title: Renal lesions: characterization with diffusion-weighted imaging versus contrast-enhanced MR imaging.
abstract: OBJECTIVE
  To compare the diagnostic performance of diffusion-weighted (DW) magnetic resonance (MR) imaging with that of contrast material-enhanced (CE) MR imaging and to assess the performance of these examinations combined for the characterization of renal lesions, with MR follow-up and histopathologic analysis as the reference standards.
  
  
  METHODS
  The institutional review board waived the requirement of informed patient consent for this retrospective HIPAA-compliant study. One hundred nine renal lesions in 64 patients (46 men, 18 women; mean age, 60.7 years) were evaluated with CE MR imaging and breath-hold DW imaging performed with various b values. Renal lesions were characterized with use of CE MR criteria, and apparent diffusion coefficients (ADCs) were measured. The ADCs of benign and malignant lesions were compared at Mann-Whitney testing. Receiver operating characteristic (ROC) analysis was performed to assess the accuracy of DW imaging and CE MR imaging in the diagnosis of renal cell carcinoma (RCC).
  
  
  RESULTS
  The 109 renal lesions--81 benign lesions and 28 RCCs--had a mean diameter of 4.2 cm +/- 2.5 (standard deviation). The mean ADC for RCCs (1.41 x 10(-3) mm(2)/sec +/- 0.61) was significantly lower (P < .0001) than that for benign lesions (2.23 x 10(-3) mm(2)/sec +/- 0.87) at DW imaging performed with b values of 0, 400, and 800 sec/mm(2). At a cutoff ADC of less than or equal to 1.92 x 10(-3) mm(2)/sec, the area under the ROC curve (AUC), sensitivity, and specificity of DW imaging for the diagnosis of RCCs (excluding angiomyolipomas) were 0.856, 86%, and 80%, respectively. The corresponding AUC, sensitivity, and specificity of CE MR imaging were 0.944, 100%, and 89%, respectively. Combined DW and CE MR imaging had 96% specificity. The AUC for the DW imaging-based diagnosis of solid RCC versus oncocytoma was 0.854. Papillary RCCs had lower ADCs than nonpapillary RCCs.
  
  
  CONCLUSIONS
  DW imaging can be used to characterize renal lesions; however, compared with CE MR imaging, it is less accurate. DW imaging can be used to differentiate solid RCCs from oncocytomas and characterize the histologic subtypes of RCC.
authors.affiliation: Department of Radiology, New York University Langone Medical Center, 560 First Ave, New York, NY 10016, USA. bachir.taouli@nyumc.org
authors.forename: Bachir
authors.initials: B
authors.lastname: Taouli
authors.forename: Ravi K
authors.initials: RK
authors.lastname: Thakur
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Mannelli
authors.forename: James S
authors.initials: JS
authors.lastname: Babb
authors.forename: Sooah
authors.initials: S
authors.lastname: Kim
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Hecht
authors.forename: Vivian S
authors.initials: VS
authors.lastname: Lee
authors.forename: Gary M
authors.initials: GM
authors.lastname: Israel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003287:Contrast Media; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D007680:Kidney Neoplasms / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged
chemical_list: D003287:Contrast Media; D019786:Gadolinium DTPA