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



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


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.


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).


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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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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Correspondence to Andreas M. Hötker.

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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).

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