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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
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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


Publication History

Article published online:
26 July 2021

© 2018. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 3 Prasad SR, Dalrymple NC, Surabhi VR. Cross-sectional imaging evaluation of renal masses. Radiol Clin North Am 2008; 46: 95-111
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    PubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    Thieme ConnectPubMedSearch in Google Scholar
  • 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
    PubMedSearch in Google Scholar
  • 25 Goyal A, Gadodia A, Sharma R. Xanthogranulomatous pyelonephritis: An uncommon pediatric renal mass. Pediatr Radiol 2010; 40: 1962-3
    CrossrefPubMedSearch in Google Scholar
  • 26 Kang SK, Chandarana H. Contemporary imaging of the renal mass. Urol Clin North Am 2012; 39: 161-70
    CrossrefPubMedSearch in Google Scholar
  • 27 Schatz SM, Lieber MM. Update on oncocytoma. Curr Urol Rep 2003; 4: 30-5
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 29 Israel GM, Bosniak MA. Pitfalls in renal mass evaluation and how to avoid them. Radiographics 2008; 28: 1325-38
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar