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Mohakud S, Das R, Bag ND, Mohapatra PR, Mishra P, Naik S. A Prospective Observational Study of Diagnostic Reliability of Semiquantitative and Quantitative High b-Value Diffusion-Weighted MRI in Distinguishing between Benign and Malignant Lung Lesions at 3 Tesla. Indian J Radiol Imaging 2024; 34:6-15. [PMID: 38106852 PMCID: PMC10723977 DOI: 10.1055/s-0043-1771530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023] Open
Abstract
Aim The aim of this study was to evaluate the usefulness of high b-value diffusion-weighted imaging (DWI) to differentiate benign and malignant lung lesions in 3 Tesla magnetic resonance imaging (MRI). Materials and Methods Thirty-one patients with lung lesions underwent a high b-value (b= 1000 s/mm 2 ) DW MRI in 3 Tesla. Thirty lesions were biopsied, followed by histopathological analysis, and one was serially followed up for 2 years. Statistical analysis was done to calculate the sensitivity, specificity, and accuracy of different DWI parameters in distinguishing benign and malignant lesions. Receiver operating characteristic (ROC) curves were used to determine the cutoff values of different parameters. Results The qualitative assessment of signal intensity on DWI based on a 5-point rank scale had a mean score of 2.71 ± 0.75 for benign and 3. 75 ± 0.60 for malignant lesions. With a cutoff of 3.5, the sensitivity, specificity, and accuracy were 75, 86, and 77.6%, respectively. The mean ADC min (minimum apparent diffusion coefficient) value of benign and malignant lesions was 1. 49 ± 0.38 × 10-3 mm 2 /s and 1.11 ± 0.20 ×10-3 mm 2 /s, respectively. ROC curve analysis showed a cutoff value of 1.03 × 10-3 mm 2 /s; the sensitivity, specificity, and accuracy were 87.5, 71.4, and 83.3%, respectively. For lesion to spinal cord ratio and lesion to spinal cord ADC ratio with a cutoff value of 1.08 and 1.38, the sensitivity, specificity, and accuracy were 83.3 and 87.5%, 71.4 and 71.4%, and 80.6 and 83.8%, respectively. The exponential ADC showed a low accuracy rate. Conclusion The semiquantitative and quantitative parameters of high b-value DW 3 Tesla MRI can differentiate benign from malignant lesions with high accuracy and make it a reliable nonionizing modality for characterizing lung lesions.
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Affiliation(s)
- Sudipta Mohakud
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Rasmibala Das
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Nerbadyswari D. Bag
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Prasanta R. Mohapatra
- Department of Pulmonary Medicine and Critical Care, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Pritinanda Mishra
- Department of Pathology and Lab Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Suprava Naik
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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Luo HC, Cheng WQ, Ding H, He L. Diagnostic performance of diffusion-weighted imaging and intravoxel incoherent motion for renal lesions: a meta-analysis. Clin Radiol 2023; 78:935-946. [PMID: 37652795 DOI: 10.1016/j.crad.2023.07.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 07/06/2023] [Accepted: 07/30/2023] [Indexed: 09/02/2023]
Abstract
AIM To compare the diagnostic performance of diffusion-weighted imaging (DWI) and intravoxel incoherent motion (IVIM) parameters, specifically true diffusion coefficient (D), pseudo diffusion coefficient (D∗), and perfusion fraction (f) for quantitatively differentiating benign and malignant renal lesions. MATERIALS AND METHODS A comprehensive search was conducted in the EMBASE and PubMed databases before September 2022 to identify studies in English investigating the diagnostic accuracy of DWI and IVIM in renal lesions. The quality of the included studies was assessed using the QUADAS-2 tool. Pooled sensitivity, specificity, and area under the curve (AUC) values were estimated for each parameter. RESULTS A total of 19 studies involving 1,860 renal lesions (1,160 malignant and 700 benign), met the inclusion criteria. Among these studies, 15 assessed the apparent diffusion coefficient (ADC), four assessed IVIM, and three evaluated both ADC and IVIM. The pooled sensitivity, specificity, and AUC for ADC were 0.84 (95% confidence interval [Cl], 0.79-0.88), 0.82 (95% Cl, 0.72-0.89), and 0.89 (95% Cl, 0.86-0.92), respectively. The IVIM parameter with the highest diagnostic accuracy was D, with a pooled sensitivity, specificity, and AUC of 0.89 (95% Cl, 0.74-0.96), 0.96 (95% Cl, 0.85-0.99), and 0.98 (95% Cl, 0.96-0.99), respectively. The pooled sensitivity, specificity and AUC for f were 0.67 (95% Cl, 0.55-0.77), 0.81 (95% Cl, 0.30-0.98), and 0.73 (95% Cl, 0.69-0.77), respectively. The pooled sensitivity, specificity, and AUC for D∗ were 0.87 (95% Cl, 0.81-0.91), 0.59 (95% Cl, 0.48-0.70), and 0.82 (95% Cl, 0.78-0.85), respectively. CONCLUSION This meta-analysis indicated that both IVIM and DWI had moderate to high diagnostic accuracy for differentiating benign and malignant renal lesions. Among the IVIM parameter, D exhibited the highest diagnostic accuracy, demonstrating higher sensitivity and specificity than ADC, D∗, and f.
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Affiliation(s)
- H C Luo
- Department of Radiology, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - W Q Cheng
- Department of Radiology, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - H Ding
- Department of Radiology, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - L He
- Department of Radiology, Children's Hospital of Chongqing Medical University, Chongqing, China.
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Kothari S, Singh A, Das U, Sarkar DK, Datta C, Hazra A. Role of exponential apparent diffusion coefficient in characterizing breast lesions by 3.0 Tesla diffusion-weighted magnetic resonance imaging. Indian J Radiol Imaging 2021; 27:229-236. [PMID: 28744085 PMCID: PMC5510322 DOI: 10.4103/ijri.ijri_405_16] [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] [Indexed: 11/20/2022] Open
Abstract
Objective: To evaluate the role of exponential apparent diffusion coefficient (ADC) as a tool for differentiating benign and malignant breast lesions. Patients and Methods: This prospective observational study included 88 breast lesions in 77 patients (between 18 and 85 years of age) who underwent 3T breast magnetic resonance imaging (MRI) including diffusion-weighted imaging (DWI) using b-values of 0 and 800 s/mm2 before biopsy. Mean exponential ADC and ADC of benign and malignant lesions obtained from DWI were compared. Receiver operating characteristics (ROC) curve analysis was undertaken to identify any cut-off for exponential ADC and ADC to predict malignancy. P value of <0.05 was considered statistically significant. Histopathology was taken as the gold standard. Results: According to histopathology, 65 lesions were malignant and 23 were benign. The mean ADC and exponential ADC values of malignant lesions were 0.9526 ± 0.203 × 10−3 mm2/s and 0.4774 ± 0.071, respectively, and for benign lesions were 1.48 ± 0.4903 × 10−3 mm2/s and 0.317 ± 0.1152, respectively. For both the parameters, differences were highly significant (P < 0.001). Cut-off value of ≤0.0011 mm2/s (P < 0.0001) for ADC provided 92.3% sensitivity and 73.9% specificity, whereas with an exponential ADC cut-off value of >0.4 (P < 0.0001) for malignant lesions, 93.9% sensitivity and 82.6% specificity was obtained. The performance of ADC and exponential ADC in distinguishing benign and malignant breast lesions based on respective cut-offs was comparable (P = 0.109). Conclusion: Exponential ADC can be used as a quantitative adjunct tool for characterizing breast lesions with comparable sensitivity and specificity as that of ADC.
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Affiliation(s)
- Shweta Kothari
- Department of Radio Diagnosis, IPGME and R and SSKM Hospital, Kolkata, West Bengal, India
| | - Archana Singh
- Department of Radio Diagnosis, IPGME and R and SSKM Hospital, Kolkata, West Bengal, India
| | - Utpalendu Das
- Department of Radio Diagnosis, IPGME and R and SSKM Hospital, Kolkata, West Bengal, India
| | - Diptendra K Sarkar
- Department of Surgery, IPGME and R and SSKM Hospital, Kolkata, West Bengal, India
| | - Chhanda Datta
- Department of Pathology, IPGME and R and SSKM Hospital, Kolkata, West Bengal, India
| | - Avijit Hazra
- Department of Pharmacology, IPGME and R and SSKM Hospital, Kolkata, West Bengal, India
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Performance of simultaneous multi-slice accelerated diffusion-weighted imaging for assessing focal renal lesions in pediatric patients with tuberous sclerosis complex. Pediatr Radiol 2021; 51:77-85. [PMID: 32845348 DOI: 10.1007/s00247-020-04798-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 07/07/2020] [Accepted: 08/04/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Diffusion-weighted imaging (DWI) is a useful MRI technique to characterize abdominal lesions in children, but long acquisition times can lead to image degradation. Simultaneous multi-slice accelerated DWI is a promising technique to shorten DWI scan times. OBJECTIVE To test the feasibility of simultaneous multi-slice DWI of the kidneys in pediatric patients with tuberous sclerosis complex (TSC) and to evaluate the accelerated protocol regarding image quality and quantitative apparent diffusion coefficient (ADC) values compared to standard echoplanar DWI sequence. MATERIALS AND METHODS We included 33 children and adolescents (12 female, 21 male; mean age 10±5 years) with TSC and renal cyst or angiomyolipoma on 3-tesla (T) MRI from 2017 to 2019. All studies included both free-breathing standard echoplanar DWI and simultaneous multi-slice DWI sequences. Subjective and quantitative image quality was evaluated using a predefined 5-point scale. ADC values were obtained for all renal cysts and angiomyolipomas ≥5 mm. All statistical analysis was performed using Stata/SE v15.1. RESULTS Simultaneous multi-slice DWI ADC values were slightly lower compared to standard echoplanar DWI for both renal cysts and angiomyolipomas (mean difference 0.05×10-3 mm2/s, 95% confidence interval [CI] 0.40-0.50 and 0.024×10-3 mm2/s, 95% CI 0.17-0.21, respectively, with P>0.1). Our results showed that renal lesions with ADC values >1.69×10-3 mm2/s were all cysts, whereas lesions with values <1.16×10-3 mm2/s were all angiomyolipomas. However, ADC values could not discriminate between lipid-rich and lipid-poor angiomyolipomas (P>0.1, for both sequences). CONCLUSION A 55% reduction in scan time was achieved using simultaneous multi-slice DWI for abdominal imaging in children with TSC, with near identical image quality as standard DWI. These results suggest that multi-slice techniques should be considered more broadly as an MRI acceleration technique in children.
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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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Diffusion-weighted Renal MRI at 9.4 Tesla Using RARE to Improve Anatomical Integrity. Sci Rep 2019; 9:19723. [PMID: 31873155 PMCID: PMC6928203 DOI: 10.1038/s41598-019-56184-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 10/23/2019] [Indexed: 12/29/2022] Open
Abstract
Diffusion-weighted magnetic resonance imaging (DWI) is a non-invasive imaging technique sensitive to tissue water movement. By enabling a discrimination between tissue properties without the need of contrast agent administration, DWI is invaluable for probing tissue microstructure in kidney diseases. DWI studies commonly make use of single-shot Echo-Planar Imaging (ss-EPI) techniques that are prone to suffering from geometric distortion. The goal of the present study was to develop a robust DWI technique tailored for preclinical magnetic resonance imaging (MRI) studies that is free of distortion and sensitive to detect microstructural changes. Since fast spin-echo imaging techniques are less susceptible to B0 inhomogeneity related image distortions, we introduced a diffusion sensitization to a split-echo Rapid Acquisition with Relaxation Enhancement (RARE) technique for high field preclinical DWI at 9.4 T. Validation studies in standard liquids provided diffusion coefficients consistent with reported values from the literature. Split-echo RARE outperformed conventional ss-EPI, with ss-EPI showing a 3.5-times larger border displacement (2.60 vs. 0.75) and a 60% higher intra-subject variability (cortex = 74%, outer medulla = 62% and inner medulla = 44%). The anatomical integrity provided by the split-echo RARE DWI technique is an essential component of parametric imaging on the way towards robust renal tissue characterization, especially during kidney disease.
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Li Y, Wang Y, Qin J, Wu J, Dai X, Xu J. Meta-analysis of diffusion-weighted imaging in the differential diagnosis of renal lesions. Clin Imaging 2018; 52:264-272. [PMID: 30172176 DOI: 10.1016/j.clinimag.2018.08.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 07/15/2018] [Accepted: 08/13/2018] [Indexed: 01/30/2023]
Abstract
PURPOSE To assess the diagnostic value of diffusion-weighted imaging (DWI) in distinguishing between renal malignant and benign lesions. MATERIALS AND METHODS Electronic databases were systematically searched to identify original studies evaluating DWI findings on renal lesions from January 2000 through January 2018. Pooled weighted estimates of sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratio (DOR) were calculated. A summary receiver operator characteristic (sROC) curve was constructed to calculate the area under the sROC curve (AUC). Publication bias was assessed by using Deeks' asymmetry test. RESULTS A total of 15 studies including 1386 renal lesions were eligible in the meta-analysis. The pooled sensitivity and specificity with a corresponding 95% confidence interval (CI) were 0.83 (95% CI: 0.80-0.86) and 0.74 (95% CI: 0.71-0.78), respectively. The PLR, NLR, and DOR were 3.21 (95% CI: 2.39-4.32), 0.24 (95% CI: 0.18-0.30), and 15.95 (95% CI: 11.19-22.71), respectively. The AUC was 0.87 (95% CI: 0.84-0.90). Significant heterogeneity was observed between the included studies. Reference standard, country, and gradient factor were identified as the most important variable sources. No evidence of notable publication bias was reported. CONCLUSIONS DWI is an informative MRI modality in discriminating benign and malignant lesions and exhibits moderately high diagnostic accuracy. However, it remains inconclusive and limited in the absence of an optimal b value and ADC cutoff value. High-quality prospective studies regarding DWI have yet to be conducted to explore optimal imaging parameters and diagnostic thresholds.
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Affiliation(s)
- Yang Li
- Department of General Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
| | - Ye Wang
- Department of General Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
| | - Jun Qin
- Department of General Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
| | - Junyi Wu
- Department of General Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
| | - Xueming Dai
- Department of General Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
| | - Junming Xu
- Department of General Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China.
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Deng L, Wang QP, Yan R, Yu N, Bai L, Duan XY, Guo YM. Combined subjective and quantitative analysis of magnetic resonance images could improve the diagnostic performance of deep myometrial invasion in endometrial cancer. Clin Imaging 2017; 43:69-73. [DOI: 10.1016/j.clinimag.2017.01.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 11/26/2016] [Accepted: 01/20/2017] [Indexed: 11/28/2022]
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Zhang H, Gan Q, Wu Y, Liu R, Liu X, Huang Z, Yuan F, Kuang M, Song B. Diagnostic performance of diffusion-weighted magnetic resonance imaging in differentiating human renal lesions (benignity or malignancy): a meta-analysis. Abdom Radiol (NY) 2016; 41:1997-2010. [PMID: 27271218 DOI: 10.1007/s00261-016-0790-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PURPOSE This study aims to quantitatively evaluate the potential of diffusion-weighted magnetic resonance imaging (DW-MRI) for differentiating malignant and benign human renal lesions. MATERIALS AND METHODS A systematic literature was performed to identify previous research related to the diagnostic performance of DW-MRI for determining whether human renal lesions were benign or malignant. ADC values were extracted from normal renal tissue and different lesion types. Data were extracted to assess the diagnostic performance of DW-MRI for differentiating malignant and benign human renal lesions, as well as running threshold effect and heterogeneity. RESULTS Nine publications with 11 subsets were eligible for data extraction and diagnostic performance calculation. A total of 988 apparent diffusion coefficient (ADC) measurements were included. The differences in ADC values between benign lesions (2.47 ± 0.81 × 10(-3) mm(2)/s) and malignant lesions (1.81 ± 0.41 × 10(-3) mm(2)/s) were statistically significant (P < 0.001). The diagnostic odds ratio, the overall positive, negative likelihood ratios, pooled weighted sensitivity and specificity with 95% CI were 20.05 (95% CI 12.56-32.02), 3.32 (95% CI 2.13-5.18), 0.20 (95% CI 0.15-0.27), 88% (95% CI 0.84-0.91) and 72% (95% CI 0.67-0.76), respectively. The area under the curve of the summary receiver operating characteristic was 0.90. CONCLUSIONS This meta-analysis indicated that DW-MRI had a relatively good diagnostic accuracy in differentiating malignant and benign human renal lesions. We preliminarily recommend that DW-MRI is performed with a maximum b value ranging from 800 to 1000 s/mm(2) at 3.0 T for imaging protocol, and that DW-MRI should be used with caution when the study population includes children.
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Affiliation(s)
- Hanmei Zhang
- Department of Radiology, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Qi Gan
- Department of Neurosurgery, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Yinghua Wu
- Department of Radiology, The Second Clinical Medicine School, Chengdu University of Traditional Chinese Medicine, No. 15, Section 4 Renmin South Road, Chengdu, 610041, Sichuan, China
| | - Rongbo Liu
- Department of Radiology, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Xijiao Liu
- Department of Radiology, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Zixing Huang
- Department of Radiology, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Fang Yuan
- Department of Radiology, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Min Kuang
- Department of Radiology, The Second Clinical Medicine School, Chengdu University of Traditional Chinese Medicine, No. 15, Section 4 Renmin South Road, Chengdu, 610041, Sichuan, China
| | - Bin Song
- Department of Radiology, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, Sichuan, China.
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Ponhold L, Javor D, Heinz-Peer G, Sevcenco S, Hofstetter M, Baltzer PA. Inter-observer variation and diagnostic efficacy of apparent diffusion coefficient (ADC) measurements obtained by diffusion-weighted imaging (DWI) in small renal masses. Acta Radiol 2016; 57:1014-20. [PMID: 26486599 DOI: 10.1177/0284185115610934] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 09/18/2015] [Indexed: 12/19/2022]
Abstract
BACKGROUND Diffusion-weighted imaging (DWI) is increasingly used to diagnose renal lesion subtypes. Especially in small renal masses, identification of less aggressive tumor types is of clinical interest, as active surveillance strategies can be applied. PURPOSE To evaluate the inter-observer variation and diagnostic efficacy of apparent diffusion coefficient (ADC) measurements obtained by DWI in small renal masses ≤4 cm (SRM). MATERIAL AND METHODS This retrospective IRB-approved study included 39 patients (46 SRM: 12 benign, 34 malignant). All underwent a 3 T DWI of SRM prior to surgery. Two radiologists independently analyzed all imaging data by three measurements. Limits of agreement, intraclass correlation coefficients (ICC), group comparisons by t-tests, and ROC analysis were performed. RESULTS Reliability of ADC measurements was very high with an ICC of >0.9 for both observers. Inter-rater reliability was high with an ICC of 0.82. Limits of agreement for average ADC values between both observers were -23.5% to 38.3% with a mean difference of 7.5% between both observers. No significant differences were found between benign and malignant lesions (P value Observer 1: 0.362, Observer 2: 0.622). Papillary carcinoma showed lower ADC values compared to non-papillary carcinoma (P value Observer 1: 0.008, Observer 2: 0.012). Consequently, ROC analysis revealed a significant (P < 0.001, respectively) area under the ROC curve of 0.853 (Observer 1) and 0.837 (Observer 2) without significant differences between both readers (P = 0.772). CONCLUSION ADC measurements of SRM at 3 T show a high reproducibility and differentiate papillary from non-papillary carcinoma subtypes. However, measurement variability may limit the application of fixed ADC thresholds for lesion diagnosis.
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Affiliation(s)
- Lothar Ponhold
- Department of Radiology, University Hospital of Sankt-Pölten, St. Pölten, Austria
| | - Domagoj Javor
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Gertraud Heinz-Peer
- Department of Radiology, University Hospital of Sankt-Pölten, St. Pölten, Austria
| | - Sabina Sevcenco
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Martin Hofstetter
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Pascal Andreas Baltzer
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
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Abstract
OBJECTIVE The purpose of this study was to differentiate clear cell renal cell carcinoma (RCC) from other common renal cortical tumors by use of DWI. MATERIALS AND METHODS The study included 117 patients (mean age, 60 years) with 122 histopathologically confirmed renal cortical tumors who underwent 1.5-T MRI that included DWI before they underwent nephrectomy between 2006 and 2013. For each tumor, two radiologists independently evaluated apparent diffusion coefficient (ADC) values on the basis of a single ROI in a nonnecrotic area of the tumor and also by assessment of the whole tumor. The concordance correlation coefficient (CCC) was calculated to assess interreader agreement. The mean ADC values of clear cell RCC and every other tumor subtype were compared using an exact Wilcoxon rank sum test. RESULTS Interreader agreement was excellent and higher in whole-tumor assessment (CCC, 0.982) than in single-ROI analysis (CCC, 0.756). For both readers, ADC values for clear cell RCC found on single-ROI assessment (2.19 and 2.08 × 10(-3) mm(2)/s) and whole-tumor assessment (2.30 and 2.32 × 10(-3) mm(2)/s) were statistically significantly higher than those for chromophobe, papillary, or unclassified RCC (p < 0.05) but were similar to those for oncocytoma found on single-ROI assessment (2.14 and 2.32 × 10(-3) mm(2)/s) and whole-tumor assessment (2.38 and 2.24 × 10(-3) mm(2)/s). ADC values were also higher for clear cell RCC than for angiomyolipoma, but the difference was statistically significant only in whole-tumor assessment (p < 0.03). CONCLUSION ADC values were statistically significantly higher for clear cell RCC than for chromophobe, papillary, or unclassified RCC subtypes; however, differentiating clear cell RCC from oncocytoma by use of DWI remains especially challenging, because similar ADC values have been shown for these two tumor types.
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Feng Q, Ma Z, Zhang S, Wu J. Usefulness of diffusion tensor imaging for the differentiation between low-fat angiomyolipoma and clear cell carcinoma of the kidney. SPRINGERPLUS 2016; 5:12. [PMID: 26759751 PMCID: PMC4700039 DOI: 10.1186/s40064-015-1627-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 12/17/2015] [Indexed: 01/03/2023]
Abstract
To investigate the value of apparent diffusion coefficient (ADC) and fractional anisotropy (FA) in differentiating clear-cell renal cell carcinoma (CCRCC) from low-fat renal angiomyolipomas (RAML), and to obtain the optimal b value. Fifty patients, including 30 cases of CCRCC and 20 cases of low-fat RAML, were retrospectively recruited to participate in this study. Before renal nephrectomy, all subjects underwent functional magnetic resonance imaging. For diffusion tensor imaging (DTI), a respiratory-triggered coronal echo planar imaging sequence was performed with three groups of different b values (0 and 400, 600, and 800). The ADC and FA of kidneys were analyzed and compared between different b values using analysis of variance. Receiver operation characteristic analysis was computed to assess the diagnostic performance of ADC and FA in differentiating low-fat RAML from CCRCC and to determine the optimal b values. With either CCRCC or low-fat RAML, the ADC values decreased with increased b values and significant differences were observed (F = 11.34, 23.15, P < 0.05), while the FA values were not significantly different (F = 0.28, 2.80, P > 0.05). The statistical differences in ADC, and the FA values for CCRCC and low-fat RAML were significantly different (P < 0.05). When the b value was 0.800 s/mm2, the cutoff FA value for differentiating CCRCC from low-fat RAML was 0.254 × 10.3 mm2/s, and had a sensitivity of 100 %, and a specificity of 73.3 %. MR-DTI can be used to differentiate CCRCC from low-fat RAML.
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Affiliation(s)
- Qiang Feng
- Department of Radiology, Affiliated Yidu Central Hospital, Weifang Medical University, Weifang, 262500 Shandong People's Republic of China
| | - Zhijun Ma
- Department of Radiology, Affiliated Yidu Central Hospital, Weifang Medical University, Weifang, 262500 Shandong People's Republic of China
| | - Sujuan Zhang
- Department of Radiology, Affiliated Yidu Central Hospital, Weifang Medical University, Weifang, 262500 Shandong People's Republic of China
| | - Jianlin Wu
- Affiliated zhongshan Hospital, Dalian University, No. 6 jiefang Road, Zhongshan District, Dalian, 116001 Liaoning People's Republic of China
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13
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Park SY, Kim CK, Park JJ, Park BK. Exponential apparent diffusion coefficient in evaluating prostate cancer at 3 T: preliminary experience. Br J Radiol 2015; 89:20150470. [PMID: 26653866 DOI: 10.1259/bjr.20150470] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To investigate the feasibility of exponential apparent diffusion coefficient (eADC) derived from diffusion-weighted imaging (DWI) in evaluating prostate cancers at 3 T. METHODS 74 consecutive patients with surgically confirmed single peripheral zone (PZ) prostate cancer ≥0.5 cm(3) who underwent pre-operative DWI at 3 T were retrospectively selected. Based on radiological-pathological correlation, eADC and apparent diffusion coefficient (ADC) (×10(-3) mm(2) s(-1)) for the cancers and benign PZ were measured by two independent readers. Tumour eADC or ADC was correlated with Gleason score. Receiver operating characteristic curve analysis was performed to differentiate between Gleason score 6 and 7 or higher, by eADC and ADC. Lesion-to-background contrast ratio was compared between eADC and ADC. RESULTS Mean tumour eADC (0.48-0.50) and ADC (0.72-0.75) were significantly different from those of benign PZ (eADC, 0.20-0.27; ADC, 1.34-1.66), respectively (p < 0.001). A moderate correlation between tumour eADC or ADC and Gleason score was seen. For differentiating between Gleason score 6 and 7 or higher, eADC (0.818-0.883) showed a similar area under the curve with ADC (0.840-0.889) (p > 0.05). Lesion-to-background contrast ratio of eADC (Reader 1, 2.43; Reader 2, 2.23) was significantly greater than that of ADC (Reader 1, 2.21; Reader 2, 2.12) (p < 0.001). CONCLUSION The eADC may offer similar diagnostic utility with ADC in the differentiation of the cancer from benign prostate tissue. Moreover, the eADC appears to allow improved tissue contrast. ADVANCES IN KNOWLEDGE The eADC may be a comparable alternative to ADC for evaluating prostate cancer, with removing T2 shine-through effects from DWI.
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Affiliation(s)
- Sung Y Park
- 1 Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan, Seoul, Republic of Korea.,2 Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Chan K Kim
- 1 Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan, Seoul, Republic of Korea.,3 Department of Medical Device Management & Research, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
| | - Jung J Park
- 1 Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan, Seoul, Republic of Korea
| | - Byung K Park
- 1 Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan, Seoul, Republic of Korea
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Wen Z, Sun Z, Wang Y. Diagnostic utility of diffusion-weighted magnetic resonance imaging in two common renal tumors. Oncol Lett 2015; 10:2565-2568. [PMID: 26622890 DOI: 10.3892/ol.2015.3605] [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: 10/21/2014] [Accepted: 07/16/2015] [Indexed: 11/05/2022] Open
Abstract
The aim of the present study was to evaluate the utility of diffusion-weighted magnetic resonance imaging (DWI) in the diagnosis of common renal tumors. Conventional magnetic resonance imaging and DWI were performed on 85 patients with renal lesions (54 renal carcinoma and 31 renal angiomyolipoma cases). The apparent diffusion coefficient (ADC) values in each case at b=800 sec/mm2 were measured in the ADC maps using a statistical software package. The 54 cases of renal cell carcinoma showed a high signal intensity in the parenchyma, and the 31 renal angiomyolipoma cases showed a well-defined mixed signal intensity on DWI. The soft-tissue component showed a high signal intensity and the fat tissue showed a low signal intensity on DWI. When the b-value was set to 800 sec/mm2, the mean ADC was significantly lower in the renal carcinoma cases than in the renal angiomyolipoma cases. In conclusion, the measurement of ADC on DWI can reveal the structure of renal tumors, which is beneficial in diagnosing and determining the prognosis of benign and malignant renal tumors.
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Affiliation(s)
- Zhaoxia Wen
- Department of Radiology, Linyi People's Hospital, Linyi, Shangdong 276003, P.R. China
| | - Zhenchao Sun
- Department of Radiology, Linyi People's Hospital, Linyi, Shangdong 276003, P.R. China
| | - Yuxing Wang
- Department of Radiology, Linyi People's Hospital, Linyi, Shangdong 276003, P.R. China
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Angiomyolipoma with minimal fat: differentiation from clear cell renal cell carcinoma and papillary renal cell carcinoma by texture analysis on CT images. Acad Radiol 2015; 22:1115-21. [PMID: 26031228 DOI: 10.1016/j.acra.2015.04.004] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2014] [Revised: 04/15/2015] [Accepted: 04/17/2015] [Indexed: 02/07/2023]
Abstract
RATIONALE AND OBJECTIVES To retrospectively evaluate the diagnostic performance of texture analysis (TA) for the discrimination of angiomyolipoma (AML) with minimal fat, clear cell renal cell cancer (ccRCC), and papillary renal cell cancer (pRCC) on computed tomography (CT) images and to determine the scanning phase, which contains the strongest discriminative power. MATERIALS AND METHODS Patients with pathologically proved AMLs (n = 18) lacking visible macroscopic fat at CT and patients with pathologically proved ccRCCs (n = 18) and pRCCs (n = 14) were included. All patients underwent CT scan with three phases (precontrast phase [PCP], corticomedullary phase [CMP], and nephrographic phase [NP]). The selected images were analyzed and classified with TA software (MaZda). Texture classification was performed for 1) minimal fat AML versus ccRCC, 2) minimal fat AML versus pRCC, and 3) ccRCC versus pRCC. The classification results were arbitrarily divided into several levels according to the misclassification rates: excellent (misclassification rates ≤10%), good (10%< misclassification rates ≤20%), moderate (20%< misclassification rates ≤30%), fair (30%< misclassification rates ≤40%), and poor (misclassification rates ≥40%). RESULTS Excellent classification results (error of 0.00%-9.30%) were obtained with nonlinear discriminant analysis for all the three groups, no matter which phase was used. On comparison of the three scanning phases, we observed a trend toward better lesion classification with PCP for minimal fat AML versus ccRCC, CMP, and NP images for ccRCC versus pRCC and found similar discriminative power for minimal fat AML versus pRCC. CONCLUSIONS TA might be a reliable quantitative method for the discrimination of minimal fat AML, ccRCC, and pRCC.
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Kim CK, Park JJ, Park BK. Prostate diffusion-weighted imaging at 3T: effect of intravenous gadobutrol administration. Eur Radiol 2015; 26:1450-6. [PMID: 26253258 DOI: 10.1007/s00330-015-3942-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 07/13/2015] [Accepted: 07/22/2015] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To investigate whether gadolinium-based contrast agent (GBCA) administration significantly affects diffusion-weighted imaging (DWI) at 3 T in the evaluation of prostate cancer and benign tissue. METHOD Thirty-four consecutive patients with surgically proven prostate cancer underwent preoperative DWI at 3 T before and after GBCA administration. Exponential apparent diffusion coefficient (EADC) and ADC maps were developed from DWI data. The ADC and EADC values pre- and post-contrast were measured in the cancer and benign tissue, respectively. The signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were evaluated on pre- and post-contrast DWI. RESULTS The ADC and EADC values of the cancer and benign transition zone were not significantly different between pre- and post-contrast, respectively (P > 0.05), while those in the benign peripheral zone were significantly different (P = 0.030 and 0.037, respectively). In all tissues, the SNRs and CNRs of the DWI, ADC map and EADC map were not significantly different between pre- and post-contrast (P > 0.05). Between pre- and post-contrast, ADC and EADC values showed excellent agreement (intraclass correlation coefficient ≥ 0.894) and variability of ≤3.2 %. CONCLUSION Prostate 3 T-DWI after GBCA administration may be used without a significant difference in SNR or CNR, with minimal variability of the cancer ADC and EADC values. KEY POINTS • ADCs and EADCs have excellent agreement before and after gadobutrol administration. • SNRs of prostate DWI are similar before and after gadobutrol administration. • CNRs of cancers are similar between pre- and post-contrast DWI.
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Affiliation(s)
- Chan Kyo Kim
- Department of Medical Device Management and Research, SAIHST, Sungkyunkwan University, Seoul, 06351, Korea. .,Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 06351, Korea.
| | - Jung Jae Park
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 06351, Korea
| | - Byung Kwan Park
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 06351, Korea
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Zhang HM, Wu YH, Gan Q, Lyu X, Zhu XL, Kuang M, Liu RB, Huang ZX, Yuan F, Liu XJ, Song B. Diagnostic Utility of Diffusion-weighted Magnetic Resonance Imaging in Differentiating Small Solid Renal Tumors (≤ 4 cm) at 3.0T Magnetic Resonance Imaging. Chin Med J (Engl) 2015; 128:1444-9. [PMID: 26021498 PMCID: PMC4733766 DOI: 10.4103/0366-6999.157648] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The aim of this study was to assess the performance of apparent diffusion coefficient (ADC) measurement obtained with diffusion-weighted magnetic resonance imaging (DW-MRI) to distinguish renal cell carcinomas (RCCs) from small benign solid renal tumors (≤ 4 cm). METHODS In this cross-sectional study, 49 consecutive patients with histopathologically confirmed small solid renal tumors, and seven healthy volunteers were imaged using nonenhanced MRI and DW-MRI. The ADC map was calculated using the b values of 0, 50, 400, and 600 s/mm 2 and values compared via the Kruskal-Wallis and Mann-Whitney tests. The utility of ADC for differentiating RCCs and benign lesions was assessed using a receiver operating characteristic curve. Multiple nonenhanced MRI features were analyzed by Logistic regression. RESULTS The tumors consisted of 33 cases of clear-cell RCCs (ccRCCs) and 16 cases of benign tumors, including 14 cases of minimal fat angiomyolipomas and 2 cases of oncocytomas. The ADCs showed significant differences among benign tumors ([0.90 ± 0.52] × 10-3 mm 2 /s), ccRCCs ([1.53 ± 0.31] × 10-3 mm 2 /s) and the normal renal parenchyma ([2.22 ± 0.12] × 10-3 mm 2 /s) (P < 0.001). Moreover, there was statistically significant difference between high and low-grade ccRCCs (P = 0.004). Using a cut-off ADC of 1.36 × 10-3 mm 2 /s, DW-MRI resulted in an area under the curve (AUC), sensitivity, and specificity equal to 0.839, 75.8%, and 87.5%, respectively. Nonenhanced MRI alone and the combination of imaging methods led to an AUC, sensitivity and specificity equal to 0.919, 93.9%, and 81.2%, 0.998, 97%, and 100%, respectively. The Logistic regression showed that the location of the center of the tumor (inside the contour of the kidney) and appearance of stiff blood vessel were significantly helpful for diagnosing ccRCCs. CONCLUSIONS DW-MRI has potential in distinguishing ccRCCs from benign lesions in human small solid renal tumors (≤ 4 cm), and in increasing the accuracy for diagnosing ccRCCs when combined with nonenhanced MRI.
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Affiliation(s)
- Han-Mei Zhang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Ying-Hua Wu
- Department of Radiology, The Second Clinical Medicine School, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan 610041, China
| | - Qi Gan
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Xiao Lyu
- Department of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Xiang-Lan Zhu
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Min Kuang
- Department of Radiology, The Second Clinical Medicine School, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan 610041, China
| | - Rong-Bo Liu
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Zi-Xing Huang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Fang Yuan
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Xi-Jiao Liu
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Bin Song
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
- Address for correspondence: Dr. Bin Song, Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China E-Mail:
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Diagnostic Significance of Diffusion-Weighted MRI in Renal Cancer. BIOMED RESEARCH INTERNATIONAL 2015; 2015:172165. [PMID: 26064881 PMCID: PMC4430628 DOI: 10.1155/2015/172165] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Accepted: 01/16/2015] [Indexed: 12/21/2022]
Abstract
Background. This study aimed to investigate whether diffusion-weighted imaging (DWI) could contribute to the discrimination between benign and malignant renal cancer. Methods. We searched the PubMed electronic database for eligible studies. STATA 12.0 software was used for statistical analysis. The SMD and 95% CI were calculated. Results. Decreased ADC signal was seen in all renal cancer patients (cancer tissue versus normal tissue: SMD = 1.63 and 95% CI = 0.96~2.29, P < 0.001; cancer tissue versus benign tissue: SMD = 2.22 and 95% CI = 1.53~2.90 and P < 0.001, resp.). MRI machine type-stratified analysis showed that decreased ADC signal was found by all included MRI machine types in cancer tissues compared with benign cancer tissues (all P < 0.05). The ADC values of renal cancer patients were significantly lower than those of normal controls for all included P values (all P < 0.05), and there was a decreased ADC signal at b-500, b-600, b-1000, b-500, and 1000 gradients compared with benign cancer tissues (all P < 0.05). Conclusion. Our study concluded that decreased ADC signal presented in DWI may be essential for the differential diagnosis of renal cancer.
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Liu JH, Tian SF, Ju Y, Li Y, Chen AL, Chen LH, Liu AL. Apparent diffusion coefficient measurement by diffusion weighted magnetic resonance imaging is a useful tool in differentiating renal tumors. BMC Cancer 2015; 15:292. [PMID: 25886301 PMCID: PMC4403953 DOI: 10.1186/s12885-015-1221-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 03/19/2015] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND To determine the clinical value of apparent diffusion coefficient (ADC) measurement by diffusion weighted magnetic resonance imaging (DW-MRI) in differentiating renal tumors. METHODS Electronic databases were searched using combinations of keywords and free words relating to renal tumor, ADC and DW-MRI. Based on carefully selected inclusion and exclusion criteria, relevant case-control studies were identified and the related clinical data was acquired. Statistical analyses were performed using STATA 12.0 (Stata Corporation, College station, TX). RESULTS Sixteen case-control studies were ultimately included in the present meta-analysis. These 16 high quality studies contained a combined total of 438 normal renal tissues and 832 renal tumor lesions (597 malignant and 235 benign). The results revealed that ADC values of malignant renal tumor tissues were markedly lower than normal renal tissues and benign renal tumor tissues. ADC values of benign renal tumor tissues were also significantly lower than normal renal tissue. CONCLUSIONS ADC measurement by DW-MRI provided clinically useful information on the internal structure of renal tumors and could be an important radiographic index for differentiation of malignant renal tumors from benign renal tumors.
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Affiliation(s)
- Jing-Hong Liu
- Department of Radiology, The First Affiliated Hospital of Dalian Medical University, Zhongshan Road No. 222, Xigang District, Dalian, 116011, P. R China.
| | - Shi-Feng Tian
- Department of Radiology, The First Affiliated Hospital of Dalian Medical University, Zhongshan Road No. 222, Xigang District, Dalian, 116011, P. R China.
| | - Ye Ju
- Department of Radiology, The First Affiliated Hospital of Dalian Medical University, Zhongshan Road No. 222, Xigang District, Dalian, 116011, P. R China.
| | - Ye Li
- Department of Radiology, Dalian Medical University, Dalian, 116044, P. R China.
| | - An-Liang Chen
- Department of Radiology, Dalian Medical University, Dalian, 116044, P. R China.
| | - Li-Hua Chen
- Department of Radiology, Dalian Medical University, Dalian, 116044, P. R China.
| | - Ai-Lian Liu
- Department of Radiology, The First Affiliated Hospital of Dalian Medical University, Zhongshan Road No. 222, Xigang District, Dalian, 116011, P. R China.
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20
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Czarnecka AM, Kornakiewicz A, Kukwa W, Szczylik C. Frontiers in clinical and molecular diagnostics and staging of metastatic clear cell renal cell carcinoma. Future Oncol 2015; 10:1095-111. [PMID: 24941992 DOI: 10.2217/fon.13.258] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The last few years have brought advances in the understanding of the molecular biology of metastatic clear cell renal cell carcinoma (RCC). Both preclinical research and clinical trials brought together results from the latest advancements in RCC diagnostic and staging. Understanding of the complex molecular alterations involved in the development and progression of RCC enables development of immunohistochemical and genetic diagnostic tools and is also opening the doors for experimental targeted therapies. At the same time, improvements of medical and molecular imaging improves the sensitivity and specificity of metastatic disease diagnosis. Moreover, independent validation of molecular profiles across high-throughput platforms, methods, laboratories and cancer populations has recently been successfully performed in RCC. Generation of informative, clinical diagnostic tools is likely to contribute to development of novel personalized diagnostic and treatment protocols and ensure prolonged survival of RCC patient in the near future.
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Affiliation(s)
- Anna M Czarnecka
- Department of Oncology with Laboratory of Molecular Oncology, Military Institute of Medicine, Szaserow 128, 04-141 Warsaw, Poland
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