Diffusion-weighted magnetic resonance imaging in the differentiation of angiomyolipoma with minimal fat from clear cell renal cell carcinoma

The aim of the present study was to evaluate diffusion-weighted (DW) magnetic resonance imaging (MRI) in differentiating between minimal fat angiomyolipoma (MFAML) and clear cell renal cell carcinoma (CCRCC). Forty-one solid renal tumors without visible macroscopic fat on unenhanced computed tomography images were evaluated by MRI, including DW-MRI, and were diagnosed pathologically as CCRCC (n = 36) or MFAML (n = 5). To evaluate the heterogeneity of diffusion in each tumor, the signals of the tumors on DW-MRI were analyzed subjectively and the apparent diffusion coefficient (ADC) values and histograms assessed objectively. Thirty-three of 36 CCRCC (92%) exhibited a heterogeneous signal on DW-MRI and several peaks in the ADC value histogram, whereas four of five MFAML exhibited a homogeneous signal on DW-MRI and a single prominent peak in the histogram. The standard deviations of the ADC values were significantly smaller for MFAML than for CCRCC (P = 0.0015). In conclusion, DW-MRI can be considered a useful and noninvasive addition to the preoperative differentiation of CCRCC and MFAML.