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Multicenter Study
. 2020 Oct;45(10):3202-3212.
doi: 10.1007/s00261-020-02475-w.

Diffusion-weighted MRI in the assessment of nephroblastoma: results of a multi-center trial

Andreas M Hötker  1 , André Lollert  2 , Yousef Mazaheri  3 , Sabine Müller  4   5 , Jens-Peter Schenk  6 , Philipp C Mildenberger  7 , Oguz Akin  8 , Norbert Graf  4 , Gundula Staatz  2
Affiliations
Multicenter Study

Diffusion-weighted MRI in the assessment of nephroblastoma: results of a multi-center trial

Andreas M Hötker et al. Abdom Radiol (NY). 2020 Oct.

Abstract

Purpose: To assess the value of diffusion-weighted MRI in the pre-therapeutic evaluation of pediatric renal cortical tumors.

Methods: This IRB-approved, retrospective multi-center study included 122 pediatric patients with 130 renal tumors, who underwent MRI including DWI before neoadjuvant chemotherapy and nephrectomy. Two radiologists independently assessed each tumor volumetrically, and apparent diffusion coefficient (ADC) values were calculated on a voxel-wise basis, including parameters derived from histogram and texture analysis.

Results: Inter-reader agreement was excellent (ICC 0.717-0.975). For both readers, patients with locally aggressive tumor growth (SIOP 3 stage) or with metastases (M1) had significantly lower 12.5th-percentile ADC values (p ≤ 0.028) compared to those with lower-stage tumors, and the parameter energy differed significantly between patients with M1 and those with M0 status (p ≤ 0.028). Contrast and homogeneity differed significantly between benign nephroblastomatosis and malignant nephroblastoma (p ≤ 0.045, both readers). As compared to all other subtypes, the blastemal subtype demonstrated significantly higher skewness (p ≤ 0.022, both readers) and the diffuse anaplastic subtype demonstrated significantly higher 75th-percentile ADC values (p ≤ 0.042, both readers).

Conclusions: Diffusion-weighted MRI may be of value in identifying benign nephroblastomatosis and assessing nephroblastoma subtypes. Therefore, further research is warranted to assess its value in risk stratification for pediatric patients with renal tumors in the future.

Keywords: Diffusion-weighted imaging; Magnetic resonance imaging; Nephroblastoma.

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Figures

Fig. 1:
Fig. 1:
Flow chart detailing the patient inclusion process.
Fig. 2 a/b:
Fig. 2 a/b:
Representative ADC map of a blastemal nephroblastoma (female patient, 11 years old) and the corresponding histogram.
Fig. 3 a/b:
Fig. 3 a/b:
Representative ADC map of a diffuse anaplastic nephroblastoma (female patient, 4 years old) and the corresponding histogram.
Fig. 4 a-c:
Fig. 4 a-c:
ROC curves for the MRI parameters found helpful in the distinction between nephroblastomatosis (a), blastemal subtype of nephroblastoma (b) and diffuse anaplastic subtype of nephroblastoma (c) and other pediatric renal tumors.
See this image and copyright information in PMC

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