Korean J Radiol.  2019 May;20(5):791-800. 10.3348/kjr.2018.0474.

Comparison of Monoexponential, Biexponential, Stretched-Exponential, and Kurtosis Models of Diffusion-Weighted Imaging in Differentiation of Renal Solid Masses

• Zhang J
• Suo S
• Liu G
• Zhang S
• Zhao Z
• Xu J
• Wu G

• KMID: 2442713
• DOI: http://doi.org/10.3348/kjr.2018.0474

Abstract

OBJECTIVE
To compare various models of diffusion-weighted imaging including monoexponential apparent diffusion coefficient (ADC), biexponential (fast diffusion coefficient [Df], slow diffusion coefficient [Ds], and fraction of fast diffusion), stretched-exponential (distributed diffusion coefficient and anomalous exponent term [α]), and kurtosis (mean diffusivity and mean kurtosis [MK]) models in the differentiation of renal solid masses.
MATERIALS AND METHODS
A total of 81 patients (56 men and 25 women; mean age, 57 years; age range, 30-69 years) with 18 benign and 63 malignant lesions were imaged using 3T diffusion-weighted MRI. Diffusion model selection was investigated in each lesion using the Akaike information criteria. Mann-Whitney U test and receiver operating characteristic (ROC) analysis were used for statistical evaluations.
RESULTS
Goodness-of-fit analysis showed that the stretched-exponential model had the highest voxel percentages in benign and malignant lesions (90.7% and 51.4%, respectively). ADC, Ds, and MK showed significant differences between benign and malignant lesions (p < 0.05) and between low- and high-grade clear cell renal cell carcinoma (ccRCC) (p < 0.05). α was significantly lower in the benign group than in the malignant group (p < 0.05). All diffusion measures showed significant differences between ccRCC and non-ccRCC (p < 0.05) except Df and α (p = 0.143 and 0.112, respectively). α showed the highest diagnostic accuracy in differentiating benign and malignant lesions with an area under the ROC curve of 0.923, but none of the parameters from these advanced models revealed significantly better performance over ADC in discriminating subtypes or grades of renal cell carcinoma (RCC) (p > 0.05).
CONCLUSION
Compared with conventional diffusion parameters, α may provide additional information for differentiating benign and malignant renal masses, while ADC remains the most valuable parameter for differentiation of RCC subtypes and for ccRCC grading.

Keyword

Magnetic resonance imaging; Diffusion-weighted imaging; Differentiation; Renal cell carcinoma; Renal masses

MeSH Terms

Carcinoma, Renal Cell
Diffusion
Female
Humans
Magnetic Resonance Imaging
Male
ROC Curve

Figure

• 

  Fig. 1 Clear cell renal cell carcinoma (grade II) in right kidney in 39-year-old man.A. Voxels preferred by monoexponential, biexponential, stretched-exponential, and kurtosis models in lesion. B. Plot of decay of diffusionweighted signal intensity as function of b-value from representative voxel within ROI. C. Multiparametric diffusion parameter maps within ROI. ADC = apparent diffusion coefficient, DDC = distributed diffusion coefficient, Df = fast diffusion coefficient, Ds = slow diffusion coefficient, f = fraction of fast diffusion, MD = mean diffusivity, MK = mean kurtosis, ROI = region of interest, α = anomalous exponent term

• 

  Fig. 2 Angiomyolipoma in left kidney in 55-year-old woman.A. Voxels preferred by monoexponential, biexponential, stretched-exponential and kurtosis models in lesion. B. Plot of decay of diffusion-weighted signal intensity as function of b-value from representative voxel within ROI. C. Multiparametric diffusion parameter maps within ROI.

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