Diffusion-weighted MRI of kidney in the diagnosis of clear cell renal cell carcinoma of various grades of differentiation
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Diagnostic Imaging Department, National Medical University, L’viv, Ukraine
Euroclinic Medical Centre, L’viv, Ukraine
ZOZ Nr. 2, Rzeszów, Poland
Department of Urology, National Medical University, L’viv, Ukraine
Andrzej Górecki   

ZOZ Nr. 2, ul. Fredry 9, Rzeszów
J Pre Clin Clin Res. 2015;9(1):30–35
Renal cell carcinoma (RCC) is the most common malignant epithelial tumour of the kidney, accounting for 85–90% of all solid renal tumours in adults and comprising 1–3% of all malignant visceral neoplasms. Recently, computed tomography (CT) has been considered the ‘gold standard’ in the diagnostic imaging of RCC; however, the use of CT is always associated with radiation exposure and consequently carries a significant increase in the risk of malignancy for patients with neoplastic processes. In recent years, magnetic resonance imaging (MRI) is increasingly attracting the attention of clinicians as the method of choice for the diagnosis and staging of RCC, due to several advantages over CT.

Material and Methods:
The study involved 62 adult patients with a pathologically verified clear cell subtype of the renal cell carcinoma (ccRCC) and 15 healthy volunteers. All patients underwent renal MRI which included diffusion-weighted imaging (DWI) with subsequent apparent diffusion coefficient (ADC) measurement.

A significant difference was observed in the mean ADC value of the normal renal parenchyma and ccRCC – 1.82 ± 0.16 × 10– 3 mm2/s vs 2.15 ± 0.12 × 10– 3 mm2/s, respectively (р < 0,05). Additionally, statistically reliable differences in ADC values in patients with high and low ccRCC grades were obtained: in patients with the I grade, the mean ADC value was 1.92 ± 0.12 × 10– 3 mm2/s, in patients with the II grade, this value was 1.84 ± 0.14 × 10– 3 mm2/s, in patients with the III grade, the mean ADC value was 1.79 ± 0.12 × 10– 3 mm2/s, and in patients with the IV grade of nuclear polymorphism the mean ADC value was 1.72 ± 0.11 × 10– 3 mm2/s (p <0.05).

The data obtained in the survey show a significant restriction in the diffusion of hydrogen molecules in tissues of ccRCC, compared to the healthy renal parenchyma due to the tumour’s greater density. A statistically significant difference was observed in the mean ADC values of ccRCC tumours with different Fuhrman nuclear grades: tumours with a low grade of differentiation demonstrated higher mean ADC values compared to highly differentiated tumours. Application of DWI modality of MR imaging with ADC calculation allows to obtain valuable information that is vital for the diagnosis of ccRCC and differentiation of its degree of malignancy.

Jemal A, Siegel R, Ward E, et al. Cancer statistics. A Cancer Journal for Clinicians 2009; 59(4): 225–249.
Sun MR, Ngo L, Genega EM, et al. Renal cell carcinoma: dynamic contrast-enhanced MR imaging for differentiation of tumor subtypes – correlation with pathologic findings. Radiology 2009; 250: 793–802.
Eble JL, Sauter G, Epstein JI, et al. Pathology and genetics of tumours of the urinary system and male genital organs. Lyon: IARC; 2004.
Cheville JC, Lohse CM, Zincke H, et al. Comparisons of outcome and prognostic features among histologic subtypes of renal cell carcinoma. American Journal of Surgical Pathology 2003;27(5):612–624.
Crepel M, Jeldres C, Perrotte P, et al. Nephron-sparing surgery is equally effective to radical nephrectomy for T1BN0M0 renal cell carcinoma: a population-based assessment. Urology 2010;75(2):271–275.
Miguel V, Fernando L, Carlos M, et al. Nuclear grade prediction of renal cell carcinoma using contrasted computed tomography. J Urol. 2009; 181(4): 249–249.
Sheir KZ, El-Azab M, Mosbah A, et al. Differentiation of renal cell carcinoma subtypes by multislice computerized tomography. J Urol. 2005; 174(2): 451–455.
Sodickson A. CT radiation risks coming into clearer focus. BMJ. 2013; 21: 346:f3102.
Mathews J, Forsythe A, Brady Z, et al. Cancer risk in 680 000 people exposed to computed tomography scans in childhood or adolescence: data linkage study of 11 million Australians. BMJ 2013; 346: f2360.
Kim JK, Kim TK, Ahn HJ, Kim CS, Kim KR, Cho KS. Differentiation of subtypes of renal cell carcinoma on helical CT scans. AJR Am J Roentgenol. 2002; 178: 1499.
Taouli B, Thakur R, Mannelli L. Renal Lesions: Characterization with Diffusion-weighted Imaging versus Contrast-enhanced MR Imaging. Radiology. 2009; 251(2): 398–407.
Taouli B, Vilgrain V, Dumont E, et al. Evaluation of liver diffusion isotropy and characterization of focal hepatic lesions with two single-shot echoplanar MR imaging sequences: prospective study in 66 patients. Radiology 2003; 226(1): 71–78.
Pedrosa I, Sun MR, Spencer M, et al. MR imaging of renal masses: correlation with findings at surgery and pathologic analysis. Radiographics 2008; 28(4): 985–1003.
Sun MR, Ngo L, Genega EM, et al. Renal cell carcinoma: dynamic contrastenhanced MR imaging for differentiation of tumor subtypes – correlation with pathologic findings. Radiology 2009; 250(3): 793–802.
Kumaresan S , Sundaram ChP, Ramaswamy R, et al. Usefulness of Diffusion-Weighted Imaging in the Evaluation of Renal Masses. American Journal of Roentgenology 2010; 194(2): 438-445.
Haiyi Wang, Liuquan Cheng, Xu Zhang, et al. Renal Cell Carcinoma: Diffusion-weighted MR Imaging for Subtype Differentiation at 3.0 T. Radiology 2010; 257(1): 135–143.
Razek AA, Farouk A, Mousa A, et al. Role of diffusion-weighted magnetic resonance imaging in characterization of renal tumors. J Comput Assist Tomogr. 2011;35(3): 332-336.
Sun M, Lughezzani G, Jeldres C, et al. A proposal for reclassification of the Fuhrman grading system in patients with clear cell renal cell carcinoma. Eur Urol. 2009; 56(5): 775-781.
Hong SK, Jeong CW, Park JH, Kim HS, Kwak C, Choe G, Kim HH, Lee, SE. Application of simplified Fuhrman grading system in clear-cell renal cell carcinoma. BJU International 2011; 107: 409–415.
Rosenkrantz B. Andrew , Benjamin E. Niver, Erin F. Fitzgerald, et al. Utility of the Apparent Diffusion Coefficient for Distinguishing Clear Cell Renal Cell Carcinoma of Low and High Nuclear Grade. American Journal of Roentgenology 2010; 195: 5: 344–351.
Le Bihan D. Molecular diffusion nuclear magnetic resonance imaging. Magnetic Resonance Quarterly 1991; 7(1): 1–30.
Hatakenaka M, Soeda H, Yabuuchi H, et al. Apparent diffusion coefficients of breast tumors: clinical application. Magnetic Resonance in Medical Sciences 2008; 7(1): 23–29.
Taouli B, Thakur RK, Mannelli L, et al. Renal lesions: characterization with diffusion-weighted imaging versus contrast-enhanced MR imaging. Radiology 2009; 251(2): 398–407.
Wang H, Cheng L, Zhang X, et al. Renal cell carcinoma: diffusion-weighted MR imaging for subtype differentiation at 3.0 T. Radiology 2010; 257(1): 135–143.
Cova M, Squillaci E, Stacul F, et al. Diffusion-weighted MRI in the evaluation of renal lesions: preliminary results. British Journal of Radiology 2004; 77(922): 851–857.