Objective To investigate the diagnostic value of multiple MRI models based on diffusion-weighted imaging(DWI)for high and low grade clear cell renal cell carcinoma(CCRCC).Methods A retrospective analysis of 66 cases of histopathologically confirmed CCRCC patients was conducted.There were 49 cases in the low grade group and 17 cases in the high grade group.All cases were examined with diffusion weighted imaging(DWI),intravoxel incoherent motion ima-ging(IVIM),and diffusion kurtosis imaging(DKI).Clinical pathological data,conventional MRI features,and apparent diffusion coefficient(ADC),IVIM and DKI parameters between the two groups were analyzed.The IVIM parameter in-cludes true diffusion coefficient(D),perfusion-related diffusion coefficient(D*),perfusion fraction(f),and the DKI pa-rameter includes mean diffusion kurtosis(MK),mean diffusivity(MD).ROC was plotted to compare the diagnostic effica-cy.Results Compared with the low grade CCRCC group,unclear lesion boundary,bleeding,fat infiltration,venous tumor thrombus and lymph node metastasis were more common in the high grade CCRCC group,,and the difference between the two groups was statistically significant(P＜0.05).The AUC of conventional MRI model including border,hemor-rhage,perirenal fat infiltration,venous tumor thrombus and lymph node enlargement was 0.816,the sensitivity was 100％,the specificity was 52.94％,and the accuracy was 87.9％.ADC,D and MD of CCRCC in high-grade group were lower than those in low-grade group,while MK was higher than those in low-grade group,with statistical significance(P＜0.05),and there was no statistical difference in D*and f.The D value of a single parameter had the largest diagnostic efficacy(AUC=0.852)and the highest specificity(94.12％).The diagnostic efficiency(AUC=0.926)of ADC,D,MD,and MK combined with multiple parameter values was higher than that of single parameter(Z=3.226,P=0.0013;Z=2.217,P=0.0267;Z=2.512,P=0.0120;Z=2.605,P=0.0092).The specificity was 100％and the accuracy was 84.8％,which were higher than that of conventional MRI model,and the optimal diagnostic threshold was ADC=1.55 × 10-3mm2/s,D=0.60 × 10-3mm2/s,MD=1.36 × 10-3mm2/s,MK=1.53.Conclusion MRI models based on DWI can be ap-plied to predict high and low grade CCRCC,The combination of DWI,IVIM,and DKI models can improve the differential diagnostic efficiency of high and low level CCRCC,which is beneficial for accurate preoperative evaluation and treatment of patients.
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