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Role of ultra-high b-value DWI in the imaging of hereditary leiomyomatosis and renal cell carcinoma (HLRCC)

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

Abstract

Purpose

Hereditary leiomyomatosis and renal cell carcinoma (HLRCC) syndrome is associated with an aggressive form of renal cell carcinoma with high risk of metastasis, even in small primary tumors with unequivocal imaging findings. In this study, we compare the performance of ultra-high b-value diffusion-weighted imaging (DWI) sequence (b = 2000 s/mm2) to standard DWI (b = 800 s/mm2) sequence in identifying malignant lesions in patients with HLRCC.

Methods

Twenty-eight patients (n = 18 HLRCC patients with 22 lesions, n = 10 controls) were independently evaluated by three abdominal radiologists with different levels of experience using four combinations of MRI sequences in two separate sessions (session 1: DWI with b-800, session 2: DWI with b-2000). T1 precontrast, T2-weighted (T2WI), and apparent diffusion coefficient (ADC) sequences were similar in both sessions. Each identified lesion was subjectively assessed using a six-point cancer likelihood score based on individual sequences and overall impression.

Results

The ability to distinguish benign versus malignant renal lesions improved with the use of b-2000 for more experienced radiologists (Reader 1 AUC: Session 1—0.649 and Session 2—0.938, p = 0.017; Reader 2 AUC: Session 1—0.781 and Session 2—0.921, p = 0.157); whereas no improvement was observed for the less experienced reader (AUC: Session 1—0.541 and Session 2—0.607, p = 0.699).

Conclusion

The inclusion of ultra-high b-value DWI sequence improved the ability of classification of renal lesions in patients with HLRCC for experienced radiologists. Consideration should be given toward incorporation of DWI with b-2000 s/mm2 into existing renal MRI protocols.

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Acknowledgements

We acknowledge the contributions of Fatemeh Homayounieh, Safa Samimi and Maria Antony for their valuable contributions to the database.This work was supported by funding from the Clinical Center’s Research Award for Staff Clinicians (RASCL) and NIH Intramural Grants.

Funding

This work was supported by funding from the NIH Intramural Grants.

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Authors and Affiliations

  1. Urologic Oncology Branch, National Cancer Institute (NCI), National Institutes of Health, Bethesda, MD, USA

    Aditi Chaurasia, Nikhil Gopal, Mark W. Ball & W. Marston Linehan

  2. Radiology and Imaging Sciences, Clinical Center (CC), National Institutes of Health, 10 Center Drive, 1C352, Bethesda, MD, 20892, USA

    Fatemeh Dehghani Firouzabadi, Pouria Yazdian Anari, Elizabeth C. Jones, Baris Turkbey, Fahimul Huda, Evrim B. Turkbey & Ashkan A. Malayeri

  3. Biostatistics and Clinical Epidemiology Service, Clinical Center, National Institutes of Health, Bethesda, MD, USA

    Paul Wakim

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  1. Aditi Chaurasia
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  2. Nikhil Gopal
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Corresponding author

Correspondence to Ashkan A. Malayeri.

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Ethical approval

This single-institution study was approved by the institutional review board.

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All patients were enrolled on an IRB approved protocol, with written consent obtained.

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Chaurasia, A., Gopal, N., Dehghani Firouzabadi, F. et al. Role of ultra-high b-value DWI in the imaging of hereditary leiomyomatosis and renal cell carcinoma (HLRCC). Abdom Radiol 48, 340–349 (2023). https://doi.org/10.1007/s00261-022-03689-w

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  • DOI: https://doi.org/10.1007/s00261-022-03689-w

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