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.

中文翻译：

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扩散加权 MRI 评估肾母细胞瘤：多中心试验的结果。

摘要

目的

评估弥散加权 MRI 在儿童肾皮质肿瘤治疗前评估中的价值。

方法

这项 IRB 批准的回顾性多中心研究包括 122 名患有 130 个肾肿瘤的儿科患者，这些患者在新辅助化疗和肾切除术前接受了包括 DWI 在内的 MRI。两名放射科医生独立地对每个肿瘤进行体积评估，并在体素的基础上计算表观扩散系数 (ADC) 值，包括从直方图和纹理分析得出的参数。

结果

读者之间的一致性非常好（ICC 0.717-0.975）。对于两位读者，局部侵袭性肿瘤生长（SIOP 3 期）或转移（M1）患者的 12.5% ADC 值（p  ≤ 0.028）显着低于低分期肿瘤患者，并且参数能量差异显着M1 和 M0 状态患者之间的差异 ( p  ≤ 0.028)。良性肾母细胞瘤病和恶性肾母细胞瘤之间的对比度和同质性差异显着（p  ≤ 0.045，两位读者）。与所有其他亚型相比，胚细胞亚型显示出显着更高的偏度（p  ≤ 0.022，两个读者），而弥漫性间变亚型显示出显着更高的 75% ADC 值（p  ≤ 0.042，两个读者）。

结论

弥散加权 MRI 在识别良性肾母细胞瘤病和评估肾母细胞瘤亚型方面可能有价值。因此，有必要进一步研究以评估其在未来儿童肾肿瘤患者的风险分层中的价值。