Assessment of the extracellular volume fraction for the grading of clear cell renal cell carcinoma: first results and histopathological findings

Lisa C. Adams, Philipp Jurmeister, Bernhard Ralla, Keno K. Bressem, Ute L. Fahlenkamp, Guenther Engel, Stefan Siepmann, Moritz Wagner, Bernd Hamm, Jonas Busch, Marcus R. Makowski

Research output: Contribution to journalArticlepeer-review

17 Scopus citations

Abstract

Objectives: To assess the potential of T1 mapping–based extracellular volume fraction (ECV) for the identification of higher grade clear cell renal cell carcinoma (cRCC), based on histopathology as the reference standard. Methods: For this single-center, institutional review board–approved prospective study, 27 patients (17 men, median age 62 ± 12.4 years) with pathologic diagnosis of cRCC (nucleolar International Society of Urological Pathology (ISUP) grading) received abdominal MRI scans at 1.5 T using a modified Look-Locker inversion recovery (MOLLI) sequence between January 2017 and June 2018. Quantitative T1 values were measured at different time points (pre- and postcontrast agent administration) and quantification of the ECV was performed on MRI and histological sections (H&E staining). Results: Reduction in T1 value after contrast agent administration and MR-derived ECV were reliable predictors for differentiating higher from lower grade cRCC. Postcontrast T1diff values (T1diff = T1 difference between the native and nephrogenic phase) and MR-derived ECV were significantly higher for higher grade cRCC (ISUP grades 3–4) compared with lower grade cRCC (ISUP grades 1–2) (p < 0.001). A cutoff value of 700 ms could distinguish higher grade from lower grade tumors with 100% (95% CI 0.69–1.00) sensitivity and 82% (95% CI 0.57–0.96) specificity. There was a positive and strong correlation between MR-derived ECV and histological ECV (p < 0.01, r = 0.88). Interobserver agreement for quantitative longitudinal relaxation times in the T1 maps was excellent. Conclusions: T1 mapping with ECV measurement could represent a novel in vivo biomarker for the classification of cRCC regarding their nucleolar grade, providing incremental diagnostic value as a quantitative MR marker. Key Points: • Reduction in MRI T1 relaxation times after contrast agent administration and MR-derived extracellular volume fraction are useful parameters for grading of clear cell renal cell carcinoma (cRCC). • T1 differences between the native and the nephrogenic phase are higher for higher grade cRCC compared with lower grade cRCC and MRI-derived extracellular volume fraction (ECV) and histological ECV show a strong correlation. • T1 mapping with ECV measurement may be helpful for the noninvasive assessment of cRCC pathology, being a safe and feasible method, and it has potential to optimize individualized treatment options, e.g., in the decision of active surveillance.

Original languageEnglish
Pages (from-to)5832-5843
Number of pages12
JournalEuropean Radiology
Volume29
Issue number11
DOIs
StatePublished - 1 Nov 2019
Externally publishedYes

Keywords

  • Extracellular matrix
  • Extracellular space
  • Magnetic resonance imaging
  • Neoplasm grading
  • Renal cell carcinoma

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