Elsevier

Academic Radiology

Volume 20, Issue 6, June 2013, Pages 685-693
Academic Radiology

Original Investigation
Combined Diffusion-Weighted, Blood Oxygen Level–Dependent, and Dynamic Contrast-Enhanced MRI for Characterization and Differentiation of Renal Cell Carcinoma

https://doi.org/10.1016/j.acra.2013.01.015Get rights and content

Purpose

To investigate a multiparametric magnetic resonance imaging (MRI) approach comprising diffusion-weighted imaging (DWI), blood oxygen–dependent (BOLD), and dynamic contrast-enhanced (DCE) MRI for characterization and differentiation of primary renal cell carcinoma (RCC).

Material and Methods

Fourteen patients with clear-cell carcinoma and four patients with papillary RCC were examined with DWI, BOLD MRI, and DCE MRI at 1.5T. The apparent diffusion coefficient (ADC) was calculated with a monoexponential decay. The spin-dephasing rate R2* was derived from parametric R2* maps. DCE-MRI was analyzed using a two-compartment exchange model allowing separation of perfusion (plasma flow [FP] and plasma volume [VP]), permeability (permeability surface area product [PS]), and extravascular extracellular volume (VE). Statistical analysis was performed with Wilcoxon signed-rank test, Pearson's correlation coefficient, and receiver operating characteristic curve analysis.

Results

Clear-cell RCC showed higher ADC and lower R2* compared to papillary subtypes, but differences were not significant. FP of clear-cell subtypes was significantly higher than in papillary RCC. Perfusion parameters showed moderate but significant inverse correlation with R2*. VE showed moderate inverse correlation with ADC. Fp and Vp showed best sensitivity for histological differentiation.

Conclusion

Multiparametric MRI comprising DWI, BOLD, and DCE MRI is feasible for assessment of primary RCC. BOLD moderately correlates to DCE MRI–derived perfusion. ADC shows moderate correlation to the extracellular volume, but does not correlate to tumor oxygenation or perfusion. In this preliminary study DCE-MRI appeared superior to BOLD and DWI for histological differentiation.

Section snippets

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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