Abstract
BackgroundWe sought to determine the comparative diagnostic performance of standard b-value (800–1000 s/mm2) versus low b-value (400–500 s/mm2) diffusion-weighted magnetic resonance imaging (DW-MRI) in the detection of renal cell carcinoma (RCC).MethodAfter a systematic review of the available literature, studies were included that reported b-values, used a histopathological reference standard, and allowed construction of 2 × 2 contingency tables for detection of RCC lesions using DW-MRI. In addition, a summary receiver operating characteristic (SROC) analysis was performed.ResultsFour articles that complied with all inclusion and exclusion criteria were selected for data extraction and analysis (n = 248 lesions in 266 patients). All four studies were high quality. Standard b-value DW-MRI displayed a pooled sensitivity of 0.59 (95% confidence interval (CI): 0.51-0.67) and a pooled specificity of 0.50 (95% CI: 0.30-0.70), while low b-value DW-MRI displayed a pooled sensitivity of 0.58 (95% CI: 0.48-0.63) and a pooled specificity of 0.23 (95% CI: 0.09-0.44). The SROC curve of standard b-value DW-MRI displayed an AUC of 0.61 and a Q*index of 0.59, while the SROC curve of low b-value DW-MRI displayed an AUC of 0.68 and a Q*index of 0.64.ConclusionStandard b-value DW-MRI showed a superior specificity but an approximately equivalent sensitivity to low b-value DW-MRI in detecting RCC lesions in the kidney. However, low b-value DW-MRI displayed an overall superior diagnostic accuracy over standard b-value DW-MRI.
Highlights
We sought to determine the comparative diagnostic performance of standard b-value (800–1000 s/mm2) versus low b-value (400–500 s/mm2) diffusion-weighted magnetic resonance imaging (DW-MRI) in the detection of renal cell carcinoma (RCC)
The remaining four articles complied with all inclusion and exclusion criteria and were selected for data extraction and data analysis (Table 1) [26,27,28,29]
The random effects model was used in all cases
Summary
We sought to determine the comparative diagnostic performance of standard b-value (800–1000 s/mm2) versus low b-value (400–500 s/mm2) diffusion-weighted magnetic resonance imaging (DW-MRI) in the detection of renal cell carcinoma (RCC). Renal cell carcinoma (RCC) is the most common form of adult renal cancer, accounting for 85-90% of kidney neoplasms and ~3% of adult malignancies [1]. Contrast-enhanced studies are typically precluded in patients who have renal impairment or allergies to contrast agents [7]. These clinical limitations have led to the use of other imaging modalities, such as diffusionweighted MRI (DW-MRI), which provide both qualitative and quantitative tissue characterization without the need for contrast enhancement
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