OBJECTIVE: To compare the diagnostic accuracy of intravoxel incoherent motion (IVIM)-derived parameters and apparent diffusion coefficient (ADC) in distinguishing between renal cell carcinoma (RCC) and fat poor angiomyolipoma (AML). MATERIALS AND METHODS: Eighty-three patients with pathologically confirmed renal tumors were included in the study. All patients underwent renal 1.5T MRI, including IVIM protocol with 8 b values (0–800 s/mm²). The ADC, diffusion coefficient (D), pseudodiffusion coefficient (D*), and perfusion fraction (f) were calculated. One-way ANOVA was used for comparing ADC and IVIM-derived parameters among clear cell RCC (ccRCC), non-ccRCC and fat poor AML. The diagnostic performance of these parameters was evaluated by using receiver operating characteristic (ROC) analysis. RESULTS: The ADC were significantly greater in ccRCCs than that of non-ccRCCs and fat poor AMLs (each p < 0.010, respectively). The D and D* among the three groups were significantly different (all p < 0.050). The f of non-ccRCCs were less than that of ccRCCs and fat poor AMLs (each p < 0.050, respectively). In ROC analysis, ADC and D showed similar area under the ROC curve (AUC) values (AUC = 0.955 and 0.964, respectively, p = 0.589) in distinguishing between ccRCCs and fat poor AMLs. The combination of D > 0.97 × 10⁻³ mm²/s, D* < 28.03 × 10⁻³ mm²/s, and f < 13.61% maximized the diagnostic sensitivity for distinguishing non-ccRCCs from fat poor AMLs. The final estimates of AUC (95% confidence interval), sensitivity, specificity, positive predictive value, negative predictive value and accuracy for the entire cohort were 0.875 (0.719–0.962), 100% (23/23), 75% (9/12), 88.5% (23/26), 100% (9/9), and 91.4% (32/35), respectively. CONCLUSION: The ADC and D showed similar diagnostic accuracy in distinguishing between ccRCCs and fat poor AMLs. The IVIM-derived parameters were better than ADC in discriminating non-ccRCCs from fat poor AMLs.
Angiomyolipoma* ; Area Under Curve ; Carcinoma, Renal Cell* ; Cohort Studies ; Diffusion ; Diffusion Magnetic Resonance Imaging ; Humans ; Magnetic Resonance Imaging ; Perfusion ; ROC Curve ; Sensitivity and Specificity

The popularization and promotion of exercise prescription plays a crucial role in the effective prevention and treatment of chronic diseases. In order to promote the development of sports-medicine integration and the clinical application of exercise prescription, the authors analyzed the basic connotation of exercise prescription, screened out 135 medical service items related to exercise prescription, including 114 exercise practice-type items, 13 experimental inspection-type items and 8 monitoring and evaluation-type items through searching the information query database of the National Medical Insurance Service Platform (data updated to June 2023), and explored the current situation of medical insurance payment for exercise prescription. Then the authors sorted out the existing problems of medical insurance payment for exercise prescription in China, and put forward such suggestions, as strengthening the standardized management of medical service items for exercise prescription, enhancing the enthusiasm of hospitals to apply exercise prescription, guaranteeing the seamless transition of the implementation of exercise prescription both inside and outside the hospitals, perfecting the evaluation system of the effect of exercise prescription medical service as well as advancing the medical insurance payment for exercise prescription.