Goyal Ankur, Sharma Raju, Bhalla Ashu S, Gamanagatti Shivanand, Seth Amlesh
Department of Radiodiagnosis, All India Institute of Medical Sciences (A.I.I.M.S.), New Delhi, India.
Department of Urology, All India Institute of Medical Sciences (A.I.I.M.S.), New Delhi, India.
Indian J Radiol Imaging. 2018 Jan-Mar;28(1):27-36. doi: 10.4103/ijri.IJRI_40_17.
To compare the diagnostic performance of multidetector computed tomography (MDCT), magnetic resonance imaging (MRI), and MRI with diffusion-weighted imaging (DWI) in the characterization of focal renal lesions. We also compared MDCT and MRI in the staging of renal cell carcinoma (RCC).
One hundred and twenty adult patients underwent MDCT (40-row and 128-row scanners), MRI (at 1.5 T), and DWI (at b-values of 0 and 500 s/mm) for characterization of 225 renal lesions. There were 65 malignant neoplasms (44 RCCs), 25 benign neoplasms, 25 abscesses, 45 pseudotumors, 15 hemorrhagic cysts, and 50 benign cysts. A composite gold standard including histology, typical imaging criteria, and follow-up imaging was employed. To determine the diagnostic performance of imaging modalities, area-under-curve (AUC) was calculated by receiver-operating-characteristic analysis and compared. Fisher's exact test was used to compare the diagnostic accuracies and confidence levels with MDCT, MRI, and MRI + DWI. Cross-tabulation was used to assess the precision of MDCT and MRI in RCC staging.
AUC for MDCT (0.834) and MRI (0.841) in the classification of benign and malignant lesions were within corresponding 95% confidence interval (CI) ( = 0.88) whereas MRI + DWI had significantly better performance (AUC 0.968, = 0.0002 and 0.0004, respectively). Both CT and MRI had low specificity (66.9% and 68.8%, respectively), which increased substantially with DWI (93.8%) owing to correct diagnosis of pseudotumors. MRI was superior to CT in diagnosing necrotic RCC and hemorrhagic cysts. MRI + DWI had the highest accuracy (94.2%) in assigning the definitive diagnosis and 97.6% lesions were diagnosed with very high confidence, significantly better than CT and MRI. Both CT and MRI had the same accuracy (86.1%) in RCC staging and evaluation of intravascular thrombi.
Characterization of renal lesions was most accurate with MRI + DWI. The latter is also the most suitable modality in diagnosing pseudotumors and evaluating patients with renal dysfunction. CT and MRI were equivalent in RCC staging.
比较多排螺旋计算机断层扫描（MDCT）、磁共振成像（MRI）以及联合扩散加权成像（DWI）的MRI对局灶性肾病变的诊断性能。我们还比较了MDCT和MRI在肾细胞癌（RCC）分期中的表现。
120例成年患者接受了MDCT（40排和128排扫描仪）、MRI（1.5T）以及DWI（b值为0和500s/mm²）检查，以明确225个肾病变的特征。其中有65个恶性肿瘤（44个RCC）、25个良性肿瘤、25个脓肿、45个假肿瘤、15个出血性囊肿以及50个良性囊肿。采用包括组织学、典型影像标准及随访影像的综合金标准。为确定各成像方式的诊断性能，通过接受者操作特征分析计算曲线下面积（AUC）并进行比较。采用Fisher精确检验比较MDCT、MRI及MRI + DWI的诊断准确性和置信水平。采用交叉表评估MDCT和MRI在RCC分期中的准确性。
MDCT（0.834）和MRI（0.841）对良恶性病变分类的AUC在相应的95%置信区间（CI）内（= 0.88），而MRI + DWI表现明显更好（AUC 0.968，分别为 = 0.0002和0.0004）。CT和MRI的特异性均较低（分别为66.9%和68.8%），由于对假肿瘤的正确诊断，DWI使其特异性大幅提高（93.8%）。MRI在诊断坏死性RCC和出血性囊肿方面优于CT。MRI + DWI在明确最终诊断方面准确性最高（94.2%），97.6%的病变诊断置信度很高，明显优于CT和MRI。CT和MRI在RCC分期及血管内血栓评估方面准确性相同（86.1%）。
MRI + DWI对肾病变的特征描述最准确。后者也是诊断假肿瘤及评估肾功能不全患者最适合的方式。CT和MRI在RCC分期方面等效。
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