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Contribution of diffusion weighted MRI to the differential diagnosis of renal masses
(Wydawnictwo Uniwersytetu Rzeszowskiego, 2022) Kış, Naciye; Düzkalır, Hanife Gülden; Ağaçlı, Mehmet Oğuzhan; Erok, Berrin; Kılıçoğlu, Zeynep Gamze
Introduction and aim. We aimed to assess the usefulness of diffusion weighted imaging (DWI) and apparent diffusion coefficients (ADCs) for characterizing renal masses. Material and method. In this retrospective study we measured the ADC values of renal masses at b=0, b=500 and b=1000. Measurements were made by placing a circular region of interest with a diameter of 1 cm.ADC values from normal renal parenchyma were taken to define the ADC and to compare with the ADC values of the lesions. Results. A total of 72 lesions of 54 patients were included.40 of the masses were benign and 32 were malignant. The ADC values of benign lesions at both b values were significantly higher than malignant lesions. We found the lowest values in angiomyolipomas (AMLs) and oncocytomas and the highest values in Bosniac type I cysts. Similarities was found between the ADC values of some AMLs and the RCCs. In terms of statistical results, the inclusion of AMLs in the analysis did not significantly affect the difference between malignant and benign lesions. Conclusion. In our study, the ADC values of benign renal masses were higher than those of normal renal parenchyme, which is higher than those of malignant renal masses.The lowest ADC values were observed in AMLs and oncocytomas.
Diffusion weighted imaging in differentiation of the clear cell RCC from the major non-clear cell RCC subtypes
(Wydawnictwo Uniwersytetu Rzeszowskiego, 2021) Kış, Naciye; Erok, Berrin
Introduction. Renal cell carcinoma (RCC) is the most common malignant renal tumor in adults accounting for 80-90% of primary malignant adult renal neoplasms. RCC represents a very heterogenous groups of tumors with a number of distinct histological varieties, of which the major 3 subtypes are clear cell RCC (70-80%), papillary RCC (13-20%), and chromophobe RCC (5%). Imaging features are varied from solid and relatively homogenous appearance to markedly heterogenous appearance with cystic changes, hemorrhage and necrosis. The use of diffusion weighted imaging (DWI) for RCC subtyping and also for differentiation of high grade and low grade tumors has been showed to be useful in many studies in the literature. Aim. In this study, we aimed to determine the comparative contribution of DWI in differentiation of the clear cell RCC from the major non-clear cell RCC subtypes at standard high b-value (1000 s/mm2) versus low b-value (500 s/mm2). In addition, we also aimed to assess the diagnostic performance of DWI for differentiating high grade clear cell RCC from low grade clear cell RCC based on Fuhrman grades in our patients. Material and methods. 62 cases with a prediagnosis of RCC according to MRI findings including DWI sequence with histological verification and subtyping of renal cortical tumor following a total or partial nephrectomy were included in the study. Results. Among 62 cases, 46 were male and 16 were female, with mean age of 59.5 ± 15.7. Pathological diagnoses of 62 cases were as follows, clear cell RCC, (44) papillary cell RCC (14) and chromophobe cell RCC (4). They were divided into two groups as clear cell RCC group (44 cases) and non-clear cell RCC group (18 cases). There was no statistically significant difference between the mean ADC values of clear cell and non-clear cell groups at b-value of 1000 s/mm2 (p>0.05). However, the mean ADC level for clear cell RCC group at b-value of 500 s/mm2 were significantly higher than for non-clear cell RCC group (p<0.05). When a value of 0.99x10-3 mm2/s was set as cut-off for ADC at b-factor of 500 s/mm2, differentiation was achieved with a high sensitivity (91%) and specificity (56%). Regarding the diagnostic performance of DWI for differentiating high from low Fuhrman grades clear cell RCCs, there was no statistically significant difference between the ADC values of Grade I-II clear cell RCC cases and Grade III-IV clear cell RCC cases at b-factor of 1000 s/mm2 (p>0.05). However, ADC values for grade III-IV group was statistically significantly lower than ADC values for Grade I-II group at b-factor of 500 s/mm2 level. Conclusion. ADC measurements at moderate b-value of 500 s/mm2 were more sensitive in subtyping and grading of RCC cases. This technique can be used in clinical practice as a fast and additional sequence in abdominal MRI.