title: The additional utility of apparent diffusion coefficient values of clear-cell renal cell carcinoma for predicting metastasis during clinical staging.
abstract: BACKGROUND
  The apparent diffusion coefficient (ADC) value is known to be an indicator of tumor activity. The ADC value of high-grade clear-cell renal cell carcinoma (RCC) is significantly lower than that of low-grade clear-cell RCC.
  
  
  OBJECTIVE
  To investigate the utility of ADC values of clear-cell RCC by comparing ADC values between groups with T1a RCC (tumor size ≤ 4 cm) without metastasis and the group with metastasis.
  
  
  METHODS
  A retrospective review was performed on 51 patients with 51 RCCs who underwent 1.5 T magnetic resonance imaging (MRI) for evaluating a renal mass confirmed pathologically to be clear-cell RCC between January 2010 and August 2014. We compared ADC values between group A (T1a RCC without metastasis, T1aN0M0) and group B (RCC with metastasis) using the Mann-WhitneyUtest.
  
  
  RESULTS
  The patients were divided into group A (n = 30; tumor size: median, 24.5 mm; range, 8-40 mm; ADC value [×10-3mm2/s]: median, 1.71; range, 1.23-2.24) and group B (n = 21; tumor size: median, 87.5 mm; range, 18-150 mm; ADC value [×10-3mm2/s]: median, 1.35; range, 0.91-1.94). The ADC value differed significantly between the two groups. The area under the receiver operating characteristic curve was 0.869. Using the optimum cutoff value (1.552 × 10-3mm2/s), ADC had a sensitivity of 80.0% and specificity of 81.0%.
  
  
  CONCLUSIONS
  There was a statistically significant difference in the ADC between group A (T1a clear-cell RCC without distant metastasis) and group B (advanced clear-cell RCC with lymph node metastasis or distant metastasis).
authors.affiliation: Department of Radiology, Shimane University, Faculty of Medicine, Shimane, Japan.
authors.forename: Rika
authors.initials: R
authors.lastname: Yoshida
authors.affiliation: Department of Radiology, Shimane University, Faculty of Medicine, Shimane, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Yoshizako
authors.affiliation: Department of Radiology, Matsue Seikyo Hospital, Japan.
authors.forename: Araki
authors.initials: A
authors.lastname: Hisatoshi
authors.affiliation: Department of Radiology, Shimane University, Faculty of Medicine, Shimane, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Mori
authors.affiliation: Department of Radiation Oncology, Shimane University, Faculty of Medicine, Shimane, Japan.
authors.forename: Yukihisa
authors.initials: Y
authors.lastname: Tamaki
authors.affiliation: Department of Organ Pathology, Shimane University, Faculty of Medicine, Shimane, Japan.
authors.forename: Noriyoshi
authors.initials: N
authors.lastname: Ishikawa
authors.affiliation: Department of Radiology, Shimane University, Faculty of Medicine, Shimane, Japan.
authors.forename: Hajime
authors.initials: H
authors.lastname: Kitagaki
keywords: 1.5 T magnetic resonance imaging (MRI); ADC value; Clear-cell renal cell carcinoma (RCC); diffusion-weighted imaging (DWI)