Direct correlation of intravoxel incoherent motion imaging based on implicit neural representations and histopathology in pediatric Wilms tumors: can it differentiate between subtypes?
Wilms tumor (WT) is a heterogeneous pediatric renal malignancy. Invasive procedures to establish histology prior to pre operative treatment are not recommended by the International Society of Pediatric (SIOP) Oncology Renal Tumor Study Group, yet different tissue components are associated with different responses to therapy (SIOP Umbrella protocol). Intravoxel incoherent motion (IVIM) magnetic resonance imaging (MRI) may improve subtype differentiation before surgery as a noninvasive radiographic biomarker by capturing both diffusion and perfusion characteristics, as opposed to the conventionally used apparent diffusion coefficient (ADC). The objective of this study is to evaluate the discriminative performance of IVIM MRI in differentiating WT subtypes. IVIM provides quantitative parameters that disentangle the diffusion coefficient (D), incoherent blood flow (pseudodiffusion Dstar) and perfusion fraction (f). This retrospective study included thirthy children with WT. Standardized 1.5T MRI with 10 b value diffusion weighted imaging (DWI) was performed. IVIM parameters were estimated using a selfsupervised implicit neural representations network and were correlated with histopathology via a patient specific 3D printed cutting guide. Statistical analyses included mixed models, receiver operating curve analysis, and logistic regression. Thirty lesions were MRI histopathology correlated on slice level. Significant subtype differences were observed for Dstar stromal versus epithelial (p = 0.024), regressive tumors (p = 0.031) and mixed WT tumors (p = 0.043). ADC showed no significant subtype differences. Direct MRI histopathology correlation enabled differentiation between stromal subtype and epithelial, mixed and regressive subtype on macroscopic slice level using Dstar.