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International Urology and Nephrology

, Volume 49, Issue 2, pp 215–224 | Cite as

Renal cell carcinoma: applicability of the apparent coefficient of the diffusion-weighted estimated by MRI for improving their differential diagnosis, histologic subtyping, and differentiation grade

  • Yulian Mytsyk
  • Ihor Dutka
  • Yuriy Borys
  • Iryna Komnatska
  • Iryna Shatynska-Mytsyk
  • Ammad Ahmad Farooqi
  • Katarina Gazdikova
  • Martin Caprnda
  • Luis Rodrigo
  • Peter Kruzliak
Urology - Original Paper

Abstract

Background

Renal cell carcinoma (RCC) represents the most common malignant epithelial neoplasm of the kidney. Accurate assessment of the renal masses, defining the histologic subtype and the grade of differentiation of the tumor, is vital to ensure an adequate case management as well as for staging and prognosis. Recently, diffusion-weighted imaging (DWI) magnetic resonance imaging (MRI) tends to be increasingly appealing for the clinicians as an imaging procedure of choice for the diagnosis and staging of the RCC, which is predetermined by several advantages over CT. The goal of the survey was to assess the applicability of the apparent diffusion coefficient (ADC) of the DWI MRI for the differential diagnostics, histologic subtyping, and defining the grade of differentiation of the RCC.

Methods

The study enrolled 288 adult patients with renal lesions: 188 patients with solid RCC—126 patients with clear cell subtype (ccRCC), 32 patients with papillary RCC (pRCC), 30 patients with chromophobe RCC (chRCC); 27 patient with cystic form or RCC (Bosniak cyst, category IV); 32 patients with renal angiomyolipoma (AML); 25 patients with renal oncocytoma (OC); and 16 patients with the renal abscess (AB). In total, 245 lesions were pathologically verified. As a reference, 19 healthy volunteers were included into the study. All patients underwent MRI of the kidneys, involving DWI with subsequent evaluation of the ADC.

Results

There was a reliable difference (p < 0.05) in mean ADC values between the normal renal parenchyma (NRP), solid RCC of different histologic subtypes and grades, cystic RCC, and benign renal lesions. The mean ADC values obtained in the result of the study were (×10−3 mm2/s): 2.47 ± 0.12 in NRP, 1.63 ± 0.29 in all solid RCCs, 1.82 ± 0.22 in solid ccRCC (1.92 ± 0.11—Fuhrman grade I, 1.84 ± 0.14—Fuhrman grade II, 1.79 ± 0.10—Fuhrman grade III, 1.72 ± 0.06—Fuhrman grade IV), 1.61 ± 0.07 in pRCC, 1.46 ± 0.09 in chRCC, 2.68 ± 0.11 in cystic RCC, 2.13 ± 0.08 in AML, 2.26 ± 0.06 in OC, and 3.30 ± 0.07 in AB.

Conclusion

The data received in our study demonstrate a substantial restriction of diffusion of hydrogen molecules in tissues of ccRCC in comparison with the healthy renal parenchyma preconditioned by the greater density of tumor. A statistically significant difference in mean ADC values of ccRCC with different grades of nuclear pleomorphism by Fuhrman was observed: Low-grade tumors showed higher mean ADC values compared to high-grade tumors. The modality of the MRI DWI along with ADC measurement allows to reliably differentiate between the solid RCC of main histologic subtypes and grades, cystic RCC, and the benign renal lesions.

Keywords

Renal cell carcinoma Magnetic resonance imaging Diffusion-weighted imaging Apparent diffusion coefficient 

Abbreviations

AB

Renal abscess

ADC

Apparent diffusion coefficient

AML

Angiomyolipoma

ccRCC

Clear cell renal cell carcinoma

chRCC

Chromophobe renal cell carcinoma

CT

Computed tomography

DWI

Diffusion-weighted images

FIESTA FAT SAT

Fast imaging employing steady-state acquisition with fat saturation

FRFSE

Fast-recovery fast spin-echo

FSPGR-DE

Fast spoiled gradient-recalled echo dual-echo

LAVA

Liver acquisition with volume acquisition

MRI

Magnetic resonance imaging

NRP

Normal renal parenchyma

OC

Oncocytoma

pRCC

Papillary renal cell carcinoma

RCC

Renal cell carcinoma

RCC

Renal cell carcinoma

ROI

Region of interest

SNR

Signal-to-noise ratio

SSFSE

Single-shot fast spin-echo

TE

Echo time

TR

Repetition time

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

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Copyright information

© Springer Science+Business Media Dordrecht 2016

Authors and Affiliations

  • Yulian Mytsyk
    • 1
  • Ihor Dutka
    • 2
  • Yuriy Borys
    • 1
  • Iryna Komnatska
    • 2
  • Iryna Shatynska-Mytsyk
    • 3
  • Ammad Ahmad Farooqi
    • 4
  • Katarina Gazdikova
    • 5
    • 6
  • Martin Caprnda
    • 7
  • Luis Rodrigo
    • 7
  • Peter Kruzliak
    • 8
    • 9
  1. 1.Department of UrologyLviv National Medical UniversityLvivUkraine
  2. 2.Euroclinic Medical CenterLvivUkraine
  3. 3.Department of RadiologyLviv National Medical UniversityLvivUkraine
  4. 4.Laboratory of Translational Oncology and Personalized MedicineRashid Latif Medical CollegeLahorePakistan
  5. 5.Department of Nutrition, Faculty of Nursing and Professional Health StudiesSlovak Medical UniversityBratislavaSlovak Republic
  6. 6.Department of General Medicine, Faculty of MedicineSlovak Medical UniversityBratislavaSlovak Republic
  7. 7.University of Oviedo, Central University Hospital of Asturias (HUCA)OviedoSpain
  8. 8.Department of Chemical Drugs, Faculty of PharmacyUniversity of Veterinary and Pharmaceutical SciencesBrnoCzech Republic
  9. 9.2nd Department of Surgery, Faculty of MedicineMasaryk UniversityBrnoCzech Republic

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