title: Use of MRI in Differentiation of Papillary Renal Cell Carcinoma Subtypes: Qualitative and Quantitative Analysis.
abstract: OBJECTIVE
  The purpose of this study was to determine whether qualitative and quantitative MRI feature analysis is useful for differentiating type 1 from type 2 papillary renal cell carcinoma (PRCC).
  
  
  METHODS
  This retrospective study included 21 type 1 and 17 type 2 PRCCs evaluated with preoperative MRI. Two radiologists independently evaluated various qualitative features, including signal intensity, heterogeneity, and margin. For the quantitative analysis, a radiology fellow and a medical student independently drew 3D volumes of interest over the entire tumor on T2-weighted HASTE images, apparent diffusion coefficient parametric maps, and nephrographic phase contrast-enhanced MR images to derive first-order texture metrics. Qualitative and quantitative features were compared between the groups.
  
  
  RESULTS
  For both readers, qualitative features with greater frequency in type 2 PRCC included heterogeneous enhancement, indistinct margin, and T2 heterogeneity (all, p < 0.035). Indistinct margins and heterogeneous enhancement were independent predictors (AUC, 0.822). Quantitative analysis revealed that apparent diffusion coefficient, HASTE, and contrast-enhanced entropy were greater in type 2 PRCC (p < 0.05; AUC, 0.682-0.716). A combined quantitative and qualitative model had an AUC of 0.859. Qualitative features within the model had interreader concordance of 84-95%, and the quantitative data had intraclass coefficients of 0.873-0.961.
  
  
  CONCLUSIONS
  Qualitative and quantitative features can help discriminate between type 1 and type 2 PRCC. Quantitative analysis may capture useful information that complements the qualitative appearance while benefiting from high interobserver agreement.
authors.affiliation: 1 Department of Radiology, Center for Biomedical Imaging, NYU School of Medicine, NYU Langone Medical Center, 660 First Ave, 3rd Fl, New York, NY 10016.
authors.forename: Ankur M
authors.initials: AM
authors.lastname: Doshi
authors.affiliation: 1 Department of Radiology, Center for Biomedical Imaging, NYU School of Medicine, NYU Langone Medical Center, 660 First Ave, 3rd Fl, New York, NY 10016.
authors.forename: Justin M
authors.initials: JM
authors.lastname: Ream
authors.affiliation: 2 Department of Radiology, New York-Presbyterian Hospital-Weill Cornell Medical Center, New York, NY.
authors.forename: Andrea S
authors.initials: AS
authors.lastname: Kierans
authors.affiliation: 1 Department of Radiology, Center for Biomedical Imaging, NYU School of Medicine, NYU Langone Medical Center, 660 First Ave, 3rd Fl, New York, NY 10016.
authors.forename: Matthew
authors.initials: M
authors.lastname: Bilbily
authors.affiliation: 1 Department of Radiology, Center for Biomedical Imaging, NYU School of Medicine, NYU Langone Medical Center, 660 First Ave, 3rd Fl, New York, NY 10016.
authors.forename: Henry
authors.initials: H
authors.lastname: Rusinek
authors.affiliation: 3 Department of Urology, Division of Urologic Oncology, NYU Langone Medical Center, New York, NY.
authors.forename: William C
authors.initials: WC
authors.lastname: Huang
authors.affiliation: 1 Department of Radiology, Center for Biomedical Imaging, NYU School of Medicine, NYU Langone Medical Center, 660 First Ave, 3rd Fl, New York, NY 10016.
authors.forename: Hersh
authors.initials: H
authors.lastname: Chandarana
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000175:diagnosis* / Q000473:pathology; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000175:diagnosis* / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
keywords: papillary renal cell carcinoma; texture