The role of MRI texture analysis based on susceptibility-weighted imaging in predicting Fuhrman grade of clear cell renal cell carcinoma

Background The Fuhrman nuclear grade system is one of the most important independent indicators in patients with clear cell renal cell carcinoma (ccRCC) for aggressiveness and prognosis. Preoperative assessment of tumor aggressiveness is important for surgical decision-making. Purpose To explore the role of magnetic resonance imaging (MRI) texture analysis based on susceptibility-weighted imaging (SWI) in predicting Fuhrman grade of ccRCC. Material and Methods A total of 45 patients with SWI and surgically proven ccRCC were divided into two groups: the low-grade group (Fuhrman I/II, n = 29) and the high-grade group (Fuhrman III/IV, n = 16). Texture features were extracted from SWI images. Feature selection was performed, and multivariable logistic regression analysis was performed to develop the SWI-based texture model for grading ccRCCs. Receiver operating characteristic (ROC) curve analysis and leave-group-out cross-validation (LGOCV) were performed to test the reliability of the model. Results A total of 396 SWI-based texture features were extracted from each SWI image. The SWI-based texture model developed by multivariable logistic regression analysis was: SWIscore = –0.59 + 1.60 * ZonePercentage. The area under the ROC curve of the SWI-based texture model for differentiating high-grade ccRCC from low-grade ccRCC was 0.81 (95% confidence interval 0.67–0.94), with 80% accuracy, 56.25% sensitivity, and 93.10% specificity. After 100 LGOCVs, the mean accuracy, sensitivity, and specificity were 90.91%, 91.83%, and 89.89% for the training sets, and 77.29%, 80.52%, and 71.44% for the test sets, respectively. Conclusion SWI-based texture analysis might be a reliable quantitative approach for differentiating high-grade ccRCC from low-grade ccRCC.