Work

Quantitative Analysis With Time-Dependent Diffusion MRI for Assessing WHO/ISUP Tumor Grade in Clear Cell Renal Cell Carcinoma

Year: 2025

Type: article

Abstract: Objective: To investigate the feasibility of time-dependent diffusion-weighted imaging (td-dMRI) in assessing the pathological World Health Organization/International Society of Urological Pathology (WHO/ISUP) grade of clear cell renal cell carcinoma (ccRCC). Materials and Methods:A total of 138 patients (median age, 58 years [interquartile range, 51-64 years]; 89 males) with surgically confirmed ccRCC, comprising 48 high-grade (WHO/ISUP grade III/IV) and 90 low-grade (WHO/ISUP grade I/II) tumors, were included in the study among patients who underwent preoperative td-dMRI for suspected RCC between May 2022 and May 2024.The td-dMRI microstructural parameters, including cell diameter (d), intracellular volume fraction (fin), cellularity, and extracellular diffusivities (Dex), were quantified using a two-compartment model.The solid tumor area was manually annotated to extract the mean values from each parameter map.We analyzed the differences in td-dMRI parameters between the high-and low-grade tumors and evaluated the ability of these parameters to distinguish between the two tumor groups.High-definition hematoxylin-and-eosin-stained slides were obtained from 92 patients.We assessed the correlation between td-dMRI parameters and pathologic nuclear fraction, which was quantified using an automated nucleus segmentation model (Hover-Net).Results: Compared to high-grade tumors, low-grade tumors exhibited lower cellularity and fin and higher diameter and Dex.For differentiation between low-and high-grade ccRCC, the fin exhibited the highest diagnostic performance (areas under the receiver operating characteristic curve [AUC] = 0.943; 95% confidence interval, 0.906-0.980),followed by cellularity (AUC = 0.931; 0.887-0.976),Dex (AUC = 0.863; 0.800-0.926),and diameter (AUC = 0.690; 0.596-0.784).The nuclei on pathology slides were automatically segmented, and the nuclear fraction exhibited a moderate correlation with fin (r = 0.65, P < 0.001).Conclusion: td-dMRI parameters show potential for assessing pathological WHO/ISUP grades and may serve as promising noninvasive biomarkers for characterizing RCC.

Source: Korean Journal of Radiology

DOI: 10.3348/kjr.2024.1202