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. 2022 Jun 15:87:e325-e332.
doi: 10.5114/pjr.2022.117593. eCollection 2022.

Local recurrence of renal cell carcinoma after partial nephrectomy: applicability of the apparent diffusion coefficient of MRI as an imaging marker - a multicentre study

Yulian Mytsyk  1 , Andriy Borzhiyevskyy  1 , Ihor Dutka  2 , Alexander Shulyak  3 , Paweł Kowal  4 , Dmytro Vorobets  1 , Michał Skrzypczyk  5 , Oleksandr Borzhiyevs'kyy  1 , Andrzej Górecki  6 , Viktoria Matskevych  7
Affiliations

Local recurrence of renal cell carcinoma after partial nephrectomy: applicability of the apparent diffusion coefficient of MRI as an imaging marker - a multicentre study

Yulian Mytsyk et al. Pol J Radiol. .

Abstract

Purpose: The goal of the study was an assessment of the diagnostic performance of diffusion-weighted images (DWI) and apparent diffusion coefficient (ADC) of magnetic resonance imaging (MRI) in distinguishing local recurrence (LR) of renal cell carcinoma (RCC) from benign conditions after partial nephrectomy.

Material and methods: Thirty-nine patients after partial nephrectomy for solid RCC were enrolled in the study. Patients were followed up using MRI, which included DWI sequence (b = 800 s/mm2). All patients with MRI features of LR were included in the main group (n = 14) and patients without such features - into the group of comparison (n = 25). Apparent diffusion coefficient (ADC) values of suspicious lesions were recorded. In all patients with signs of locally recurrent RCC, surgical treatment was performed followed by pathologic analysis.

Results: The mean ADC values of recurrent RCC demonstrated significantly higher numbers compared to benign fibrous tissues and were 1.64 ± 0.15 × 10-3 mm2/s vs. 1.02 ± 0.26 × 10-3 mm2/s (p < 0.001). The mean ADC values of RCCs' LR and benign post-op changes in renal scar substantially differed from mean ADC values of healthy kidneys' parenchyma; the latter was 2.58 ± 0.05 × 10-3 mm2/s (p < 0.001). In ROC analysis, the use of ADC with a threshold value of 1.28 × 10-3 mm2/s allowed us to differentiate local recurrence of RCC from benign postoperative changes with 100% sensitivity, 80% specificity, and accuracy: AUC = 0.980 (p < 0.001).

Conclusions: The apparent diffusion coefficient of DWI of MRI can be used as a potential imaging marker for the diagnosis of local recurrence of RCC.

Keywords: MRI; apparent diffusion coefficient; diffusion-weighted images; local recurrence; relapse; renal cell carcinoma.

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Conflict of interest statement

The authors report no conflict of interest.

Figures

Figure 1
Figure 1
The box plot of the apparent diffusion coefficient of renal cell carcinoma (RCC) local recurrence, benign postoperative changes of the kidney, and the normal renal parenchyma
Figure 2
Figure 2
The ROC-curves of ADC in differentiation of renal cell carcinoma (RCC) local recurrence from benign postoperative changes of a renal parenchyma
Figure 3
Figure 3
Magnetic resonance imaging data of female patient B., 65 years old, 23 months after partial nephrectomy due to clear cell renal cell carcinoma of the right kidney, stage pT1aN0M0, high grade according to Fuhrman system (arrows), axial projections. A) Axial T2-weighted fast recovery fast spin echo; B) axial dual-echo fast spoiled gradient-echo; C) axial diffusion-weighted imaging, in the region of post-op scar of the renal parenchyma there is an area of hyperintensity; D) ADC-map, the value of ADC over the region of post-op kidney defect was 1.59 × 10-3 mm2/s. Pathological diagnosis after re-resection of the kidney: recurrent conventional RCC pT1aN0M0, HG according to Fuhrman system
Figure 4
Figure 4
Magnetic resonance imaging data of female patient S., 61 years old, 19 months after partial nephrectomy due to clear cell renal cell carcinoma (RCC) of the lower pole of the left kidney, stage pT1aN0M0, high grade according to Fuhrman system (arrows), axial projections. The increased contrast accumulation was observed in area of postoperative kidney defect as well as the progressive increasement in size of lesion in the region of surgery. A) Axial T2-weighted fast recovery fast spin echo; B) axial dual-echo fast spoiled gradient-echo (FSPGR); C) axial T2-weighted fast recovery fast spin echo; D) axial T1-weighted FSPGR; E) axial diffusion-weighted imaging, in the region of post-op scar of the renal parenchyma there is an area of hyperintensity; F) ADC-map, the value of ADC over the region of post-op kidney defect was 1.67 × 10-3 mm2/s. Pathomorphological diagnosis after re-resection of the kidney: recurrent conventional RCC pT1aN0M0, HG according to Fuhrman system
Figure 5
Figure 5
Magnetic resonance imaging (MRI) data of male patient N., 63 years old, 25 months after enucleation of tumour due to clear cell renal cell carcinoma (RCC) of the left kidney, stage pT1aN0M0, low grade according to Fuhrman system (arrows), axial projections, without MRI features of RCC recurrence (no evidence of the expansive enlargement of post-operative renal scar with mild to moderate contrast enhancement and without invasive behaviour). A) Axial T2-weighted fast recovery fast spin echo; B) axial T1-weighted fast spoiled gradient-echo; C) axial diffusion-weighted imaging, in the region of post-op scar of the renal parenchyma there is an area of hyperintensity; D) ADC-map, the value of ADC over the region of post-op kidney defect was 0.81 × 10-3 mm2/s
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