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. 2022 Feb 1;58(2):221.
doi: 10.3390/medicina58020221.

Renal Cell Carcinoma or Oncocytoma? The Contribution of Diffusion-Weighted Magnetic Resonance Imaging to the Differential Diagnosis of Renal Masses

Melike Metin  1 , Hasan Aydın  2 , Mustafa Karaoğlanoğlu  3
Affiliations

Renal Cell Carcinoma or Oncocytoma? The Contribution of Diffusion-Weighted Magnetic Resonance Imaging to the Differential Diagnosis of Renal Masses

Melike Metin et al. Medicina (Kaunas). .

Abstract

Background and Objectives: Renal Cell Carcinoma (RCC) accounts for 85% and oncocytomas constitute 3-7% of solid renal masses. Oncocytomas can be confused, especially with hypovascular RCC. The purpose of this research was to evaluate the contribution of diffusion-weighted imaging (DWI) and contrast-enhanced MRI sequences in the differential diagnosis of RCC and oncocytoma Materials and Methods: 465 patients with the diagnosis of RCC and 45 patients diagnosed with oncocytoma were retrospectively reviewed between 2009 to 2020. All MRI acquisitions were handled by a 1.5 T device (Achieva, Philips Healthcare, Best, The Netherlands) and all images were evaluated by the consensus of two radiologists with 10-15 years' experience. The SPSS package program version 15.0 software was used for statistical analysis of the study. Chi-square test, Mann-Whitney U test or the Kruskal-Wallis tests were used in the statistical analysis. A receiver operating characteristic (ROC) curve was used to calculate the cut-off values Results: The results were evaluated with a 95% confidence interval and a significance threshold of p < 0.05. ADC values (p < 0.001) and enhancement index (p < 0.01) were significantly lower in the RCC group than the oncocytoma group. Conclusion: DWI might become an alternative technique to the contrast-enhanced MRI in patients with contrast agent nephropathy or with a high risk of nephrogenic systemic fibrosis, calculation of CI of the oncocytoma and RCCs in the contrast-enhanced acquisitions would contribute to the differential diagnosis.

Keywords: ADC; DWI; carcinoma; cell; oncocytoma; renal.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
ROC curve of the ADC values for the differentiation of RCC and oncocytoma separation.
Figure 2
Figure 2
ROC curve of the combined ADC value and CI for the differentiation of RCC and oncocytoma.
Figure 3
Figure 3
(a) Renal mass (RCC) in the lower pole of right kidney, low enhancing proportional to the renal cortex but very dark with low ADC and (b) concrete restricted diffusion in diffusion-weighted imaging (DWI).
Figure 3
Figure 3
(a) Renal mass (RCC) in the lower pole of right kidney, low enhancing proportional to the renal cortex but very dark with low ADC and (b) concrete restricted diffusion in diffusion-weighted imaging (DWI).
Figure 4
Figure 4
(a) Oncocytoma in the the lower pole of left kidney, (b) iso-mild hyperintense in T2W images with obvious restricted diffusion and (c) hyperintense in DWI.
Figure 4
Figure 4
(a) Oncocytoma in the the lower pole of left kidney, (b) iso-mild hyperintense in T2W images with obvious restricted diffusion and (c) hyperintense in DWI.
Figure 5
Figure 5
(a) Renal mass lesion (RCC) in the upper pole of right kidney, (b) hyperintense in T2W images with high contrast enhancing.
Figure 6
Figure 6
(a) Oncocytoma in the upper pole of left kidney, (b) iso-hyperintense in T2W images with high diffusion restriction and (c) moderate contrast enhancing.
Figure 6
Figure 6
(a) Oncocytoma in the upper pole of left kidney, (b) iso-hyperintense in T2W images with high diffusion restriction and (c) moderate contrast enhancing.
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