcinoma, serous carcinoma, and clear cell carcinoma. Eur Radiol 2022; 32:4128-4136. [DOI: 10.1007/s00330-021-08512-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 10/19/2021] [Accepted: 12/10/2021] [Indexed: 12/24/2022]
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Yu B, Huang C, Fan X, Li F, Zhang J, Song Z, Zhi N, Ding J. Application of MR Imaging Features in Differentiation of Renal Changes in Patients With Stage III Type 2 Diabetic Nephropathy and Normal Subjects. Front Endocrinol (Lausanne) 2022; 13:846407. [PMID: 35600605 PMCID: PMC9114464 DOI: 10.3389/fendo.2022.846407] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 03/21/2022] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The objective of the study was to explore the value of MRI texture features based on T1WI, T2-FS and diffusion-weighted imaging (DWI) in differentiation of renal changes in patients with stage III type 2 diabetic nephropathy (DN) and normal subjects. MATERIALS AND METHODS A retrospective analysis was performed to analyze 44 healthy volunteers (group A) and 40 patients with stage III type 2 diabetic nephropathy (group B) with microalbuminuria. Urinary albumin to creatinine ratio (ACR) <30 mg/g, estimated glomerular filtration rate (eGFR) in the range of 60-120 ml/(min 1.73 m2), and randomly divided into primary cohort and test cohort. Conventional MRI and DWI of kidney were performed using 1.5 T magnetic resonance imaging (MRI). The outline of the renal parenchyma was manually labeled in fat-suppressed T2-weighted imaging (FS-T2WI), and PyRadiomics was used to extract radiomics features. The radiomics features were then selected by the least absolute shrinkage and selection operator (LASSO) method. RESULTS There was a significant difference in sex and body mass index (BMI) (P <0.05) in the primary cohort, with no significant difference in age. In the final results, the wavelet and Laplacian-Gaussian filtering are used to extract 1,892 image features from the original T1WI image, and the LASSO algorithm is used for selection. One first-order feature and six texture features are selected through 10 cross-validations. In the mass, 1,638 imaging extracts features from the original T2WI image.1 first-order feature and 5 texture features were selected. A total of 1,241 imaging features were extracted from the original ADC images, and 5 texture features were selected. Using LASSO-Logistic regression analysis, 10 features were selected for modeling, and a combined diagnosis model of diabetic nephropathy based on texture features was established. The average unit cost in the logistic regression model was 0.98, the 95% confidence interval for the predictive efficacy was 0.9486-1.0, specificity 0.97 and precision 0.93, particularly. ROC curves also revealed that the model could distinguish with high sensitivity of at least 92%. CONCLUSION In consequence, the texture features based on MR have broad application prospects in the early detection of DN as a relatively simple and noninvasive tool without contrast media administration.
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Affiliation(s)
- Baoting Yu
- Department of Radiology, China–Japan Union Hospital of Jilin University, Changchun, China
| | - Chencui Huang
- Department of Research Collaboration, R&D Center, Beijing Deepwise & League of PHD Technology Co., Ltd., Beijing, China
| | - Xiaofei Fan
- Department of Radiology, China–Japan Union Hospital of Jilin University, Changchun, China
| | - Feng Li
- Department of Research Collaboration, R&D Center, Beijing Deepwise & League of PHD Technology Co., Ltd., Beijing, China
| | - Jianzhong Zhang
- Department of Radiology, China–Japan Union Hospital of Jilin University, Changchun, China
| | - Zihan Song
- Department of Radiology, Chang Chun Central Hospital, Changchun, China
| | - Nan Zhi
- Department of Radiology, China–Japan Union Hospital of Jilin University, Changchun, China
| | - Jun Ding
- Department of Radiology, China–Japan Union Hospital of Jilin University, Changchun, China
- *Correspondence: Jun Ding,
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Borrelli P, Zacchia M, Cavaliere C, Basso L, Salvatore M, Capasso G, Aiello M. Diffusion tensor imaging for the study of early renal dysfunction in patients affected by bardet-biedl syndrome. Sci Rep 2021; 11:20855. [PMID: 34675323 PMCID: PMC8531379 DOI: 10.1038/s41598-021-00394-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 10/11/2021] [Indexed: 11/28/2022] Open
Abstract
Kidney structural abnormalities are common features of Bardet-Biedl syndrome (BBS) patients that lead to a progressive decline in renal function. Magnetic resonance diffusion tensor imaging (DTI) provides useful information on renal microstructures but it has not been applied to these patients. This study investigated using DTI to detect renal abnormalities in BBS patients with no overt renal dysfunction. Ten BBS subjects with estimated glomerular filtration rates over 60 ml/min/1.73m2 and 14 individuals matched for age, gender, body mass index and renal function were subjected to high-field DTI. Fractional anisotropy (FA), and mean, radial and axial diffusivity were evaluated from renal cortex and medulla. Moreover, the corticomedullary differentiation of each DTI parameter was compared between groups. Only cortical FA statistically differed between BBS patients and controls (p = 0.033), but all the medullary DTI parameters discriminated between the two groups with lower FA (p < 0.001) and axial diffusivity (p = 0.021) and higher mean diffusivity (p = 0.043) and radial diffusivity (p < 0.001) in BBS patients compared with controls. Corticomedullary differentiation values were significantly reduced in BBS patients. Thus, DTI is a valuable tool for investigating microstructural alterations in renal disorders when kidney functionality is preserved.
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Affiliation(s)
| | - Miriam Zacchia
- Department of Medical and Translational Sciences, University of Campania L. Vanvitelli, Naples, Italy
| | | | - Luca Basso
- IRCCS SDN, Via Emanuele Gianturco 113, 80131, Naples, Italy
| | | | - Giovambattista Capasso
- Department of Medical and Translational Sciences, University of Campania L. Vanvitelli, Naples, Italy.,Biogem, Research Institute for Molecular Biology and Genetics, Ariano Irpino, Italy
| | - Marco Aiello
- IRCCS SDN, Via Emanuele Gianturco 113, 80131, Naples, Italy
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Jing M, Cao Y, Zhang P, Zhang B, Lin X, Deng L, Han T, Zhou J. The Benefit of Apparent Diffusion Coefficient in Evaluating the Invasiveness of Hepatocellular Carcinoma. Front Oncol 2021; 11:719480. [PMID: 34504795 PMCID: PMC8423087 DOI: 10.3389/fonc.2021.719480] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 08/05/2021] [Indexed: 12/14/2022] Open
Abstract
Background This study aimed to evaluate hepatocellular carcinoma (HCC) invasiveness using the apparent diffusion coefficient (ADC). Methods Eighty-one patients with HCC confirmed by pathology and examined by preoperative magnetic resonance imaging diffusion-weighted imaging from January 2015 to September 2020 were retrospectively analyzed. Clinical and pathological data were recorded. The minimum ADC (ADCmin), average ADC (ADCmean), and the ratio of ADCmean to normal-appearing hepatic parenchyma ADC (ADCnahp) were assessed. The associations between clinical information, ADC value, and HCC invasiveness (microvascular invasion [MVI], tumor differentiation, and Ki-67 expression) were evaluated statistically. Independent risk factors related to HCC invasiveness were screened using binary logistic regression, and the diagnostic efficiency was evaluated by the receiver operating characteristic curve and its area under the curve (AUC) value. Results Tumor size was related to HCC MVI and tumor differentiation (P < 0.05). HCC MVI was associated with ADCmin, ADCmean, and the ADCmean-to-ADCnahp ratio (all P < 0.05) with AUC values of 0.860, 0.860, and 0.909, respectively. If these were combined with tumor size, the AUC value increased to 0.912. The degree of tumor differentiation was associated with ADCmin, ADCmean, and the ADCmean-to-ADCnahp ratio (all P < 0.05) with AUC values of 0.719, 0.708, and 0.797, respectively. If these were combined with tumor size, the AUC value increased to 0.868. Ki-67 expression was associated with ADCmin, ADCmean, and the ADCmean-to-ADCnahp ratio (all P < 0.05) with AUC values of 0.731, 0.747, and 0.746, respectively. Combined them, the AUC value increased to 0.763. Conclusions The findings indicated that the ADC value has significant potential for the non-invasive preoperative evaluation of HCC invasiveness.
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Affiliation(s)
- Mengyuan Jing
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China.,Second Clinical School, Lanzhou University, Lanzhou, China.,Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China
| | - Yuntai Cao
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China.,Second Clinical School, Lanzhou University, Lanzhou, China.,Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China.,Department of Radiology, Affiliated Hospital of Qinghai University, Xining, China
| | - Peng Zhang
- Department of Pathology, Lanzhou University Second Hospital, Lanzhou, China
| | - Bin Zhang
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China.,Second Clinical School, Lanzhou University, Lanzhou, China.,Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China
| | - Xiaoqiang Lin
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China.,Second Clinical School, Lanzhou University, Lanzhou, China.,Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China
| | - Liangna Deng
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China.,Second Clinical School, Lanzhou University, Lanzhou, China.,Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China
| | - Tao Han
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China.,Second Clinical School, Lanzhou University, Lanzhou, China.,Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China
| | - Junlin Zhou
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China.,Second Clinical School, Lanzhou University, Lanzhou, China.,Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China
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Diagnostic test accuracy of ADC values for identification of clear cell renal cell carcinoma: systematic review and meta-analysis. Eur Radiol 2020; 30:4023-4038. [PMID: 32144458 DOI: 10.1007/s00330-020-06740-w] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 01/14/2020] [Accepted: 02/11/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To perform a systematic review on apparent diffusion coefficient (ADC) values of renal tumor subtypes and meta-analysis on the diagnostic performance of ADC for differentiation of localized clear cell renal cell carcinoma (ccRCC) from other renal tumor types. METHODS Medline, Embase, and the Cochrane Library databases were searched for studies published until May 1, 2019, that reported ADC values of renal tumors. Methodological quality was evaluated. For the meta-analysis on diagnostic test accuracy of ADC for differentiation of ccRCC from other renal lesions, we applied a bivariate random-effects model and compared two subgroups of ADC measurement with vs. without cystic and necrotic areas. RESULTS We included 48 studies (2588 lesions) in the systematic review and 13 studies (1126 lesions) in the meta-analysis. There was no significant difference in ADC of renal parenchyma using b values of 0-800 vs. 0-1000 (p = 0.08). ADC measured on selected portions (sADC) excluding cystic and necrotic areas differed significantly from whole-lesion ADC (wADC) (p = 0.002). Compared to ccRCC, minimal-fat angiomyolipoma, papillary RCC, and chromophobe RCC showed significantly lower sADC while oncocytoma exhibited higher sADC. Summary estimates of sensitivity and specificity to differentiate ccRCC from other tumors were 80% (95% CI, 0.76-0.88) and 78% (95% CI, 0.64-0.89), respectively, for sADC and 77% (95% CI, 0.59-0.90) and 77% (95% CI, 0.69-0.86) for wADC. sADC offered a higher area under the receiver operating characteristic curve than wADC (0.852 vs. 0.785, p = 0.02). CONCLUSIONS ADC values of kidney tumors that exclude cystic or necrotic areas more accurately differentiate ccRCC from other renal tumor types than whole-lesion ADC values. KEY POINTS • Selective ADC of renal tumors, excluding cystic and necrotic areas, provides better discriminatory ability than whole-lesion ADC to differentiate clear cell RCC from other renal lesions, with area under the receiver operating characteristic curve (AUC) of 0.852 vs. 0.785, respectively (p = 0.02). • Selective ADC of renal masses provides moderate sensitivity and specificity of 80% and 78%, respectively, for differentiation of clear cell renal cell carcinoma (RCC) from papillary RCC, chromophobe RCC, oncocytoma, and minimal-fat angiomyolipoma. • Selective ADC excluding cystic and necrotic areas are preferable to whole-lesion ADC as an additional tool to multiphasic MRI to differentiate clear cell RCC from other renal lesions whether the highest b value is 800 or 1000.
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