Sevcenco S, Heinz-Peer G, Ponhold L, Javor D, Kuehhas F E, Klingler H C, Remzi M, Weibl P, Shariat S F, Baltzer P A
Medical University of Vienna, Dept. of Urology, Waehringer Gürtel 18-20, 1090 Vienna, Austria.
Medical University of Vienna, Dept. of Biomedical Imaging and Image-guided Therapy, Waehringer Gürtel 18-20, 1090 Vienna, Austria.
Eur J Radiol. 2014 Jun;83(6):909-913. doi: 10.1016/j.ejrad.2014.02.026. Epub 2014 Mar 24.
To investigate utility and limitations of 3-Tesla diffusion-weighted (DW) magnetic resonance imaging (MRI) for differentiation of benign versus malignant renal lesions and renal cell carcinoma (RCC) subtypes.
Sixty patients with 71 renal lesions underwent 3 Tesla DW-MRI of the kidney before diagnostic tissue confirmation. The images were retrospectively evaluated blinded to histology. Single-shot echo-planar imaging was used as the DW imaging technique. Apparent diffusion coefficient (ADC) values were measured and compared with histopathological characteristics.
There were 54 malignant and 17 benign lesions, 46 lesions being small renal masses ≤ 4 cm. Papillary RCC lesions had lower ADC values (p=0.029) than other RCC subtypes (clear cell or chromophobe). Diagnostic accuracy of DW-MRI for differentiation of papillary from non-papillary RCC was 70.3% resulting in a sensitivity and specificity of 64.3% (95% CI, 35.1-87.2) and 77.1 (95% CI, 59.9-89.6%). Accuracy increased to 83.7% in small renal masses (≤ 4 cm diameter) and sensitivity and specificity were 75.0% and 88.5%, respectively. The ADC values did not differ significantly between benign and malignant renal lesions (p=0.45).
DW-MRI seems to distinguish between papillary and other subtypes of RCCs especially in small renal masses but could not differentiate between benign and malignant renal lesions. Therefore, the use of DW-MRI for preoperative differentiation of renal lesions is limited.
探讨3特斯拉扩散加权磁共振成像（DW-MRI）在鉴别肾良性与恶性病变及肾细胞癌（RCC）亚型方面的效用和局限性。
60例患有71个肾病变的患者在进行诊断性组织确认前接受了肾脏的3特斯拉DW-MRI检查。对图像进行回顾性评估，评估时不了解组织学情况。采用单次激发回波平面成像作为DW成像技术。测量表观扩散系数（ADC）值并与组织病理学特征进行比较。
有54个恶性病变和17个良性病变，其中46个病变为直径≤4 cm的小肾肿块。乳头状RCC病变的ADC值低于其他RCC亚型（透明细胞或嫌色细胞）（p=0.029）。DW-MRI鉴别乳头状与非乳头状RCC的诊断准确性为70.3%，敏感性和特异性分别为64.3%（95%CI，35.1-87.2）和77.1（95%CI，59.9-89.6%）。在小肾肿块（直径≤4 cm）中，准确性提高到83.7%，敏感性和特异性分别为75.0%和88.5%。良性和恶性肾病变之间的ADC值无显著差异（p=0.45）。
DW-MRI似乎能够区分乳头状RCC与其他RCC亚型，尤其是在小肾肿块中，但无法区分肾良性与恶性病变。因此，DW-MRI在肾病变术前鉴别诊断中的应用有限。
