Hötker Andreas M, Lollert André, Mazaheri Yousef, Müller Sabine, Schenk Jens-Peter, Mildenberger Philipp C, Akin Oguz, Graf Norbert, Staatz Gundula
Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland.
Section of Pediatric Radiology, Department of Diagnostic and Interventional Radiology, Universitätsmedizin Mainz, Langenbeckstr. 1, 55131, Mainz, Germany.
Abdom Radiol (NY). 2020 Oct;45(10):3202-3212. doi: 10.1007/s00261-020-02475-w.
To assess the value of diffusion-weighted MRI in the pre-therapeutic evaluation of pediatric renal cortical tumors.
This IRB-approved, retrospective multi-center study included 122 pediatric patients with 130 renal tumors, who underwent MRI including DWI before neoadjuvant chemotherapy and nephrectomy. Two radiologists independently assessed each tumor volumetrically, and apparent diffusion coefficient (ADC) values were calculated on a voxel-wise basis, including parameters derived from histogram and texture analysis.
Inter-reader agreement was excellent (ICC 0.717-0.975). For both readers, patients with locally aggressive tumor growth (SIOP 3 stage) or with metastases (M1) had significantly lower 12.5th-percentile ADC values (p ≤ 0.028) compared to those with lower-stage tumors, and the parameter energy differed significantly between patients with M1 and those with M0 status (p ≤ 0.028). Contrast and homogeneity differed significantly between benign nephroblastomatosis and malignant nephroblastoma (p ≤ 0.045, both readers). As compared to all other subtypes, the blastemal subtype demonstrated significantly higher skewness (p ≤ 0.022, both readers) and the diffuse anaplastic subtype demonstrated significantly higher 75th-percentile ADC values (p ≤ 0.042, both readers).
Diffusion-weighted MRI may be of value in identifying benign nephroblastomatosis and assessing nephroblastoma subtypes. Therefore, further research is warranted to assess its value in risk stratification for pediatric patients with renal tumors in the future.
评估扩散加权磁共振成像（MRI）在小儿肾皮质肿瘤治疗前评估中的价值。
这项经机构审查委员会（IRB）批准的回顾性多中心研究纳入了122例患有130个肾肿瘤的小儿患者，这些患者在新辅助化疗和肾切除术前接受了包括扩散加权成像（DWI）在内的MRI检查。两名放射科医生独立对每个肿瘤进行体积评估，并在体素基础上计算表观扩散系数（ADC）值，包括从直方图和纹理分析得出的参数。
阅片者间一致性良好（组内相关系数ICC为0.717 - 0.975）。对于两位阅片者而言，与低分期肿瘤患者相比，具有局部侵袭性肿瘤生长（国际小儿肿瘤学会（SIOP）3期）或有转移（M1）的患者其第12.5百分位数的ADC值显著更低（p≤0.028），且M1患者与M0状态患者之间的能量参数差异显著（p≤0.028）。良性肾母细胞瘤病与恶性肾母细胞瘤之间的对比度和均匀性差异显著（两位阅片者的p值均≤0.045）。与所有其他亚型相比，胚芽型亚型的偏度显著更高（两位阅片者的p值均≤0.022），弥漫间变型亚型的第75百分位数的ADC值显著更高（两位阅片者的p值均≤0.042）。
扩散加权MRI在鉴别良性肾母细胞瘤病和评估肾母细胞瘤亚型方面可能具有价值。因此，有必要进一步开展研究以评估其未来在小儿肾肿瘤患者风险分层中的价值。
