European journal of radiology · 2026
Multiparametric MRI assessment of renal Masses: Diagnostic performance of the modified clear cell likelihood score and ancillary MRI features.
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Asfuroğlu Umut, Cindil Emetullah, Kalafat Burak, Badem Asude, Uçar Murat, Tokgöz Nil
Аннотация
PURPOSE: To evaluate the diagnostic performance and interreader agreement of the Clear Cell Likelihood Score (ccLS), the modified Clear Cell Likelihood Score (m-ccLS), and ancillary MRI features for differentiating benign from malignant renal masses and clear cell renal cell carcinoma (ccRCC) from non-ccRCC lesions.
MATERIALS AND METHODS: This retrospective single-center study included 106 patients with renal masses who underwent multiparametric magnetic resonance imaging (mpMRI) between 2018 and 2026. MRI features, including T1 signal intensity (SI) ratio, T2 SI ratio, apparent diffusion coefficient (ADC) ratio, and arterial-to-delayed enhancement ratio (ADER), were evaluated. Diagnostic performance was assessed using receiver operating characteristic analysis in both the overall cohort and the cT1a subgroup. Two radiologists independently assigned ccLS and m-ccLS scores and assessed the presence of a pseudocapsule for interreader agreement analysis.
RESULTS: Among 106 renal masses, 73 (68.9 %) were classified as cT1a tumors. For differentiating benign from malignant renal masses, m-ccLS demonstrated higher diagnostic performance than ccLS in both the overall cohort (AUC, 0.770 vs. 0.654) and the cT1a subgroup (AUC, 0.784 vs. 0.689). For differentiating ccRCC from non-ccRCC lesions, ccLS and m-ccLS showed comparable diagnostic performance in both the overall cohort (AUC, 0.884 vs. 0.868) and the cT1a subgroup (AUC, 0.885 vs. 0.876). Among the evaluated ancillary MRI features, the T2 SI ratio was significantly associated with both benign-malignant discrimination and ccRCC identification. Interreader agreement for ccLS, m-ccLS, and pseudocapsule assessment was substantial.
CONCLUSION: Incorporation of pseudocapsule assessment into the ccLS improved differentiation between benign and malignant renal masses while maintaining comparable diagnostic performance for identifying ccRCC. T2 SI ratio may provide additional value in MRI-based characterization of renal masses.
MATERIALS AND METHODS: This retrospective single-center study included 106 patients with renal masses who underwent multiparametric magnetic resonance imaging (mpMRI) between 2018 and 2026. MRI features, including T1 signal intensity (SI) ratio, T2 SI ratio, apparent diffusion coefficient (ADC) ratio, and arterial-to-delayed enhancement ratio (ADER), were evaluated. Diagnostic performance was assessed using receiver operating characteristic analysis in both the overall cohort and the cT1a subgroup. Two radiologists independently assigned ccLS and m-ccLS scores and assessed the presence of a pseudocapsule for interreader agreement analysis.
RESULTS: Among 106 renal masses, 73 (68.9 %) were classified as cT1a tumors. For differentiating benign from malignant renal masses, m-ccLS demonstrated higher diagnostic performance than ccLS in both the overall cohort (AUC, 0.770 vs. 0.654) and the cT1a subgroup (AUC, 0.784 vs. 0.689). For differentiating ccRCC from non-ccRCC lesions, ccLS and m-ccLS showed comparable diagnostic performance in both the overall cohort (AUC, 0.884 vs. 0.868) and the cT1a subgroup (AUC, 0.885 vs. 0.876). Among the evaluated ancillary MRI features, the T2 SI ratio was significantly associated with both benign-malignant discrimination and ccRCC identification. Interreader agreement for ccLS, m-ccLS, and pseudocapsule assessment was substantial.
CONCLUSION: Incorporation of pseudocapsule assessment into the ccLS improved differentiation between benign and malignant renal masses while maintaining comparable diagnostic performance for identifying ccRCC. T2 SI ratio may provide additional value in MRI-based characterization of renal masses.