| Part I Magnetic Resonance Diffusion Weighted Imaging and Diffusion Tensor Imaging in the Differential Diagnosis of Clear Cell Renal Cell Carcinoma and Minimal Fat AngiomyolipomaObjective: To evaluate and compare the diffusion weighted imaging(DWI)and diffusion tensor imaging(DTI)in differentiating clear cell renal cell carcinoma(cc RCC)and minimal fat angiomyolipoma(MFAML).Methods: Fifty-five histopathology proven ccRCC and MFAML patients(42 cases of cc RCC and 13 cases of MFAML),were retrospectively enrolled in this study.All the patients were performed abdominal MRI exams on 1.5T scanner(GE 1.5T Signa HDXT,America)from April 2012 to January 2018 in a protocol containing the routine T1 WI,T2WI,LAVA,DWI(b=0,600 s/mm2)and DTI(b=0,600 s/mm2,in 6 directions).MR images were reviewed and analyzed by two radiologists in a double-blind manner with the value of ADC from DWI,the value of ADC and FA from DTI measured using the Functool on GE ADW4.6 workstation.For every ROI,the ADC values and FA values were measured.ROIs were drawn twice in tumor parenchyma that greater than 1/3 of the tumor avoiding of part of hemorrhage and necrosis,then the average value was calculated for analysis.The data from two observers were analyzed with intra-class correlation coefficients(ICC)to assess inter-observer agreement,if the values agreed well each other,the average data from them were calculated for further statistical analysis.The differences of ADC values of DWI(ADCDWI)and the ADC values of DTI(ADCDTI)between cc RCC and MFAML were compared by independent t-test.The Mann-Whitney U test was used to compare the differences of the FA values of DTI between cc RCC and MFAML.The ROC curves of all parameters were used to analyze and compare the diagnostic value of DWI and DTI in differentiating cc RCC and MFAML.Results: The inter-observer agreements were good(ICC>0.75).The ADCDWI value of cc RCC was statistically higher than that of MFAML [(1.93±0.44)×10-3mm2/s vs.(1.40±0.29)×10-3mm2/s,P<0.001],and The ADCDTI value of cc RCC was statistically higher than that of MFAML [(2.06±0.45)×10-3mm2/s vs.(1.63±0.33)×10-3mm2/s,P=0.002].But the FA value of cc RCC was statistically lower than that of MFAML[(0.20±0.07)vs.(0.31±0.20),P=0.020].The area under the ROC curve of ADCDWI was0.845,and there were a sensitivity of 71.4%,a specificity of 84.6% and the threshold of1.63×10-3 mm2/s for differentiating cc RCC from MFAML.The AUC of ADCDTI was0.788,sensitivity 76.2% and specificity 76.9%.The ADCDTI threshold for differentiating cc RCC from MFAML was 1.77×10-3 mm2/s.The AUC of FA was 0.722,and there were a sensitivity of 88.1%,a specificity of 53.8% and the threshold of 0.27 for differentiating cc RCC from MFAML.The combined diagnosis of cc RCC and MFAML with ADCDTI and FA values is better than that with ADCDWI,ADCDTI and FA values,which showed the higher specificity.Conclusion: MRI DWI and DTI can effectively discriminate cc RCC and MFAML,and the ADC value of DWI has higher diagnostic efficacy and specificity.All parameters have high diagnostic efficiency,of which FA value was the highest.The application of DWI and DTI parameters for combined diagnosis can increase diagnostic efficacy and sensitivity.Part II Magnetic Resonance Diffusion Weighted Imaging and Diffusion Tensor Imaging in the Differential Diagnosis of Clear Cell Renal Cell Carcinoma and Transitional Cell CarcinomaObjective: To evaluate and compare the DWI and DTI in differentiating cc RCC and transitional cell carcinoma(TCC).Methods: Sixty histopathology proven ccRCC and TCC patients(42 cases of ccRCC and 18 cases of TCC),were retrospectively enrolled in this study.All the patients were performed abdominal MRI exams on 1.5T scanner(GE 1.5T Signa HDXT,America)from April 2012 to January 2018 in a protocol containing the routine T1 WI,T2WI,LAVA,DWI(b=0,600 s/mm2)and DTI(b=0,600 s/mm2,in 6 directions).MR images were reviewed and analyzed by two radiologists in a double-blind manner with the value of ADC from DWI,the value of ADC and FA from DTI measured using the Functool on GE ADW4.6 workstation.For every ROI,the ADC values and FA values were measured.ROIs were drawn twice in tumor parenchyma that greater than 1/3 of the tumor avoiding of part of hemorrhage and necrosis,then the average value was calculated for analysis.The data from two observers were analyzed with ICC to assess inter-observer agreement,if the values agreed well each other,the average data from them were calculated for further statistical analysis.The differences of ADCDWI between cc RCC and TCC were compared by independent t-test.The Mann-Whitney U test was used to compare the differences of the ADCDTI and FA values of DTI between cc RCC and TCC.The ROC curves of all parameters were used to analyze and compare the diagnostic value of DWI and DTI in differentiating cc RCC and TCC.Results: The inter-observer agreements were good(ICC>0.75).The ADCDWI value of cc RCC was statistically higher than that of TCC [(1.93±0.44)×10-3mm2/s vs.(1.40±0.41)×10-3mm2/s,P<0.001],and The ADCDTI value of cc RCC was statistically higher than that of TCC[(2.06±0.45)×10-3mm2/s vs.(1.54±0.39)×10-3mm2/s,P<0.001].But the FA value of cc RCC was statistically lower than that of TCC [(0.20±0.07)vs.(0.40±0.21),P<0.001].The area under the ROC curve of ADCDWI was 0.831,and there were a sensitivity of 81.0%,a specificity of 83.3% and the threshold of 1.55×10-3 mm2/s for differentiating cc RCC from TCC.The AUC of ADCDTI was 0.813,sensitivity 92.9%and specificity 61.1%.The ADCDTI threshold for differentiating cc RCC from TCC was1.44×10-3mm2/s.The AUC of FA was 0.863,and there were a sensitivity of 90.5%,a specificity of 72.2% and the threshold of 0.29 for differentiating cc RCC from TCC.The combined diagnosis of cc RCC and TCC with ADCDTI and FA values showed the highest efficiency with the area under the ROC curve was 0.911.The sensitivity for diagnosing cc RCC except for TCC was higher.Conclusion: MRI DWI and DTI can effectively discriminate cc RCC and TCC,and DTI is better than DWI in distinguishing them.All parameters have high diagnostic efficiency,of which FA value was the highest.The application of DWI and DTI parameters for combined diagnosis has higher efficacy and specificity.Part III Magnetic Resonance Diffusion Weighted Imaging and Diffusion Tensor Imaging in the Differential Diagnosis of the Grading of Clear Cell Renal Cell CarcinomaObjective: To explore and compare the DWI and DTI in differentiating the nuclear classification of cc RCC.Methods: Forty-two histopathology proven cc RCC patients,including 33 males and 9females,age from 32 to 85 years old,with an average age of 59.6 ± 12.0 years old,from April 2012 to January 2018 were retrospectively enrolled in this study.According to the results of pathology Fuhrman classification(WHO),patients proven cc RCC were divided into three groups: 14 patients in moderately and well-differentiated group(Fuhrman grade I and I-II),16 patients in moderately differentiated group(Fuhrman grade II),and 12 patients in poorly differentiated group(Fuhrman grade III-IV,IV).All the patients were performed abdominal MRI exams on 1.5T scanner(GE 1.5T Signa HDXT,America)in a protocol containing the routine T1 WI,T2WI,LAVA,DWI(b=0,600 s/mm2)and DTI(b=0,600 s/mm2,in 6 directions).MR images were reviewed and analyzed by two radiologists in a double-blind manner with the value of ADC from DWI,the value of ADC and FA from DTI measured using the Functool on GE ADW4.6workstation.For every ROI,the ADC values and FA values were measured.ROIs were drawn twice in tumor parenchyma that greater than 1/3 of the tumor avoiding of part of hemorrhage and necrosis,then the average value was calculated for analysis.The data from two observers were analyzed with ICC to assess inter-observer agreement,if the values agreed well each other,the average data from them were calculated for further statistical analysis.One way ANOVA was used to compare ADCDWI,ADCDTI and FA values among the three groups of cc RCCs.If there was statistical difference,the differences among every group were compared respectively.Results: The inter-observer agreements were good(ICC>0.75).ADCDWI and ADCDTI values were statistically different between the three differentiated groups of cc RCC[ADCDWI values were(2.22±0.42)×10-3mm2/s,(1.91±0.33)×10-3mm2/s,(1.61±0.40)×10-3mm2/s,P=0.001.ADCDTI values were(2.40±0.34)×10-3mm2/s,(2.03±0.38)×10-3mm2/s,(1.71±0.36)×10-3mm2/s,P< 0.001],and there were significant differences between the every two groups(P<0.05).As the nuclear grade of cc RCC increased,the values of ADCDWI and ADCDTI decreased gradually.However,there was no significant difference in FA values between three different differentiation groups of cc RCC(P>0.05).Conclusion: MRI DWI and DTI can effectively evaluate the nuclear classification of cc RCC,but the FA value of DTI can not be effectively evaluated. |
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