title: Accuracy of breath-hold magnetic resonance imaging in preoperative staging of organ-confined renal cell carcinoma.
abstract: OBJECTIVE
  To determine the accuracy of breath-hold magnetic resonance (MR) imaging for preoperative staging of patients with organ-confined (stage I) renal cell carcinoma.
  
  
  METHODS
  Preoperative MR examinations of 43 patients (50 lesions) who underwent nephrectomy were reviewed. The MR examination consisted entirely of breath-hold sequences, and images were retrospectively evaluated by 2 blinded radiologists. Reviewers independently evaluated each case for findings that could affect the radiologic staging, particularly those that distinguish between organ-confined (stage I) and non-organ-confined (>stage II) disease. Each reviewer assigned a stage, and results were correlated with findings at surgery and pathologic examination.
  
  
  RESULTS
  The difference between both reviewers and pathologic findings in evaluating an intact renal capsule (stage I) was statistically significant (P < 0.05) and resulted in a statistically significant difference between radiologic and pathologic staging (Wilcoxon test, P < 0.05). The kappa test demonstrated moderate agreement between radiologic and pathologic staging (82% and 80% for reviewers 1 and 2, kappa = 0.54 and 0.80, respectively) and substantial agreement (90%, kappa = 0.80) between the 2 reviewers in assigning a radiologic stage.
  
  
  CONCLUSIONS
  Breath-hold MR imaging has an accuracy ranging between 80% and 82% in staging patients with organ-confined renal cell carcinoma, with substantial (90%) agreement between readers.
authors.affiliation: The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA. ikamel@jhmi.edu
authors.forename: Ihab R
authors.initials: IR
authors.lastname: Kamel
authors.forename: Mary G
authors.initials: MG
authors.lastname: Hochman
authors.forename: Mary T
authors.initials: MT
authors.lastname: Keogan
authors.forename: John
authors.initials: J
authors.lastname: Eng
authors.forename: Harold E
authors.initials: HE
authors.lastname: Longmaid
authors.forename: William
authors.initials: W
authors.lastname: DeWolf
authors.forename: Robert R
authors.initials: RR
authors.lastname: Edelman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology* / Q000601:surgery; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011300:Preoperative Care; D015203:Reproducibility of Results; D012119:Respiration; D012189:Retrospective Studies; D016037:Single-Blind Method