WHO/ISUP grade and pathological T stage of clear cell renal cell carcinoma: value of ZOOMit diffusion kurtosis imaging and chemical exchange saturation transfer imaging

• Published in: European radiology 2023-06, Vol.33 (6), p.4429-4439
• Main Authors: Li, Shichao, He, Kangwen, Yuan, Guanjie, Yong, Xingwang, Meng, Xiaoyan, Feng, Cui, Zhang, Yi, Kamel, Ihab R., Li, Zhen
• Format: Article
• Language: English
• Subjects: Carcinoma; Carcinoma, Renal Cell - diagnostic imaging; Carcinoma, Renal Cell - pathology; Clear cell-type renal cell carcinoma; Correlation coefficient; Correlation coefficients; Diagnostic Radiology; Diagnostic systems; Diffusion; Diffusion Magnetic Resonance Imaging - methods; Exchanging; Humans; Imaging; Internal Medicine; Interventional Radiology; Kidney cancer; Kidney Neoplasms - diagnostic imaging; Kidney Neoplasms - pathology; Kurtosis; Mathematical analysis; Medical imaging; Medicine; Medicine & Public Health; Neuroradiology; Oncology; Parameter identification; Radiology; Retrospective Studies; Sensitivity and Specificity; Tumors; Ultrasound; World Health Organization
• ISSN: 1432-1084; 0938-7994; 1432-1084
• DOI: 10.1007/s00330-022-09312-2

Objectives To evaluate the value of ZOOMit diffusion kurtosis imaging (DKI) and chemical exchange saturation transfer (CEST) imaging in predicting WHO/ISUP grade and pathological T stage in clear cell renal cell carcinoma (ccRCC). Methods Forty-six patients with ccRCC were included in this retrospective study. All participants underwent MRI including ZOOMit DKI and CEST. The non-Gaussian mean kurtosis (MK), mean diffusivity (MD), magnetization transfer ratio asymmetry (MTRasym (3.5 ppm)), and S sat (3.5 ppm)/S 0 were analyzed based on different WHO/ISUP grades and pT stages. Binary logistic regression was used to identify the best combination of the parameters. Pearson’s correlation coefficients were calculated between CEST and diffusion-related parameters. Results The ADC, MD, and S sat (3.5 ppm)/S 0 values were significantly lower for higher WHO/ISUP grade tumors, whereas the MK and MTRasym (3.5 ppm) were higher in higher WHO/ISUP grade and higher pT stage tumors. MTRasym (3.5 ppm) combined with MD (AUC, 0.930; 95% CI, 0.858–1.000) showed the best diagnostic efficacy in evaluating the WHO/ISUP grade. MTRasym (3.5 ppm) and MK were mildly positively correlated ( r = 0.324, p = 0.028). S sat (3.5 ppm)/S 0 was moderately positively correlated with ADC ( r = 0.580, p < 0.001), mildly positively correlated with MD ( r = 0.412, p = 0.005), and moderately negatively correlated with MK ( r = −0.575, p < .001). Conclusion The microstructural and biochemical assessment of ZOOMit DKI and CEST allowed for the characterization of different WHO/ISUP grades and pT stages in ccRCC. MTRasym (3.5 ppm) combined with MD showed the best diagnostic performance for WHO/ISUP grading. Key Points • Both diffusion kurtosis imaging (DKI) and chemical exchange saturation transfer (CEST) can be used to predict the WHO/ISUP grade and pathological T stage. • MTRasym (3.5 ppm) combined with MD showed the highest AUC (0.930; 95% CI, 0.858–1.000) in WHO/ISUP grading. • MTRasym at 3.5 ppm showed a positive correlation with mean kurtosis.