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Differentiating between malignant and benign renal tumors: do IVIM and diffusion kurtosis imaging perform better than DWI?

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Abstract

Objective

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.

Methods

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.

Results

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.

Conclusion

IVIM parameters are the best, while DWI and DKI parameters have similar performance in differentiating malignant and benign renal tumors.

Key Points

• 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.

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Abbreviations

ADC:

Apparent diffusion coefficient

AUC:

Areas under the curves

ccRCC:

Clear cell renal cell carcinoma

CI:

Confidence interval

D :

True diffusivity

D* :

Pseudo-diffusion coefficient

DKI:

Diffusion kurtosis imaging

DWI:

Diffusion-weighted imaging

f :

Perfusion fraction

ICC:

Intraclass correlation coefficient

IVIM:

Intravoxel incoherent motion

MD:

Mean diffusivity

MK:

Mean kurtosis

non-ccRCC:

Non-clear cell renal cell carcinoma

ROC:

Receiver operating characteristic

ROI:

Region of interest

SPIR:

Spectral presaturation inversion recovery

TE:

Echo time

TR:

Repetition time

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Acknowledgements

We thank Caixia Fu (Siemens Healthcare) for providing the prototype diffusion sequence used in this study and for the excellent technical support.

Funding

This study has received funding by the Educational Specialist Training Fund (No.002) from Zhongshan Hospital, Fudan University.

Author information

Authors and Affiliations

  1. Department of Radiology, Zhongshan Hospital, Fudan University; Shanghai Institute of Medical Imaging, 180 Fenglin Road, Shanghai, 200032, People’s Republic of China

    Yuqin Ding, Qinxuan Tan, Wei Mao, Chenchen Dai, Mengsu Zeng & Jianjun Zhou

  2. Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, 200032, People’s Republic of China

    Xiaoyi Hu

  3. Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, 200032, People’s Republic of China

    Jun Hou

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  1. Yuqin Ding
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Correspondence to Mengsu Zeng or Jianjun Zhou.

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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.

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Jianjun Zhou and Mengsu Zeng have the same contribution to the design and guidance of this manuscript. As a result, they are listed as co-corresponding authors of this article.

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Ding, Y., Tan, Q., Mao, W. et al. Differentiating between malignant and benign renal tumors: do IVIM and diffusion kurtosis imaging perform better than DWI?. Eur Radiol 29, 6930–6939 (2019). https://doi.org/10.1007/s00330-019-06240-6

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  • DOI: https://doi.org/10.1007/s00330-019-06240-6

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