| Objective: To use intravoxel incoherent motion(IVIM)diffusion weighted imaging of different subtypes of common renal cell carcinomas(RCC)for comparing their imaging difference and the quantitative analysis,so as to conclude more valuable imaging feature for guiding clinical individualized treatment.Methods: A retrospective study was analyzed in 49 patients with RCCs that they were demonstrated by surgical pathology,and they were imaged at3.0T MRI using 8 b values(0s/mm2,20s/mm2,50s/mm2,100s/mm2,200s/mm2,500s/mm2,800s/mm2,1000 s/mm2)for diffusion-weighted imaging,and they were not completely cystic necrosis.Before the examnation,the subjects were fasted for more than 6 hours,and then took the supine position.Scan sequences include T1WI-Tra,T2 WI-Tra,T2 WI(FS)-Sag,DWI and DCE-MRI(Lava).MACP post processing software of GE ADW4.3workstation was used to process DWI image.All scanned images were carefully analyzed and tried to avoid bleeding,cystic degeneration,necrosis,calcified tissue and avoid tumor margins.In the solid content of the highest level as far as possible accurately placed three circular ROI with the same size as possible,obtaining the all parameters of IVIM-DWI value and ADC value.All the data was measured by two senior doctors with working experience in imaging diagnosis,and they didn't know the pathological types of cases,and each case was measured three times to calculate the average value included in the database analysis.The values of ADC and IVIM-DWI parameters(pseudodiffusivity,D*;tissue diffusivity,D;perfusion fraction,f)were compared between different subtypes of common renal cell carcinomas.Results:In the clear cell RCC group: the ADC value was about(1.434±0.263)×10-3 mm2/s,and the D value was about(1.102±0.505)×10-3mm2/s,and the D* value was about(6.894±4.758)×10-2mm2/s,and the f value was about(2.718± 1.253)×10-1mm2/s;In the papillary RCC group: the ADC value was about(1.142±0.176)×10-3mm2/s,and the D value was about(1.217±0.311)×10-3mm2/s,and the D*value was about(1.841±0.576)×10-2mm2/s,and the f value was about(1.301±0.400)×10-1mm2/s;In the chromophobe RCC group: the ADC value was about(1.424±0.238)×10-3mm2/s,and the D value was about(0.928±0.402)×10-3mm2/s,and the D* value was about(4.883±4.095)×10-2mm2/s,and the f value was about(3.113±1.709)×10-1mm2/s.The values of ADC,D*and f of clear cell RCC or chromophobe RCC compared with papillary RCC had statistically significant difference(P<0.05).There was no significant difference between clear cell RCC and chromophobe RCC in the values of ADC and IVIM parameters(P>0.05).The D value demonstrates no significant difference between clear cell RCC,chromophobe RCC and papillary RCC,and the values of D of three common RCC were lower than the corresponding ADC value.There was significant strong correlation between f and AUCp(r=0.76,P<0.001),but there was no-correlative between AUCp and D*(r=-0.018,P=0.902).In the normal renal cortex group: the ADC value was about(2.101±0.146)×10-3mm2/s,and the D value was about(1.617±0.378)×10-3mm2/s,and the D* value was about(7.272±8.022)×10-2mm2/s,and the f value was about(3.083±1.260)×10-1mm2/s;In the normal renal medulla group: the ADC value was about(1.965±0.194)×10-3mm2/s,and the D value was about(1.710±0.622)×10-3mm2/s,and the D* value was about(10.77±9.830)×10-2mm2/s,and the f value was about(2.351±0.986)×10-1mm2/s.Normal renal cortex-medulla ADC values had a high statistical significance(P<0.001),and D values had no statistical significance difference(P>0.05),and D*values and f values were statistically significant differences(P<0.05).Three common RCC have no obvious difference in gender(P>0.05),and the right kidney is more than the left kidney in the locations of the disease,butit is no obvious difference(P>0.05).In the study,the most common type is clear cell RCC(58%),and the second is chromophobe RCC(22%),and the third is papillary RCC(18%),and multilocular cystic RCC is rare(2%).The three common RCC are most common in 40~50 years old group(46.5%).Conclusion:1 The ADC value and the value of IVIM-D* or IVIM-f have very important clinical value in differentiating papillary RCC from clear cell RCC and chromophobe RCC;2 The ADC value and the value of IVIM are difficult to identify clear cell RCC and chromophobe RCC;3 The IVIM-D value cannot identify three common RCC,and the IVIM-D value is lower than the corresponding ADC value;4 The IVIM-f and DCE-MRI have the very good correlation in the three common RCC,and the IVIM-f can assess degree of tumor vascularity without the use of exogenous contrast agent;5 The ADC value of renal cortex is generally greater than renal medulla,and the IVIM D* value and f value of renal medulla is greater than the renal cortex,and it is no difference between the D value of renal cortex and medulla. |
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