Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
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Comparison of Monoexponential, Biexponential, Stretched-Exponential, and Kurtosis Models of Diffusion-Weighted Imaging in Differentiation of Renal Solid Masses

  • Jianjian Zhang (Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University) ;
  • Shiteng Suo (Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University) ;
  • Guiqin Liu (Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University) ;
  • Shan Zhang (Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University) ;
  • Zizhou Zhao (Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University) ;
  • Jianrong Xu (Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University) ;
  • Guangyu Wu (Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University)
  • Received : 2018.07.25
  • Accepted : 2019.01.09
  • Published : 2019.05.01
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Abstract

Objective: To compare various models of diffusion-weighted imaging including monoexponential apparent diffusion coefficient (ADC), biexponential (fast diffusion coefficient [Df], slow diffusion coefficient [Ds], and fraction of fast diffusion), stretched-exponential (distributed diffusion coefficient and anomalous exponent term [α]), and kurtosis (mean diffusivity and mean kurtosis [MK]) models in the differentiation of renal solid masses. Materials and Methods: A total of 81 patients (56 men and 25 women; mean age, 57 years; age range, 30-69 years) with 18 benign and 63 malignant lesions were imaged using 3T diffusion-weighted MRI. Diffusion model selection was investigated in each lesion using the Akaike information criteria. Mann-Whitney U test and receiver operating characteristic (ROC) analysis were used for statistical evaluations. Results: Goodness-of-fit analysis showed that the stretched-exponential model had the highest voxel percentages in benign and malignant lesions (90.7% and 51.4%, respectively). ADC, Ds, and MK showed significant differences between benign and malignant lesions (p < 0.05) and between low- and high-grade clear cell renal cell carcinoma (ccRCC) (p < 0.05). α was significantly lower in the benign group than in the malignant group (p < 0.05). All diffusion measures showed significant differences between ccRCC and non-ccRCC (p < 0.05) except Df and α (p = 0.143 and 0.112, respectively). α showed the highest diagnostic accuracy in differentiating benign and malignant lesions with an area under the ROC curve of 0.923, but none of the parameters from these advanced models revealed significantly better performance over ADC in discriminating subtypes or grades of renal cell carcinoma (RCC) (p > 0.05). Conclusion: Compared with conventional diffusion parameters, α may provide additional information for differentiating benign and malignant renal masses, while ADC remains the most valuable parameter for differentiation of RCC subtypes and for ccRCC grading.

Keywords

Acknowledgement

This study was supported by the National Natural Science Foundation of China (81601487).

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