Comparison of MDCT, MRI and MRI with diffusion-weighted imaging in evaluation of focal renal lesions: The defender, challenger, and winner!

Ankur Goyal; Raju Sharma; Ashu S Bhalla; Shivanand Gamanagatti; Amlesh Seth

doi:10.4103/ijri.IJRI_40_17

Indian Journal of Radiology and Imaging, Table of Contents

CC BY-NC-ND 4.0 · Indian J Radiol Imaging 2018; 28(01): 27-36
DOI: 10.4103/ijri.IJRI_40_17

Genitourinary Radiology

Comparison of MDCT, MRI and MRI with diffusion-weighted imaging in evaluation of focal renal lesions: The defender, challenger, and winner!

Ankur Goyal

Departments of Radiodiagnosis, All India Institute of Medical Sciences (A.I.I.M.S.), New Delhi, India

,

Raju Sharma

Departments of Radiodiagnosis, All India Institute of Medical Sciences (A.I.I.M.S.), New Delhi, India

,

Ashu S Bhalla

Departments of Radiodiagnosis, All India Institute of Medical Sciences (A.I.I.M.S.), New Delhi, India

,

Shivanand Gamanagatti

Departments of Radiodiagnosis, All India Institute of Medical Sciences (A.I.I.M.S.), New Delhi, India

,

Amlesh Seth

Departments of Urology, All India Institute of Medical Sciences (A.I.I.M.S.), New Delhi, India

› Author Affiliations
Subject Editor:

Abstract

Purpose: 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). Materials and Methods: 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/mm²) 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. Results: AUC for MDCT (0.834) and MRI (0.841) in the classification of benign and malignant lesions were within corresponding 95% confidence interval (CI) (P = 0.88) whereas MRI + DWI had significantly better performance (AUC 0.968, P = 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. Conclusions: 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.

Keywords

Contrast media - diffusion-weighted MRI - focal renal lesion - MRI - multidetector CT - renal cell carcinoma

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References

References
1 Pallwein-Prettner L, Flöry D, Rotter CR, Martinez-Moya P, Romero-Calvo I, Suarez MD. et al. Assessment and characterisation of common renal masses with CT and MRI. Insights Imaging 2011; 2: 543-56
2 Hallscheidt PJ, Bock M, Riedasch G, Zuna I, Schoenberg SO, Soder M. et al. Diagnostic accuracy of staging renal cell carcinomas using multidetector-row computed tomography and magnetic resonance imaging: A prospective study with histopathologic correlation. J Comput Assist Tomogr 2004; 28: 333-9
3 Prasad SR, Dalrymple NC, Surabhi VR. Cross-sectional imaging evaluation of renal masses. Radiol Clin North Am 2008; 46: 95-111
4 Walter C, Kruessell M, Gindele A, Brochhagen HG, Gossmann A, Landwehr P. Imaging of renal lesions: Evaluation of fast MRI and helical CT. Br J Radiol 2003; 76: 696-703
5 Hallscheidt PJ, Fink C, Haferkamp A, Bock M, Luburic A, Zuna I. et al. Preoperative staging of renal cell carcinoma with inferior vena cava thrombus using multidetector CT and MRI: Prospective study with histopathological correlation. J Comput Assist Tomogr 2005; 29: 64-8
6 Lawrentschuk N, Gani J, Riordan R, Esler S, Bolton DM. Multidetector computed tomography vs magnetic resonance imaging for defining the upper limit of tumour thrombus in renal cell carcinoma: A study and review. BJU Int 2005; 96: 291-5
7 Beer AJ, Dobritz M, Zantl N, Weirich G, Stollfuss J, Rummeny EJ. Comparison of 16-MDCT and MRI for characterization of kidney lesions. AJR Am J Roentgenol 2006; 186: 1639-50
8 Kutikov A, Fossett LK, Ramchandani P, Banner MP, Wein AJ, Seigalman ES. et al. Incidence of benign pathologic findings at partial nephrectomy for solitary renal mass presumed to be renal cell carcinoma on preoperative imaging. Urology 2006; 68: 737-40
9 Saremi F, Knoll AN, Bendavid OJ, Schultze-Haakh H, Narula N, Sarlati F. Characterization of genitourinary lesions with diffusion-weighted imaging. Radiographics 2009; 29: 1295-317
10 Squillaci E, Manenti G, Di Stefano F, Miano R, Strigari L, Simonetti G. Diffusion-weighted MR imaging in the evaluation of renal tumours. J Exp Clin Cancer Res 2004; 23: 39-45
11 Cova M, Squillaci E, Stacul F, Manenti G, Gava S, Simonetti G. et al. Diffusion-weighted MRI in the evaluation of renal lesions: Preliminary results. Br J Radiol 2004; 77: 851-7
12 Yoshikawa T, Kawamitsu H, Mitchell DG, Ohno Y, Ku Y, Seo Y. et al. ADC measurement of abdominal organs and lesions using parallel imaging technique. AJR Am J Roentgenol 2006; 187: 1521-30
13 Zhang J, Tehrani YM, Wang L, Ishill NM, Schwartz LH, Hricak H. Renal masses: Characterization with diffusion-weighted MR imaging-a preliminary experience. Radiology 2008; 247: 458-64
14 Taouli B, Thakur RK, Mannelli L, Kim S, Lee VS, Israel GM. et al. Renal lesions: Characterization with diffusion-weighted imaging versus contrast-enhanced MR imaging. Radiology 2009; 251: 398-407
15 Kilickesmez O, Inci E, Atilla S, Tasdelen N, Yetimoglu B, Gurmen N. et al. Diffusion-weighted imaging of the renal and adrenal lesions. J Comput Assist Tomogr 2009; 33: 828-33
16 Sandrasegaran K, Sundaram CP, Ramaswamy R, Akisik FM, Lin C, Aisen AM. et al. Usefulness of diffusion-weighted imaging in the evaluation of renal masses. AJR Am J Roentgenol 2010; 194: 438-45
17 Goyal A, Sharma R, Bhalla AS, Gamanagatti S, Seth A, Iyer VK. et al. Diffusion-weighted MRI in renal cell carcinoma: A surrogate marker for predicting nuclear grade and histological subtype. Acta Radiol 2012; 53: 349-58
18 Goyal A, Sharma R, Bhalla AS, Gamanagatti S, Seth A. Diffusion-weighted MRI in inflammatory renal lesions: All that glitters is not RCC!. Eur Radiol 2013; 23: 272-9
19 Goyal A, Sharma R, Bhalla AS, Gamanagatti S, Seth A. Pseudotumours in chronic kidney disease: Can diffusion-weighted MRI rule out malignancy. Eur J Radiol 2013; 82: 1870-6
20 Namimoto T, Yamashita Y, Mitsuzaki K, Nakayama Y, Tang Y, Takahashi M. Measurement of the apparent diffusion coefficient in diffuse renal disease by diffusion-weighted echo-planar MR imaging. J Magn Reson Imaging JMRI 1999; 9: 832-7
21 Thoeny HC, De Keyzer F, Oyen RH, Peeters RR. Diffusion-weighted MR imaging of kidneys in healthy volunteers and patients with parenchymal diseases: Initial experience. Radiology 2005; 235: 911-7
22 Xu X, Fang W, Ling H, Chai W, Chen K. Diffusion-weighted MR imaging of kidneys in patients with chronic kidney disease: Initial study. Eur Radiol 2010; 20: 978-83
23 Goyal A, Sharma R, Bhalla AS, Gamanagatti S, Seth A. Diffusion-weighted MRI in assessment of renal dysfunction. Indian J Radiol Imaging 2012; 22: 155-9
24 Verswijvel G, Vandecaveye V, Gelin G, Griten M, Oyen R, Palmers Y. et al. Diffusion-weighted MR imaging in the evaluation of renal infection: Preliminary results. JBR-BTR 2002; 85: 100-3
25 Goyal A, Gadodia A, Sharma R. Xanthogranulomatous pyelonephritis: An uncommon pediatric renal mass. Pediatr Radiol 2010; 40: 1962-3
26 Kang SK, Chandarana H. Contemporary imaging of the renal mass. Urol Clin North Am 2012; 39: 161-70
27 Schatz SM, Lieber MM. Update on oncocytoma. Curr Urol Rep 2003; 4: 30-5
28 Li G, Cuilleron M, Gentil-Perret A, Tostain J. Characteristics of image-detected solid renal masses: Implication for optimal treatment. Int J Urol 2004; 11: 63-7
29 Israel GM, Bosniak MA. Pitfalls in renal mass evaluation and how to avoid them. Radiographics 2008; 28: 1325-38
30 Pedrosa I, Sun MR, Spencer M, Olumi AF, Dewolf WC, Rofsky NM. et al. MR imaging of renal masses: Correlation with findings at surgery and pathologic analysis. Radiographics 2008; 28: 985-1003
31 Young JR, Margolis D, Sauk S, Pantuck AJ, Sayre J, Raman SS. Clear cell renal cell carcinoma: Discrimination from other renal cell carcinoma subtypes and oncocytoma at multiphasic multidetector CT. Radiology 2013; 267: 444-53
32 Kim JI, Cho JY, Moon KC, Lee HJ, Kim SH. Segmental enhancement inversion at biphasic multidetector CT: Characteristic finding of small renal oncocytoma. Radiology 2009; 252: 441-8
33 Sasiwimonphan K, Takahashi N, Leibovich BC, Carter RE, Atwell TD, Kawashima A. Small (<4 cm) renal mass: Differentiation of angiomyolipoma without visible fat from renal cell carcinoma utilizing MR imaging. Radiology 2012; 263: 160-8
34 Tanaka H, Yoshida S, Fujii Y, Tanaka H, Koga F, Saito K. et al. Diffusion-weighted magnetic resonance imaging in the differentiation of angiomyolipoma with minimal fat from clear cell renal cell carcinoma. Int J Urol 2011; 18: 727-30
35 Catalano C, Fraioli F, Laghi A, Napoli A, Pediconi F, Nardis P. et al. High-resolution multidetector CT in the preoperative evaluation of patients with renal cell carcinoma. AJR Am J Roentgenol 2003; 180: 1271-7
36 Catalano OA, Choy G, Zhu A, Hahn PF, Sahani DV. Differentiation of malignant thrombus from bland thrombus of the portal vein in patients with hepatocellular carcinoma: Application of diffusion-weighted mr imaging. Radiology 2010; 254: 154-62
37 Hallscheidt P, Pomer S, Roeren T, Kauffmann GW, Staehler G. Preoperative staging of renal cell carcinoma with caval thrombus: Is staging in MRI justified? Prospective histopathological correlated study. Urologe A 2000; 39: 36-40