European Radiology

, Volume 23, Issue 1, pp 272–279 | Cite as

Diffusion-weighted MRI in inflammatory renal lesions: all that glitters is not RCC!

  • Ankur Goyal
  • Raju SharmaEmail author
  • Ashu S. Bhalla
  • Shivanand Gamanagatti
  • Amlesh Seth



To evaluate the diffusion characteristics of inflammatory renal lesions and assess whether apparent diffusion coefficient (ADC) values can distinguish them from renal-cell carcinomas (RCCs).


Eighty-eight patients underwent multidetector computed tomography (MDCT), magnetic resonance imaging (MRI) and diffusion-weighted (DW) MRI (at b values of 0 and 500 s/mm2) for characterisation of focal renal lesions. On retrospective evaluation, 15 patients had 20 inflammatory lesions and 33 patients had 36 RCCs. DW images were compared and receiver operating characteristic (ROC) curves were drawn to establish cut-off ADC values.


All inflammatory lesions and 91.7% of RCCs showed restricted diffusion. DW images showed markedly restricted diffusion in fluid intensity areas of abscesses, whereas RCCs showed free diffusion in their cystic portions. Quantitatively, both abscesses and RCCs showed ADC values significantly lower than normal renal parenchyma [1.12 and 1.56 respectively vs 2.34 (× 10-3 mm2/s) for normal kidney] (P < 0.0001 for both) and significantly different from each other (P < 0.0001). ROC analysis in differentiating inflammatory lesions and RCC revealed high sensitivity (100%) and specificity (78.1%) for cut-off ADC value of 1.41 (× 10-3 mm2/s).


Both abscess and RCC showed restricted diffusion, the former did so to a greater extent, distinctly in fluid components. Thus, ADC values provide an additional paradigm for characterisation of indeterminate renal lesions.

Key Points

Both RCCs and inflammatory lesions show restricted diffusion on MRI.

Diffusion restriction is not specific for malignancy; rather, inflammatory lesions show greater restriction.

Fluid components of abscesses show marked diffusion restriction; cystic components of RCC show free diffusion.

ADC values and diffusion restriction pattern provide an additional paradigm for indeterminate lesions.

DW MRI may obviate the need of intravenous contrast in abscesses, which is useful in patients with renal dysfunction.


Diffusion weighted MRI Inflammatory renal lesion Renal abscess Renal cell carcinoma Indeterminate renal lesion 


  1. 1.
    Kutikov A, Fossett LK, Ramchandani P et al (2006) Incidence of benign pathologic findings at partial nephrectomy for solitary renal mass presumed to be renal cell carcinoma on preoperative imaging. Urology 68:737–740PubMedCrossRefGoogle Scholar
  2. 2.
    Prasad SR, Dalrymple NC, Surabhi VR (2008) Cross-sectional imaging evaluation of renal masses. Radiol Clin North Am 46:95–111, vi-viiPubMedCrossRefGoogle Scholar
  3. 3.
    Israel GM, Bosniak MA (2005) How I do it: evaluating renal masses. Radiology 236:441–450PubMedCrossRefGoogle Scholar
  4. 4.
    Bhatt S, MacLennan G, Dogra V (2007) Renal pseudotumours. AJR Am J Roentgenol 188:1380–1387PubMedCrossRefGoogle Scholar
  5. 5.
    Pickhardt PJ, Lonergan GJ, Davis CF, Kashitani N, Wagner BJ (2000) Infiltrative renal lesions: radiologic-pathologic correlation. Radiographics 20:215–243PubMedGoogle Scholar
  6. 6.
    Israel GM, Bosniak MA (2005) An update of the Bosniak renal cyst classification system. Urology 66:484–488PubMedCrossRefGoogle Scholar
  7. 7.
    Whalley PJ, Cunningham FG, Martin FG (1975) Transient renal dysfunction associated with acute pyelonephritis of pregnancy. Obstet Gynecol 46:174–177PubMedGoogle Scholar
  8. 8.
    Saremi F, Knoll AN, Bendavid OJ, Schultze-Haakh H, Narula N, Sarlati F (2009) Characterization of genitourinary lesions with diffusion-weighted imaging. Radiographics 29:1295–1317PubMedCrossRefGoogle Scholar
  9. 9.
    Ebisu T, Tanaka C, Umeda M et al (1996) Discrimination of brain abscess from necrotic or cystic tumours by diffusion-weighted echo planar imaging. Magn Reson Imaging 14:1113–1116PubMedCrossRefGoogle Scholar
  10. 10.
    Kim YJ, Chang KH, Song IC et al (1998) Brain abscess and necrotic or cystic brain tumour: discrimination with signal intensity on diffusion-weighted MR imaging. AJR Am J Roentgenol 171:1487–1490PubMedGoogle Scholar
  11. 11.
    Noguchi K, Watanabe N, Nagayoshi T et al (1999) Role of diffusion-weighted echo-planar MRI in distinguishing between brain abscess and tumour: a preliminary report. Neuroradiology 41:171–174PubMedCrossRefGoogle Scholar
  12. 12.
    Desprechins B, Stadnik T, Koerts G, Shabana W, Breucq C, Osteaux M (1999) Use of diffusion-weighted MR imaging in differential diagnosis between intracerebral necrotic tumours and cerebral abscesses. AJNR Am J Neuroradiol 20:1252–1257PubMedGoogle Scholar
  13. 13.
    Lai PH, Ho JT, Chen WL et al (2002) Brain abscess and necrotic brain tumour: discrimination with proton MR spectroscopy and diffusion-weighted imaging. AJNR Am J Neuroradiol 23:1369–1377PubMedGoogle Scholar
  14. 14.
    Squillaci E, Manenti G, Di Stefano F, Miano R, Strigari L, Simonetti G (2004) Diffusion weighted MR imaging in the evaluation of renal tumours. J Exp Clin Cancer Res 23:39–45PubMedGoogle Scholar
  15. 15.
    Cova M, Squillaci E, Stacul F et al (2004) Diffusion weighted MRI in the evaluation of renal lesions: preliminary results. Br J Radiol 77:851–857PubMedCrossRefGoogle Scholar
  16. 16.
    Yoshikawa T, Kawamitsu H, Mitchell DG et al (2006) ADC measurement of abdominal organs and lesions using parallel imaging technique. AJR Am J Roentgenol 187:1521–1530PubMedCrossRefGoogle Scholar
  17. 17.
    Zhang J, Tehrani YM, Wang L, Ishill NM, Schwartz LH, Hricak H (2008) Renal masses: characterization with diffusion-weighted MR imaging—a preliminary experience. Radiology 247:458–464PubMedCrossRefGoogle Scholar
  18. 18.
    Taouli B, Thakur R, Mannelli L et al (2009) Renal lesions: characterization with diffusion-weighted imaging versus contrast-enhanced MR imaging. Radiology 251:398–407PubMedCrossRefGoogle Scholar
  19. 19.
    Kilickesmez O, Inci E, Atilla S et al (2009) Diffusion-weighted imaging of the renal and adrenal lesions. J Comput Assist Tomography 33:828–833CrossRefGoogle Scholar
  20. 20.
    Sandrasegaran K, Sundaram CP, Ramaswamy R et al (2010) Usefulness of diffusion-weighted imaging in the evaluation of renal masses. AJR Am J Roentgenol 194:438–445PubMedCrossRefGoogle Scholar
  21. 21.
    Thoeny HC, De Keyzer F, Oyen RH, Peeters RR (2005) Diffusion- weighted MR imaging of kidneys in healthy volunteers and patients with parenchymal diseases- initial experience. Radiology 235:911–917PubMedCrossRefGoogle Scholar
  22. 22.
    Chan JHM, Tsui EYK, Luk SH et al (2001) MR diffusion-weighted imaging of kidney- Differentiation between hydronephrosis and pyonephrosis. Clinical Imaging 25:110–113PubMedCrossRefGoogle Scholar
  23. 23.
    Verswijvel G, Vandecaveye V, Gelin G et al (2002) Diffusion-weighted MR imaging in the evaluation of renal infection: preliminary results. JBR-BTR 85:100–103PubMedGoogle Scholar
  24. 24.
    Goyal A, Gadodia A, Sharma R (2010) Xanthogranulomatous pyelonephritis: an uncommon pediatric renal mass. Pediatr Radiol 40:1962–1963PubMedCrossRefGoogle Scholar

Copyright information

© European Society of Radiology 2012

Authors and Affiliations

  • Ankur Goyal
    • 1
  • Raju Sharma
    • 1
    Email author
  • Ashu S. Bhalla
    • 1
  • Shivanand Gamanagatti
    • 1
  • Amlesh Seth
    • 2
  1. 1.Department of RadiodiagnosisAll India Institute of Medical Sciences (A.I.I.M.S.)New DelhiIndia
  2. 2.Department of UrologyAll India Institute of Medical Sciences (A.I.I.M.S.)New DelhiIndia

Personalised recommendations