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

Shichao Li; Kangwen He; Guanjie Yuan; Xingwang Yong; Xiaoyan Meng; Cui Feng; Yi Zhang; Ihab R Kamel; Zhen Li

doi:10.1007/s00330-022-09312-2

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

Eur Radiol. 2023 Jun;33(6):4429-4439. doi: 10.1007/s00330-022-09312-2. Epub 2022 Dec 6.

Authors

Shichao Li¹, Kangwen He¹, Guanjie Yuan¹, Xingwang Yong², Xiaoyan Meng¹, Cui Feng¹, Yi Zhang^#³, Ihab R Kamel⁴, Zhen Li^#⁵

Affiliations

¹ Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
² Key Laboratory for Biomedical Engineering of Ministry of Education, Department of Biomedical Engineering, College of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou, Zhejiang, China.
³ Key Laboratory for Biomedical Engineering of Ministry of Education, Department of Biomedical Engineering, College of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou, Zhejiang, China. yizhangzju@zju.edu.cn.
⁴ Russell H. Morgan Department of Radiology and Radiological Science, the Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
⁵ Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China. zhenli@hust.edu.cn.

^# Contributed equally.

PMID: 36472697
DOI: 10.1007/s00330-022-09312-2

Abstract

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)/S₀ 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)/S₀ 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)/S₀ 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.

Keywords: Clear cell renal cell carcinoma; Diffusion magnetic resonance imaging; Magnetization transfer contrast imaging.

MeSH terms

Carcinoma*
Carcinoma, Renal Cell* / diagnostic imaging
Carcinoma, Renal Cell* / pathology
Diffusion Magnetic Resonance Imaging / methods
Humans
Kidney Neoplasms* / diagnostic imaging
Kidney Neoplasms* / pathology
Retrospective Studies
Sensitivity and Specificity
World Health Organization