• Haojie Li, Lili Liang, Anqin Li, Yao Hu, Daoyu Hu, Zhen Li, and Ihab R Kamel.
• Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
• J Magn Reson Imaging. 2017 Jul 1; 46 (1): 240-247.

PurposeTo determine the utility of various diffusion parameters obtained from monoexponential, biexponential, and stretched exponential diffusion-weighted imaging (DWI) models in differentiating between minimal fat angiomyolipoma (MFAML) and clear cell renal cell carcinoma (ccRCC).Materials And MethodsOne hundred thirty-one patients with pathologically confirmed MFAML (n = 27) or ccRCC (n = 104) underwent multi-b value DWI (0∼1700 s/mm2 ) imaging at 3.0 Tesla MRI. An isotropic apparent diffusion coefficient (ADC) was calculated from diffusion-weighted images by using a monoexponential model. A pseudo-ADC (Dp ), true ADC (Dt ), and perfusion fraction (fp ) were calculated from diffusion-weighted images by using a biexponential model. A water molecular diffusion heterogeneity index (α) and distributed diffusion coefficient (DDC) were calculated from diffusion-weighted images by using a stretched exponential model. All parameters were compared between MFAML and ccRCC by using the Student's t test. Receiver operating characteristic and intraclass correlation coefficient analysis were used for statistical evaluations.ResultsADC, Dt , and α values were significantly lower in the MFAML group than in the ccRCC group (P < 0.001). Dp , fp , and DDC values were slightly higher in the MFAML group than in the ccRCC group; however, the difference was not significant (P = 0.136, 0.090, and 0.424, respectively). The AUC values for both α (0.953) and Dt (0.964) were significantly higher than those for ADC (0860), Dp (0.605), fp (0.596), and DDC (0.477) in the differentiation of MFAML from ccRCC (P < 0.001).ConclusionWater molecular diffusion heterogeneity index (α) and Dt may provide additional information and could lead to improved differentiation with better sensitivity and specificity between MFAML and ccRCC compared with conventional diffusion parameters.Level Of Evidence3 Technical Efficacy: Stage 2 J. MAGN. RESON. IMAGING 2017;46:240-247.© 2016 International Society for Magnetic Resonance in Medicine.

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