Differentiating between malignant and benign renal tumors: do IVIM and diffusion kurtosis imaging perform better than DWI?

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To quantitatively compare the diagnostic values of conventional diffusion-weighted imaging (DWI), intravoxel incoherent motion (IVIM), and diffusion kurtosis imaging (DKI) in differentiating between malignant and benign renal tumors. Multiple b value DWIs and DKIs were performed in 180 patients with renal tumors, which were divided into clear cell renal cell carcinoma (ccRCC), non-ccRCC, and benign renal tumor group. The apparent diffusion coefficient (ADC), true diffusivity (D), pseudo-diffusion coefficient (D*), perfusion fraction (f), mean kurtosis (MK), and mean diffusivity (MD) maps were calculated. The diagnostic efficacy of various diffusion parameters for predicting malignant renal tumors was compared. The ADC, D, and MD values of ccRCCs were higher, while D*, f, and MK values were lower than those of benign renal tumors (all p < 0.025). The D* and f values of non-ccRCCs were lower than those of benign renal tumors (p = 0.002 and p < 0.001, respectively). The difference of ADC, D, MD, and MK values between non-ccRCCs and benign renal tumors was not statistically significant (p > 0.05). The ADC, D, MD, and f values of ccRCCs were higher, while MK values were lower than those of non-ccRCCs (all p < 0.001). The AUC values of ADC, D, D*, f, MK, and MD were 0.849, 0.891, 0.708, 0.656, 0.862, and 0.838 for differentiating ccRCCs from benign renal tumors, respectively. The AUC values of D* and f were 0.772 and 0.866 for discrimination between non-ccRCCs and benign renal tumors, respectively. IVIM parameters are the best, while DWI and DKI parameters have similar performance in differentiating malignant and benign renal tumors. • The D value is the best parameter for differentiating ccRCC from benign renal tumors. • The f value is the best parameter for differentiating non-ccRCC from benign renal tumors. • Conventional DWI and DKI have similar performance in differentiating malignant and benign renal tumors.