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Usefulness of Diffusion-Weighted Imaging in the Evaluation of Renal Masses

¹ Department of Radiology, Indiana University School of Medicine, 550 N University Blvd., UH 0279, Indianapolis IN, 46202.
² Department of Urology, Indiana University School of Medicine, Indianapolis, IN.

OBJECTIVE. The objective of our study was to assess the value of diffusion-weighted imaging in differentiating among the various subgroups of renal masses.

MATERIALS AND METHODS. This retrospective study measured the apparent diffusion coefficients (ADCs) of renal masses. Malignant lesions were confirmed with surgical pathology results. Benign cystic lesions were stable without treatment for a minimum follow-up of 24 months.

RESULTS. There were 20 and 22 patients, respectively, with benign lesions (three abscess, 31 cysts) and malignant lesions (17 clear cell, five papillary, one chromophobe, and two transitional cell cancers). The malignant lesions were larger than the benign lesions (mean diameter, 4.2 vs 2.6 cm, respectively; p = 0.01, Student's t test). The ADC values of the benign lesions were significantly higher than those of the malignant lesions (mean, 2.72 vs 1.88 x 10^–3 mm²/s; p < 0.0001). The ADCs of the 31 benign cysts were significantly higher than those of the seven cystic renal cancers (2.77 vs 2.02 x 10^–3 mm²/s; p < 0.001). There was no significant difference between the ADCs of clear cell cancers and non–clear cell cancers (1.85 vs 1.97 x 10^–3 mm²/s; p = 0.18), but an ADC of less than 1.79 x 10^–3 mm²/s was seen only with clear cell cancer. The ADCs of high-grade clear cell cancers (Fuhrman grades III and IV) tended to be lower than those of low-grade clear cell cancers (1.77 vs 1.95 x 10^–3 mm²/s; p = 0.12). Among the clear cell cancers, an ADC value of greater than 2.12 x 10^–3 mm²/s was seen only with low-grade histology. For differentiating benign from malignant lesions, receiver operating characteristic (ROC) analysis showed an area under the ROC curve of 0.989 (95% CI, 0.919–0.996; p < 0.0001).

CONCLUSION. ADC measurements may aid in differentiating among the various subgroups of renal masses, particularly benign cystic lesions from cystic renal cell cancers.

Keywords: clear cell renal cell carcinoma • diffusion-weighted imaging • MRI • papillary renal cell carcinoma • renal neoplasms

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