Original Investigation|Articles in Press

The Effectiveness of Volumetric MRI Histogram Analysis in Renal Cell Carcinoma

Published:April 25, 2023DOI:

      Rationale and Objectives

      This study investigated the utility of histogram parameters derived from diffusion-weighted imaging (DWI) for evaluating renal cell carcinoma (RCC) grading prior to surgery.

      Materials and Methods

      This retrospective study included 88 patients who were histopathologically diagnosed with RCC and underwent magnetic resonance imaging (MRI) examinations. The patients were divided into two groups as well-differentiated (Group 1) and poorly differentiated (Group 2). Demographic data, preoperative MRI findings, MRI apparent diffusion coefficient (ADC) histogram analyzes, operation types, postoperative histopathological data and cancer stages of the patients were recorded. The histogram parameters of ADC values, comprising the mean, minimum, maximum, 5th, 10th, 25th, 50th, 75th, 90th, and 95th percentiles, as well as skewness, kurtosis, and variance, were calculated.


      The study included 59 males and 29 women with an average age of 56.21 ± 1.33 years. There were 52 patients in Group 1 and 36 patients in Group 2. The ADCmin, ADCmean, ADCmax, 5th, 10th, 25th, 50th, 75th, 90th, and 95th percentiles of ADC values of the poorly differentiated group were all lower than those of the well-differentiated group. ADCmin and the 5th percentile of ADC values, as well as ADCmean and the 10th, 25th, 50th, and 75th percentiles of ADC values, showed a statistically significant difference (p < 0.05). The AUC, sensitivity, and specificity of the ADCmin value were 0.703, 56.3%, and 75.7%, respectively.


      The present study indicated that histogram parameters generated from DWI were capable of differentiating between high-grade and low-grade RCC.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Academic Radiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Gupta K.
        • Miller J.D.
        • Li J.Z.
        • et al.
        Epidemiologic and socioeconomic burden of metastatic renal cell carcinoma (mRCC): a literature review.
        Cancer Treat Rev. 2008; 34: 193-205
        • Capitanio U.
        • Montorsi F.
        Renal cancer.
        Lancet Lond Engl. 2016; 387: 894-906
        • Volpe A.
        • Patard J.J.
        Prognostic factors in renal cell carcinoma.
        World J Urol. 2010; 28: 319-327
        • Denton M.D.
        • Magee C.C.
        • Ovuworie C.
        • et al.
        Prevalence of renal cell carcinoma in patients with ESRD pre-transplantation: a pathologic analysis.
        Kidney Int. 2002; 61: 2201-2209
        • Pierorazio P.M.
        • Johnson M.H.
        • Ball M.W.
        • et al.
        Five-year analysis of a multi-institutional prospective clinical trial of delayed intervention and surveillance for small renal masses: the DISSRM registry.
        Eur Urol. 2015; 68: 408-415
        • Nickerson M.L.
        • Jaeger E.
        • Shi Y.
        • et al.
        Improved identification of von Hippel-Lindau gene alterations in clear cell renal tumors.
        Clin Cancer Res. 2008; 14: 4726-4734
        • Yap N.Y.
        • Ng K.L.
        • Ong T.A.
        • et al.
        Clinical prognostic factors and survival outcome in renal cell carcinoma patients – a Malaysian single centre perspective.
        Asian Pac J Cancer Prev. 2013; 14: 7497-7500
        • Escudier B.
        • Eisen T.
        • Stadler W.M.
        • et al.
        Sorafenib in advanced clear-cell renal-cell carcinoma.
        N Engl J Med. 2007; 356: 125-134
        • Goyal A.
        • Sharma R.
        • Bhalla A.S.
        • et al.
        Diffusion-weighted MRI in renal cell carcinoma: a surrogate marker for predicting nuclear grade and histological subtype.
        Acta Radiol. 2012; 53: 349-358
        • Leveridge M.J.
        • Finelli A.
        • Kachura J.R.
        • et al.
        Outcomes of small renal mass needle core biopsy, nondiagnostic percutaneous biopsy, and the role of repeat biopsy.
        Eur Urol. 2011; 60: 578-584
        • Lane B.R.
        • Samplaski M.K.
        • Herts B.R.
        • et al.
        Renal mass biopsy – a renaissance?.
        J Urol. 2008; 179: 20-27
        • Kutikov A.
        • Fossett L.K.
        • Ramchandani P.
        • et al.
        Incidence of benign pathologic findings at partial nephrectomy for solitary renal mass presumed to be renal cell carcinoma on preoperative imaging.
        Urology. 2006; 68: 737-740
        • Zhang X.
        • Zhang G.
        • Xu L.
        • et al.
        Prediction of World Health Organization/International Society of Urological Pathology (WHO/ISUP) pathological grading of clear cell renal cell carcinoma by dual-layer spectral CT.
        Acad Radiol. 2022; 19 (1076-6332(22)00642-0)
        • Nicolau C.
        • Antunes N.
        • Paño B.
        • et al.
        Imaging characterization of renal masses.
        Medicina. 2021; 57: 51
        • Mytsyk Y.
        • Dutka I.
        • Borys Y.
        • et al.
        Renal cell carcinoma: applicability of the apparent coefficient of the diffusion-weighted estimated by MRI for improving their differential diagnosis, histologic subtyping, and differentiation grade.
        Int Urol Nephrol. 2017; 49: 215-224
        • Kang S.K.
        • Zhang A.
        • Pandharipande P.V.
        • et al.
        DWI for renal mass characterization: systematic review and meta-analysis of diagnostic test performance.
        Am J Roentgenol. 2015; 205: 317-324
        • Zhu J.
        • Luo X.
        • Gao J.
        • et al.
        Application of diffusion kurtosis tensor MR imaging in characterization of renal cell carcinomas with different pathological types and grades.
        Cancer Imaging. 2021; 21: 30
        • Metin M.
        • Aydın H.
        • Karaoğlanoğlu M.
        Renal cell carcinoma or oncocytoma? The contribution of diffusion-weighted magnetic resonance imaging to the differential diagnosis of renal masses.
        Medicina (Kaunas). 2022; 58: 221
        • Yu X.
        • Lin M.
        • Ouyang H.
        • et al.
        Application of ADC measurement in characterization of renal cell carcinomas with different pathological types and grades by 3.0T diffusion-weighted MRI.
        Eur J Radiol. 2012; 81: 3061-3066
        • Wang H.
        • Cheng L.
        • Zhang X.
        • et al.
        Renal cell carcinoma: diffusion-weighted MR imaging for subtype differentiation at 3.0T.
        Radiology. 2010; 257: 135-143
        • Zhang J.
        • Tehrani Y.M.
        • Wang L.
        • et al.
        Renal masses: characterization with diffusion-weighted MR imaging – a preliminary experience.
        Radiology. 2008; 247: 458-464
        • Bai Y.
        • Lin Y.
        • Tian J.
        • et al.
        Grading of gliomas by using monoexponential, biexponential, and stretched exponential diffusion-weighted MR imaging and diffusion kurtosis MR imaging.
        Radiology. 2016; 278: 496-504
        • Suo S.
        • Cheng F.
        • Cao M.
        • et al.
        Multiparametric diffusion-weighted imaging in breast lesions: association with pathologic diagnosis and prognostic factors.
        J Magn Reson Imaging. 2017; 46: 740-750
        • Jensen J.H.
        • Helpern J.A.
        MRI quantification of non-Gaussian water diffusion by kurtosis analysis.
        NMR Biomed. 2010; 23: 698-710
        • Just N.
        Improving tumour heterogeneity MRI assessment with histograms.
        Br J Cancer. 2014; 111: 2205-2213
        • Anna K.
        • Paschall S.
        • Mirmomen M.
        • et al.
        Differentiating papillary type I RCC from clear cell RCC and oncocytoma: application of whole lesion volumetric ADC measurement.
        Abdom Radiol. 2018; 43: 2424-2430
        • Wang K.
        • Cheng J.
        • Wang Y.
        • et al.
        Renal cell carcinoma: preoperative evaluate the grade of histological malignancy using volumetric histogram analysis derived from magnetic resonance diffusion kurtosis imaging.
        Quant Imaging Med Surg. 2019; 9: 671-680
        • Zhang Y.D.
        • Wu C.J.
        • Wang Q.
        • et al.
        Comparison of utility of histogram apparent diffusion coefficient and R2* for differentiation of low-grade from high-grade clear cell renal cell carcinoma.
        AJR Am J Roentgenol. 2015; 205: 193-201
        • Wu G.
        • Zhao Z.
        • Yao Q.
        • et al.
        The study of clear cell renal cell carcinoma with MR diffusion kurtosis tensor imaging and its histopathologic correlation.
        Acad Radiol. 2018; 25: 430-438
        • Dai Y.
        • Yao Q.
        • Wu G.
        • et al.
        Characterization of clear cell renal cell carcinoma with diffusion kurtosis imaging: correlation between diffusion kurtosis parameters and tumor cellularity.
        NMR Biomed. 2016; 29: 873-881
        • Villavicencio C.P.
        • Mc C.R.
        • Miller F.H.
        Can diffusion-weighted magnetic resonance imaging of clear cell renal carcinoma predict low from high nuclear grade tumors.
        Abdom Radiol (NY). 2017; 42: 1241-1249
        • Ding Y.
        • Tan Q.
        • Mao W.
        • et al.
        Differentiating between malignant and benign renal tumors: do IVIM and diffusion kurtosis imaging perform better than DWI?.
        Eur Radiol. 2019; 29: 6930-6939
        • Delahunt B.
        • Bethwaite P.B.
        • Nacey J.N.
        Outcome prediction for renal cell carcinoma: evaluation of prognostic factors for tumours divided according to histological subtype.
        Pathology. 2007; 39: 459-465
        • Zhang J.
        • Suo S.
        • Liu G.
        • et al.
        Comparison of monoexponential, biexponential, stretched-exponential, and kurtosis models of diffusion-weighted imaging in differentiation of renal solid masses.
        Korean J Radiol. 2019; 20: 791-800