Korean J Radiol.  2016 Dec;17(6):853-863. 10.3348/kjr.2016.17.6.853.

Comparison of Biexponential and Monoexponential Model of Diffusion-Weighted Imaging for Distinguishing between Common Renal Cell Carcinoma and Fat Poor Angiomyolipoma

• Ding Y
• Zeng M
• Rao S
• Chen C
• Fu C
• Zhou J

• KMID: 2466282
• DOI: http://doi.org/10.3348/kjr.2016.17.6.853

Abstract

OBJECTIVE
To compare the diagnostic accuracy of intravoxel incoherent motion (IVIM)-derived parameters and apparent diffusion coefficient (ADC) in distinguishing between renal cell carcinoma (RCC) and fat poor angiomyolipoma (AML).
MATERIALS AND METHODS
Eighty-three patients with pathologically confirmed renal tumors were included in the study. All patients underwent renal 1.5T MRI, including IVIM protocol with 8 b values (0-800 s/mm²). The ADC, diffusion coefficient (D), pseudodiffusion coefficient (D*), and perfusion fraction (f) were calculated. One-way ANOVA was used for comparing ADC and IVIM-derived parameters among clear cell RCC (ccRCC), non-ccRCC and fat poor AML. The diagnostic performance of these parameters was evaluated by using receiver operating characteristic (ROC) analysis.
RESULTS
The ADC were significantly greater in ccRCCs than that of non-ccRCCs and fat poor AMLs (each p < 0.010, respectively). The D and D* among the three groups were significantly different (all p < 0.050). The f of non-ccRCCs were less than that of ccRCCs and fat poor AMLs (each p < 0.050, respectively). In ROC analysis, ADC and D showed similar area under the ROC curve (AUC) values (AUC = 0.955 and 0.964, respectively, p = 0.589) in distinguishing between ccRCCs and fat poor AMLs. The combination of D > 0.97 × 10⁻³ mm²/s, D* < 28.03 × 10⁻³ mm²/s, and f < 13.61% maximized the diagnostic sensitivity for distinguishing non-ccRCCs from fat poor AMLs. The final estimates of AUC (95% confidence interval), sensitivity, specificity, positive predictive value, negative predictive value and accuracy for the entire cohort were 0.875 (0.719-0.962), 100% (23/23), 75% (9/12), 88.5% (23/26), 100% (9/9), and 91.4% (32/35), respectively.
CONCLUSION
The ADC and D showed similar diagnostic accuracy in distinguishing between ccRCCs and fat poor AMLs. The IVIM-derived parameters were better than ADC in discriminating non-ccRCCs from fat poor AMLs.

Keyword

Intravoxel incoherent motion; Diffusion-weighted imaging; DWI; Renal cell carcinoma; Angiomyolipoma

MeSH Terms

Adult
Aged
Angiomyolipoma/*diagnosis/diagnostic imaging/pathology
Area Under Curve
Carcinoma, Renal Cell/*diagnosis/diagnostic imaging/pathology
Diffusion Magnetic Resonance Imaging
Female
Humans
Kidney Neoplasms/*diagnosis/diagnostic imaging/pathology
Male
Middle Aged
ROC Curve
Retrospective Studies
Sensitivity and Specificity

Figure

• 

  Fig. 1 Box-and-whisker plots of ADC (A), D (B), D* (C), and f (D) values for ccRCC, non-ccRCC, and fat poor AML. Bottom and top of boxes indicate 25th and 75th percentiles of values, respectively. Horizontal line inside box indicates median values. ADC = apparent diffusion coefficient, AML = angiomyolipomas, ccRCC = clear cell renal cell carcinoma, non-ccRCC = papillary RCC and chromophobe RCC

• 

  Fig. 2 MR images in 37-year-old man with 3.7 cm surgically verified ccRCC in right kidney. Diffusion-weighted image with b value of 800 s/mm2 (A), and IVIM-derived parametric maps (D, D*, and f, respectively) (B-D) calculated from IVIM-DWI data. Calculated mean values of ADC, D, D*, and f for manually drawn ROIs for ccRCC were 1.85 × 10-3 mm2/s, 1.49 × 10-3 mm2/s, 31.10 × 10-3 mm2/s, and 22.9%, respectively. ADC = apparent diffusion coefficient, ccRCC = clear cell renal cell carcinoma, DWI = diffusion-weighted imaging, IVIM = intravoxel incoherent motion, MR = magnetic resonance, ROIs = region of interests

• 

  Fig. 3 MR images in 52-year-old man with 3.5 cm surgically proven chRCC in left kidney. Diffusion-weighted image with b value of 800 s/mm2 (A), and IVIM-derived parametric maps (D, D*, and f, respectively) (B-D) calculated from IVIM-DWI data. Calculated mean values of ADC, D, D*, and f for manually drawn ROIs for non-ccRCC were 0.92 × 10-3 mm2/s, 0.74 × 10-3 mm2/s, 16.87 × 10-3 mm2/s, and 13.9%, respectively. ADC = apparent diffusion coefficient, chRCC = chromophobe renal cell carcinoma, DWI = diffusion-weighted imaging, IVIM = intravoxel incoherent motion, MR = magnetic resonance, ROIs = region of interests

• 

  Fig. 4 MR images in 36-year-old woman with 11.2 cm pathologically proven fat poor AML in right kidney. Diffusion-weighted image with b value of 800 s/mm2 (A), and IVIM-derived parametric maps (D, D*, and f, respectively) (B-D) calculated from IVIM-DWI data. Calculated mean values of ADC, D, D*, and f for manually drawn ROIs for fat poor AML were 1.16 × 10-3 mm2/s, 0.81 × 10-3 mm2/s, 50.55 × 10-3 mm2/s, and 22.8%, respectively. ADC = apparent diffusion coefficient, AML = angiomyolipomas, DWI = diffusion-weighted imaging, IVIM = intravoxel incoherent motion, MR = magnetic resonance, ROIs = region of interests

• 

  Fig. 5 ROC curves for ADC and IVIM-derived parameters in differentiating renal cell carcinomas and fat poor AMLs. A. Graph shows comparison of ROC curve analysis for discriminating ccRCC and fat poor AMLs with ADC and IVIM-derived parameters. AUCs for ADC, D, D*, and f were 0.955, 0.964, 0.668, and 0.506, respectively. B. Graph shows comparison of ROC curve analysis for differentiation between non-ccRCC and fat poor AMLs with ADC and IVIM-derived parameters. AUCs for ADC, D, D*, and f were 0.634, 0.757, 0.822, and 0.783, respectively. ADC = apparent diffusion coefficient, AML = angiomyolipomas, AUC = area under the receiver operating characteristic curve, ccRCC = clear cell renal cell carcinoma, IVIM = intravoxel incoherent motion, ROC = receiver operating characteristic

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