Dynamic Contrast-enhanced MRI in Renal Tumors: Common Subtype Differentiation using Pharmacokinetics

Abstract

Preoperative renal tumor subtype differentiation is important for radiology and urology in clinical practice. Pharmacokinetic data (K trans & V e, etc.) derived from dynamic contrast-enhanced MRI (DCE-MRI) have been used to investigate tumor vessel permeability. In this prospective study on DCE-MRI pharmacokinetic studies, we enrolled patients with five common renal tumor subtypes: clear cell renal cell carcinoma (ccRCC; n = 65), papillary renal cell carcinoma (pRCC; n = 12), chromophobic renal cell carcinoma (cRCC; n = 9), uroepithelial carcinoma (UEC; n = 14), and fat-poor angiomyolipoma (fpAML; n = 10). The results show that K trans of ccRCC, pRCC, cRCC, UEC and fpAML (0.459 ± 0.190 min−1, 0.206 ± 0.127 min−1, 0.311 ± 0.111 min−1, 0.235 ± 0.116 min−1, 0.511 ± 0.159 min−1, respectively) were different, but V e was not. K trans could distinguish ccRCC from non-ccRCC (pRCC & cRCC) with a sensitivity of 76.9% and a specificity of 71.4%, respectively, as well as to differentiate fpAML from non-ccRCC with a sensitivity of 100% and a specificity of 76.2%, respectively. Our findings suggest that DCE-MRI pharmacokinetics are promising for differential diagnosis of renal tumors, especially for RCC subtype characterization and differentiation between fpAML and non-ccRCC, which may facilitate the treatment of renal tumors.

Can contrast enhanced ultrasound differentiate benign cystic nephroma from malignant multicystic renal lesions? A case report

“…Wang et al examined the use of dynamic contrast enhanced (DCE) MRI pharmacokinetics in differentiating benign and malignant solid renal masses and found no significant difference between benign and malignant renal masses 5 . DCE kinetic measurements were statistically different however between the various subtypes of RCC and in distinguishing fat poor angiomyolipoma from non clear cell RCC.…”

A modern view on the effect of radiation exposure of patients during diagnostic evaluation of renal cell carcinoma and ways to avoid it

“…By the data of EAU such modality of MRI as diffusion weighted imaging (DWI) possess es a potential for the differential diagnostics of RCC [6]. However, none of the studies presents the data that are sufficient to apply radiological biomarkers of RCC based on the MRI in common medical practice [29][30][31][32]. Our previous publications demonstrated high efficacy of the measuring of apparent diffusion coefficient of DWI.…”

“…З часу впровад ження цих принципів, захворюваність на НСФ знач но зменшилась [28]. За даними EAU така мо дальність МРТ, як дифузійно зважені зображення (ДЗЗ) володіє потенціалом для диференційної діаг ностики НКР [6], проте у жодному з досліджень не було наведено даних, достатніх для використання променевих біомаркерів НКР на основі МРТ зобра жень в широкій медичній практиці [29][30][31][32]. У наших попередніх публікаціях нами була продемонстрова на висока ефективність застосування вимірюваного коефіцієнта дифузії ДЗЗ МРТ у якості променевого біомаркеру НКР, що дозволяло не тільки достовірно діагностувати дану патологію, але й проводити її ди ференціацію з доброякісними нирковими новоутво реннями, уникаючи використання контрастних ре човин [33,34].…”

Imaging biomarkers based on multiphase CT data in differentiation of renal cell carcinoma

“…Ó äîñë³äaeåíí³ Link et al, ïîíàä 30% ïóõëèí, ÿê³ ìàëè îçíàêè çëîÿê³ñíîñò³ çà äàíèìè ïðîìåíåâèõ ìåòîä³â îáñòåaeåíü, âèÿâèëèñü äîáðîÿê³ñíèìè ï³ñëÿ âèêîíàííÿ ëàïàðîñêîï³÷íî¿ ïàðö³àëü-íî¿ íåôðåêòî쳿 [3]. Íåçâàaeàþ÷è íà çíà÷íèé ïðîãðåñ ó ðîçâèòêó ïðîìåíåâèõ ìåòîä³â îáñòåaeåííÿ, íèí³ äîñòîâ³ðíî äèôåðåíö³þâàòè ÍÊÐ â³ä äîáðîÿê³ñíèõ ïóõëèí íèðîê, òàêèõ ÿê îíêîöèòîìà (ÎÖ), àíã³îì³îë³ïîìà (ÀÌË) ç íèçüêèì âì³ñòîì aeèðó ÷è ïàï³ëÿðíà àäåíîìà (ÏÀ) íèðêè, à òàêîae òî÷íî ä³àãíîñòóâàòè ð³çí³ ã³ñòîëîã³÷í³ ï³äòèïè òà ñòóï³íü äèôåðåíö³àö³¿ öüîãî ÇÍ, ïðàê-òè÷íî íåìîaeëèâî, ùî ñòâîðþº ñåðéîçíó êë³í³÷íó äèëåìó (4). Ó çâ'ÿçêó ç öèì â îñòàíí³ ðîêè ³íòåðåñ äîñë³äíèê³â ñôîêóñîâàíèé íà âèçíà÷åíí³ ðîë³ ïðîìåíåâèõ á³îìàðêåð³â ÍÊÐ íà îñíîâ³ ÓÇÄ, ÊÒ, ÌÐÒ òà ðàä³îíóêë³äíèõ ìåòîä³â äîñë³äaeåííÿ äëÿ ä³àãíîñòèêè òà ïðîãíîçóâàííÿ ïåðåá³ãó öüîãî çàõâîðþâàííÿ.…”

“…Ó äèôåðåíö³àö³¿ ñâ³òëîêë³òèííîãî ÍÊÐ íèçüêîãî ñòóïåíÿ â³ä âèñîêîãî çà Fuhrman íàé-êðàù³ ïîêàçíèêè òåñòó áóëî äîñÿãíóòî çà óìîâ âèêîðèñòàííÿ ïðîìåíåâî¿ ù³ëüíîñò³ ïóõëèíè âèì³ðÿíî¿ ç ÊÒ-çîáðàaeåíü íåôðîãðàô³÷íî¿ ôàçè: ïðè ïîðîãîâîìó çíà÷åíí³ 87,78 HU áóëî îòðèìàíî âèñîêîòî÷íèé òåñò: ÷óòëèâ³ñòü -100%, ñïå-öèô³÷í³ñòü -90,9%, AUC=0,969 (95% IJ=0,922-1,0, ð<0,001) (ðèñ. 4,5).…”