In Wilms Tumour (WT) Blastemal subtype has the worst prognosis. Diffusion MRI (DWI) can distinguish some histological subtypes. Gadolinium-contrast-injected T1 MRI (T1gad) identifies necrotic tissue. Gadolinium is contra-indicated in renal failure. 27 patients received DWI, 20/27 received T1gad. DWI was fitted with Intravoxel Incoherent Motion providing Dmaps. Viable and necrotic regions identified on T1gad were transferred to corresponding Dmaps. ROC analysis determined a D threshold separating necrotic and viable tissue. ANOVAs showed viable regions separated Blastemal from other subtypes, whole lesions could not. DWI separates necrotic and viable tissue in WT potentially identifying subtypes, assessing chemotherapy, guiding biopsies and surgery.
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