Abstract
Purpose
To determine whether objective volumetric whole-lesion apparent diffusion coefficient (ADC) distribution analysis improves upon the capabilities of conventional subjective small region-of-interest (ROI) ADC measurements for prediction of renal cell carcinoma (RCC) subtype.
Methods
This IRB-approved study retrospectively enrolled 55 patients (152 tumors). Diffusion-weighted imaging DWI was acquired at b values of 0, 250, and 800 s/mm2 on a 1.5T system (Aera, Siemens Healthcare). Whole-lesion measurements were performed by a research fellow and reviewed by a fellowship-trained radiologist. Mean, median, skewness, kurtosis, and every 5th percentile ADCs were determined from the whole-lesion histogram. Linear mixed models that accounted for within-subject correlation of lesions were used to compare ADCs among RCC subtypes. Receiver-operating characteristic (ROC) curve analysis with optimal cutoff points from the Youden index was used to test the ability of ADCs to differentiate clear cell RCC (ccRCC), papillary RCC (pRCC), and oncocytoma subtypes.
Results
Whole-lesion ADC values were significantly different between pRCC and ccRCC, and between pRCC and oncocytoma, demonstrating strong ability to differentiate subtypes across the quantiles (both P < 0.001). Best percentile ROC analysis demonstrated AUC values of 95.2 for ccRCC vs. pRCC; 67.6 for oncocytoma vs. ccRCC; and 95.8 for oncocytoma vs. pRCC. Best percentile ROC analysis further indicated model sensitivities/specificities of 84.5%/93.1% for ccRCC vs. pRCC; 100.0%/10.3% for oncocytoma vs. ccRCC; and 88.5%/93.1% for oncocytoma vs. pRCC.
Conclusion
The objective methodology of whole-lesion volumetric ADC measurements maintains the sensitivity/specificity of conventional expert-based ROI analysis, provides information on lesion heterogeneity, and reduces observer bias.
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This work was supported by the Intramural Research Programs (no grant number) of the Center for Cancer Research-National Cancer Institute and the National Institutes of Health Clinical Center, Bethesda, Maryland, USA.
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The authors declare no conflicts of interest.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional review board and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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Informed consent was obtained from all individual participants included in the study.
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Supplemental Fig. 8
ROC curves and sensitivity plots of quantiles for differentiation of pRCC and oncocytoma demonstrate improved performance of lower quantiles (TIFF 37,676 kb)
Supplemental Fig. 9
ROC curves and sensitivity plots of quantiles for differentiation of ccRCC and oncocytoma, illustrating the difficulty of determining lesion subtype and improved sensitivity for the lower quantiles (TIFF 38,034 kb)
Supplemental Fig. 10
ROC curves and sensitivity plots of quantiles for differentiation of ccRCC and pRCC, demonstrating improved performance of lower quantiles (TIFF 38,748 kb)
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Paschall, A.K., Mirmomen, S.M., Symons, R. et al. Differentiating papillary type I RCC from clear cell RCC and oncocytoma: application of whole-lesion volumetric ADC measurement. Abdom Radiol 43, 2424–2430 (2018). https://doi.org/10.1007/s00261-017-1453-4
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DOI: https://doi.org/10.1007/s00261-017-1453-4