Can non-contrast magnetic resonance imaging replace contrast-enhanced computerized tomography in the local staging of pediatric renal tumors?

Abstract

BackgroundRenal tumors account for approximately 6–7% of the total incidence of pediatric cancers. Wilms tumor (WT) is the most common renal malignancy observed in the pediatric population under 5 years old. Computed tomography (CT) is used for staging of the renal tumors. Magnetic resonance imaging (MRI) offers enhanced soft tissue resolution and provides more comprehensive insights into tumor extension through the capsule, including tumor infiltration into the renal vein or IVC. MRI is a noninvasive imaging modality that does not involve any radiation hazards, making it safe for children. In addition, MRI can be performed without the administration of contrast agents in patients with impaired renal function. Therefore, MRI plays a vital role in screening, staging, preoperative evaluation, and follow-up. Diffusion-weighted imaging (DWI) is a functional tool that aids in locating the most receptive tumoral region to guide confirmatory biopsies. In this study, we aim to evaluate the potential value of non-contrast MRI in staging pediatric renal tumors compared to contrast-enhanced CT.ResultsThis study included 50 patients presented with renal mass, with ages ranging from 1 to 8 years and a mean age of 4.27 ± 1.27 (mean ± SD). The final diagnosis was Wilm’s tumor at 86%, clear cell sarcoma at 4%, rhabdoid tumor at 4%, rhabdomyosarcoma at 2%, and nephroblastomatosis with no malignant transformation at 4%. CT accurately diagnosed stages 4 and 5 in agreement with pathological findings while upstaging the other cases, with a CT sensitivity of 90.91%, specificity of 82.35%, PPV of 92%, and NPV of 84%. MRI is superior to CT in stages 1 and 3, accurately diagnosing stages 2, 4, and 5, with a sensitivity of 93.30%, specificity of 95.65%, PPV of 95%, and NPV of 97%.ConclusionsNon-contrast MRI could be considered the optimal radiation-free imaging modality in staging pediatric renal tumors mainly Wilm’s tumor as it offers high sensitivity and specificity of capsular and vascular infiltration, compared to contrast-enhanced CT especially in cases with impaired renal functions.