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ORIGINAL RESEARCH article

Front. Oncol.
Sec. Genitourinary Oncology
Volume 14 - 2024 | doi: 10.3389/fonc.2024.1456701

Grading of clear cell renal cell carcinoma by using monoexponential, biexponential, and stretched exponential diffusion-weighted MR imaging

Provisionally accepted
Wenhui Wang Wenhui Wang 1Lingdian Wang Lingdian Wang 2Jing Zhou Jing Zhou 1Taiyuan Liu Taiyuan Liu 1Yan Bai Yan Bai 1Meiyun Wang Meiyun Wang 1*
  • 1 Department of Medical Imaging, Zhengzhou University People’s Hospital & Henan Provincial People’s Hospital, Zhengzhou, China
  • 2 Department of Urinary Surgery, Zhengzhou University People’s Hospital & Henan Provincial People’s Hospital, Zhengzhou, China., Zhengzhou, Henan Province, China

The final, formatted version of the article will be published soon.

    Objectives: To evaluate the diagnostic accuracy of monoexponential, biexponential and stretched-exponential diffusion-weighted imaging (DWI) models in the grading of clear cell renal cell carcinoma (ccRCC). Materials and Methods: Fifty-one patients with pathologically proven ccRCC underwent DWI with fifteen b factors (0, 10, 30, 50, 70, 100, 150, 200, 300, 400, 600, 800, 1000, 1500, 2000 sec/mm²) on a 3.0T MR scanner. The isotropic apparent diffusion coefficient (ADC), true diffusion coefficient (ADCslow), pseudodiffusion coefficient (ADCfast), and fraction of perfusion (f) were derived from DWI using a biexponential model. The water diffusion heterogeneity index (α) and distributed diffusion coefficient (DDC) were derived from DWI using a stretched-exponential model. All values were calculated for the solid area of tumors and compared between high-grade and low-grade ccRCC. The Mann‒Whitney U test and receiver operating characteristic (ROC) analysis were used for statistical analysis. The DeLong test was performed to compare the ROC curves. Results: The mean ADC, DDC, ADCslow and α values were significantly lower in high-grade ccRCC than in low-grade ccRCC (P < 0.01). However, the ADCfast and f were not significantly different between the two groups (P > 0.05). According to the ROC analyses, the AUC for α was 0.941, which was significantly greater than those of the other parameters, with a sensitivity of 100% and a specificity of 84.2%. The DeLong test showed that there were significant differences in the ROCs among ADCfast/ADC, ADCfast/α, f/ADCslow, ADCfast/ADCslow, f/α, DDC/α, and f/ADC. Conclusions: Diffusion-related parameters (ADC, DDC, ADCslow and α) could be used to distinguish between low- and high-grade ccRCC. The α derived from the stretched-exponential model may be the most promising parameter for grading ccRCC.

    Keywords: Stretched exponential, IVIM, ccRCC, Monoexponential, Biexponential

    Received: 29 Jun 2024; Accepted: 14 Oct 2024.

    Copyright: © 2024 Wang, Wang, Zhou, Liu, Bai and Wang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Meiyun Wang, Department of Medical Imaging, Zhengzhou University People’s Hospital & Henan Provincial People’s Hospital, Zhengzhou, China

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.