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Diffusion-weighted MRI in the assessment of nephroblastoma: results of a multi-center trial

  • Kidneys, Ureters, Bladder, Retroperitoneum
  • Published:
Abdominal Radiology Aims and scope Submit manuscript

Abstract

Purpose

To assess the value of diffusion-weighted MRI in the pre-therapeutic evaluation of pediatric renal cortical tumors.

Methods

This IRB-approved, retrospective multi-center study included 122 pediatric patients with 130 renal tumors, who underwent MRI including DWI before neoadjuvant chemotherapy and nephrectomy. Two radiologists independently assessed each tumor volumetrically, and apparent diffusion coefficient (ADC) values were calculated on a voxel-wise basis, including parameters derived from histogram and texture analysis.

Results

Inter-reader agreement was excellent (ICC 0.717–0.975). For both readers, patients with locally aggressive tumor growth (SIOP 3 stage) or with metastases (M1) had significantly lower 12.5th-percentile ADC values (p ≤ 0.028) compared to those with lower-stage tumors, and the parameter energy differed significantly between patients with M1 and those with M0 status (p ≤ 0.028). Contrast and homogeneity differed significantly between benign nephroblastomatosis and malignant nephroblastoma (p ≤ 0.045, both readers). As compared to all other subtypes, the blastemal subtype demonstrated significantly higher skewness (p ≤ 0.022, both readers) and the diffuse anaplastic subtype demonstrated significantly higher 75th-percentile ADC values (p ≤ 0.042, both readers).

Conclusions

Diffusion-weighted MRI may be of value in identifying benign nephroblastomatosis and assessing nephroblastoma subtypes. Therefore, further research is warranted to assess its value in risk stratification for pediatric patients with renal tumors in the future.

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Acknowledgements

This research was funded in part through the NIH/NCI Cancer Center Support Grant P30 CA008748. This study was funded partly by Deutsche Krebshilfe Grant No: 50-2709-Gr2 and by the European Union’s Seventh Framework Program for research, technological development, and demonstration under Grant Agreement No. 600841 (CHIC project). The authors want to thank all institutions that contributed to this study as part of the SIOP 2001 register trial. In addition, they thank Ada Muellner, MS for her editing.

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Authors and Affiliations

  1. Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland

    Andreas M. Hötker

  2. Section of Pediatric Radiology, Department of Diagnostic and Interventional Radiology, Universitätsmedizin Mainz, Langenbeckstr. 1, 55131, Mainz, Germany

    André Lollert & Gundula Staatz

  3. Department of Medical Physics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA

    Yousef Mazaheri

  4. Department of Pediatric Oncology and Hematology, Saarland University, Kirrberger Straße, 66421, Homburg, Germany

    Sabine Müller & Norbert Graf

  5. Mathematical Image Analysis Group, Saarland University, Campus E1.7, 66041, Saarbrücken, Germany

    Sabine Müller

  6. Division of Pediatric Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 153, 69120, Heidelberg, Germany

    Jens-Peter Schenk

  7. Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), Universitätsmedizin Mainz, Langenbeckstr. 1, 55131, Mainz, Germany

    Philipp C. Mildenberger

  8. Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA

    Oguz Akin

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  1. Andreas M. Hötker
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  2. André Lollert
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  3. Yousef Mazaheri
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  4. Sabine Müller
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  9. Gundula Staatz
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Correspondence to Andreas M. Hötker.

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All authors declare that they have no conflicts of interest.

Research involving human participants

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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The requirement for informed consent was waived by the local IRB for this retrospective study.

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Hötker, A.M., Lollert, A., Mazaheri, Y. et al. Diffusion-weighted MRI in the assessment of nephroblastoma: results of a multi-center trial. Abdom Radiol 45, 3202–3212 (2020). https://doi.org/10.1007/s00261-020-02475-w

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  • DOI: https://doi.org/10.1007/s00261-020-02475-w

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