Original InvestigationCombined Diffusion-Weighted, Blood Oxygen Level–Dependent, and Dynamic Contrast-Enhanced MRI for Characterization and Differentiation of Renal Cell Carcinoma
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Study Subjects
The local ethics committee approved the study. After giving informed consent, 18 patients (10 female, 8 male, age 58.4 ± 3.2 years) with known RCC and planned surgical resection were included in this study. The initial diagnosis of RCC had been made before on computed tomography or ultrasound. Common criteria for exclusion from MRI (eg, pacemaker, contrast allergies, glomerular filtration rate (modified diet in renal disease [MDRD] formula <30 mL/min) were applied. According to these criteria,
Morphology and Histology
The glomerular filtration rate was calculated with the MDRD formula of all patients was >60 mL/minute. An overview of tumor morphology is provided in Table 1. Sixteen of the 18 tumors presented as a solid mass. All examinations were diagnostic. Two tumors showed significant necrosis, but no solid tumor portion could be defined. These tumors were investigated separately and not included in the correlation and ROC curve analysis. Three tumors showed signs of hemorrhage (high signal in T1). On
Results of the Single Modalities
Characterization of RCC is of therapeutical interest. Recent developments in the understanding of the biology of RCC have led to therapeutical interest in presurgical characterization of RCC (1). Tyrosine kinase inhibitors (eg, Sunitinib, Sorafenib) are effective treatment options for patients with clear-cell RCC but show lower efficacy for patients with papillary and chromophobe tumors (1), whereas temsirolimus shows improved efficacy for the treatment of patients with papillary tumors (22).
Conclusions
In conclusion, our initial data obtained in this rather small patient cohort suggests that a multiparametric MRI approach comprising DWI, BOLD, and DCE MRI is feasible for the preoperative assessment of RCC. In particular, perfusion parameters derived from DCE MRI are suited for separation of tumor subtypes; BOLD MRI and DWI did not improve the diagnostic accuracy because AUC of DCE MRI was already very high. R2* shows a moderate correlation with tumor perfusion derived from DCE MRI and yields
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2020, Magnetic Resonance Imaging Clinics of North AmericaCitation Excerpt :Compared with CT, MR is considered to be more sensitive to contrast enhancement for renal masses.15 Dynamic contrast imaging has been shown to be useful in the differentiation of the subtypes of RCC.16,17 This is important for the detection of papillary RCCs, which typically show low-level enhancement (Fig. 4), increasing on later phases and may be missed on CT.6
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2014, European Journal of RadiologyCitation Excerpt :Furthermore, additional MRI features that may have been of value, such as presence of intra-lesional hemosiderin and the dynamic contrast kinetics of lesions, were not evaluated. Finally, quantitative techniques such as diffusion-weighted imaging (DWI) MRI [22], blood–oxygen level dependent (BOLD) MRI [23], and perfusion imaging [19], were not evaluated. However, among these, only DWI is routinely employed at our institution, and this technique was not incorporated into our standard protocol until much more recently than the start date of this study in 2003.
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2014, Clinical RadiologyCitation Excerpt :The ADC value is significantly higher in RCC than in TCC. Among various subtypes of RCC, clear cell RCC shows higher ADC values than non-clear cell RCC.12 Prediction of histopathological grade is also possible solely based on DWI.