The role of diffusion-weighted MRI and contrast-enhanced MRI for differentiation between solid renal masses and renal cell carcinoma subtypes

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Abstract
Purpose To assess the value of diffusion-weighted magnetic resonance imaging (DW-MRI) and contrast-enhanced MRI (CE-MRI) for differentiation between benign and malignant solid renal masses, renal cell carcinoma (RCC) subtypes, oncocytomas, and lipid-poor angiomyolipomas (LP-AML). Methods Minimum or lowest ‘apparent diffusion coefficient’ (ADC1) and representative ADC values (ADC2) of 112 renal masses (n: 46 benign renal mass, n: 66 malignant renal mass) were measured on DW-MRI images (b 50, 400, 800 s/mm2). Signal intensity (SI) measurements were performed in normal renal parenchyma and most avid enhanced area of the renal masses at precontrast, corticomedullary, and nephrographic phases on CE-MRI. Contrast enhancement rate (CER) and contrast enhancement index (CEI) values of renal masses were compared between benign-malignant renal masses and RCC subtypes, oncocytomas, and LP-AMLs. Results There was no significant difference between ADC1, ADC2 values, and SI of benign and malignant renal masses (p = 0.721, p = 0.255, p = 0.872). Mean ADC1 and ADC2 values of clear cell RCCs were significantly higher than nonclear cell RCCs (p = 0.005 p = 0.002). Mean CER value of clear cell RCCs was significantly higher than nonclear cell RCCs in nephrographic phase (p = 0.003). Mean CEI values of clear cell RCCs were significantly higher than nonclear cell RCCs in the corticomedullary and nephrographic phase (p = 0.027 vs. 0.008). LP-AMLs were differentiated from other renal masses with wash-out phenomenon. Conclusion Combined usage of ADC, SI, CER, and CEI values may be useful for discrimination between RCC subtypes, oncocytomas, and lipid-poor AMLs.

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