Inter-observer variation and diagnostic efficacy of apparent diffusion coefficient (ADC) measurements obtained by diffusion-weighted imaging (DWI) in small renal masses

Lothar Ponhold, Domagoj Javor, Gertraud Heinz-Peer, Sabina Sevcenco, Martin Hofstetter, Pascal Andreas Baltzer

Research output: Journal article (peer-reviewed)Journal article

8 Citations (Scopus)

Abstract

BACKGROUND: Diffusion-weighted imaging (DWI) is increasingly used to diagnose renal lesion subtypes. Especially in small renal masses, identification of less aggressive tumor types is of clinical interest, as active surveillance strategies can be applied.

PURPOSE: To evaluate the inter-observer variation and diagnostic efficacy of apparent diffusion coefficient (ADC) measurements obtained by DWI in small renal masses ≤4 cm (SRM).

MATERIAL AND METHODS: This retrospective IRB-approved study included 39 patients (46 SRM: 12 benign, 34 malignant). All underwent a 3 T DWI of SRM prior to surgery. Two radiologists independently analyzed all imaging data by three measurements. Limits of agreement, intraclass correlation coefficients (ICC), group comparisons by t-tests, and ROC analysis were performed.

RESULTS: Reliability of ADC measurements was very high with an ICC of >0.9 for both observers. Inter-rater reliability was high with an ICC of 0.82. Limits of agreement for average ADC values between both observers were -23.5% to 38.3% with a mean difference of 7.5% between both observers. No significant differences were found between benign and malignant lesions (P value Observer 1: 0.362, Observer 2: 0.622). Papillary carcinoma showed lower ADC values compared to non-papillary carcinoma (P value Observer 1: 0.008, Observer 2: 0.012). Consequently, ROC analysis revealed a significant (P < 0.001, respectively) area under the ROC curve of 0.853 (Observer 1) and 0.837 (Observer 2) without significant differences between both readers (P = 0.772).

CONCLUSION: ADC measurements of SRM at 3 T show a high reproducibility and differentiate papillary from non-papillary carcinoma subtypes. However, measurement variability may limit the application of fixed ADC thresholds for lesion diagnosis.

Original languageEnglish
Pages (from-to)1014-1020
Number of pages7
JournalActa Radiologica
Volume57
Issue number8
DOIs
Publication statusPublished - Aug 2016

Keywords

  • Aged
  • Aged, 80 and over
  • Contrast Media
  • Diffusion Magnetic Resonance Imaging/methods
  • Female
  • Humans
  • Kidney Neoplasms/diagnostic imaging
  • Male
  • Middle Aged
  • Observer Variation
  • Reproducibility of Results
  • Bland-Altman-plot
  • Apparent diffusion coefficient (ADC)
  • ROC analysis
  • Diffusion-weighted imaging (DWI)
  • Reproducibility
  • Small renal masses

ASJC Scopus subject areas

  • Radiological and Ultrasound Technology
  • Radiology, Nuclear Medicine and Imaging

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