The value of combined application of 3D-ASL and DWI imaging in the differential diagnosis of renal cell carcinoma and renal pelvic carcinoma

Motivation: Given that renal cell carcinoma (RCC) and renal pelvis carcinoma (RPC) with parenchymal involvement present overlapping imaging features, their accurate differentiation is essential for guiding surgical approaches. Goal(s): This study evaluates the diagnostic potential of three-dimensional arterial spin labeling (3D-ASL) and diffusion-weighted imaging (DWI) in differentiating RCC from RPC with renal parenchymal invasion. Approach: This prospective study included 16 renal tumors patients and evaluated the differences in apparent diffusion coefficient (ADC) values and renal blood flow (RBF) ratio between RCC and RPC. Results: Findings indicate that RCC has a significantly higher RBF ratio and lower ADC values. Combined use may improve diagnostic accuracy. Impact: 3D-ASL, especially when combined with DWI, represents a promising, non-invasive approach for differentiating RCC from RPC. This contrast-free approach not only enhances patient safety but also expands diagnostic options for a broader patient population, supporting more flexible clinical decision-making.