Differentiating between malignant and benign renal tumors: do IVIM and diffusion kurtosis imaging perform better than DWI?
To quantitatively compare the diagnostic values of conventional diffusion-weighted imaging (DWI), intravoxel incoherent motion (IVIM), and diffusion kurtosis imaging (DKI) in differentiating between malignant and benign renal tumors.
Multiple b value DWIs and DKIs were performed in 180 patients with renal tumors, which were divided into clear cell renal cell carcinoma (ccRCC), non-ccRCC, and benign renal tumor group. The apparent diffusion coefficient (ADC), true diffusivity (D), pseudo-diffusion coefficient (D*), perfusion fraction (f), mean kurtosis (MK), and mean diffusivity (MD) maps were calculated. The diagnostic efficacy of various diffusion parameters for predicting malignant renal tumors was compared.
The ADC, D, and MD values of ccRCCs were higher, while D*, f, and MK values were lower than those of benign renal tumors (all p < 0.025). The D* and f values of non-ccRCCs were lower than those of benign renal tumors (p = 0.002 and p < 0.001, respectively). The difference of ADC, D, MD, and MK values between non-ccRCCs and benign renal tumors was not statistically significant (p > 0.05). The ADC, D, MD, and f values of ccRCCs were higher, while MK values were lower than those of non-ccRCCs (all p < 0.001). The AUC values of ADC, D, D*, f, MK, and MD were 0.849, 0.891, 0.708, 0.656, 0.862, and 0.838 for differentiating ccRCCs from benign renal tumors, respectively. The AUC values of D* and f were 0.772 and 0.866 for discrimination between non-ccRCCs and benign renal tumors, respectively.
IVIM parameters are the best, while DWI and DKI parameters have similar performance in differentiating malignant and benign renal tumors.
• The D value is the best parameter for differentiating ccRCC from benign renal tumors.
• The f value is the best parameter for differentiating non-ccRCC from benign renal tumors.
• Conventional DWI and DKI have similar performance in differentiating malignant and benign renal tumors.
KeywordsRenal neoplasms Diffusion-weighted MRI Intravoxel incoherent motion Diffusion kurtosis imaging Differential diagnosis
Apparent diffusion coefficient
Areas under the curves
Clear cell renal cell carcinoma
Diffusion kurtosis imaging
Intraclass correlation coefficient
Intravoxel incoherent motion
Non-clear cell renal cell carcinoma
Receiver operating characteristic
Region of interest
Spectral presaturation inversion recovery
We thank Caixia Fu (Siemens Healthcare) for providing the prototype diffusion sequence used in this study and for the excellent technical support.
This study has received funding by the Educational Specialist Training Fund (No.002) from Zhongshan Hospital, Fudan University.
Compliance with ethical standards
The scientific guarantor of this publication is Jianjun Zhou.
Conflict of interest
The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.
Statistics and biometry
No complex statistical methods were necessary for this paper.
Written informed consent was waived by the Institutional Review Board.
Institutional Review Board approval was obtained.
• cross-sectional study/diagnostic study
• performed at one institution
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