Suhua Li

Diagnostic accuracy of 320-slice computed tomography angiography for detection of coronary artery stenosis: Meta-analysis

OBJECTIVE This study aims to review the recent literatures on the diagnostic accuracy of 320-slice computed tomography angiography (CTA) for detection of coronary artery stenosis, with invasive coronary angiography (ICA) as the reference standard. METHODS A PubMed and EMBASE cross-search of the literatures on use of 320-slice CTA compared with ICA for detection of coronary artery stenosis, with publication date limited to January 1, 2008 to December 31, 2012. Individual and pooled sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated at the patient-, vessel- and segment-level. A positive result was defined as greater than or equal to 50%-diameter stenosis. RESULTS A total of ten studies were included in the present meta-analysis, examining 1088 patients, 1629 vessels and 12,406 segments. The meta-analysis at the patient-level indicated a pooled sensitivity of 93% (95%CI: 91%-95%), specificity of 86% (95%CI: 82%-89%), PPV of 90% (95%CI: 87%-92%) and NPV of 90% (95%CI: 87%-93%). At the vessel-level, the pooled sensitivity was 92% (95%CI: 89%-94%), specificity 95% (95%CI: 94%-96%), PPV 87% (95%CI: 83%-90%), and NPV 97% (95%CI: 96%-98%). At the segment-level, the pooled sensitivity was 78% (95%CI: 76%-80%), specificity 98% (95%CI: 97%-98%), PPV 82% (95%CI: 80%-84%), and NPV 97% (95%CI: 97%-97%). CONCLUSIONS 320-CTA can effectively identify the majority of patients with coronary artery disease (CAD). The high NPV makes it as an effective noninvasive alternative to ICA for the exclusion of stenosis.

The diagnostic performance of CT-derived fractional flow reserve for evaluation of myocardial ischaemia confirmed by invasive fractional flow reserve: a meta-analysis

AIM To review the literature on the diagnostic accuracy of CT-derived fractional flow reserve (FFRCT) for the evaluation of myocardial ischaemia in patients with suspected or known coronary artery disease, with invasive fractional flow reserve (FFR) as the reference standard. MATERIALS AND METHODS A PubMed, EMBASE, and Cochrane cross-search was performed. The pooled diagnostic accuracy of FFRCT, with FFR as the reference standard, was primarily analysed, and then compared with that of CT angiography (CTA). The thresholds to diagnose ischaemia were FFR ≤0.80 or CTA ≥50% stenosis. Data extraction, synthesis, and statistical analysis were performed by standard meta-analysis methods. RESULTS Three multicentre studies (NXT Trial, DISCOVER-FLOW study and DeFACTO study) were included, examining 609 patients and 1050 vessels. The pooled sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (LR+), negative likelihood ratio (LR-), and diagnostic odds ratio (DOR) for FFRCT were 89% (85-93%), 71% (65-75%), 70% (65-75%), 90% (85-93%), 3.31 (1.79-6.14), 0.16 (0.11-0.23), and 21.21 (9.15-49.15) at the patient-level, and 83% (78-63%), 78% (75-81%), 61% (56-65%), 92% (89-90%), 4.02 (1.84-8.80), 0.22 (0.13-0.35), and 19.15 (5.73-63.93) at the vessel-level. At per-patient analysis, FFRCT has similar sensitivity but improved specificity, PPV, NPV, LR+, LR-, and DOR versus those of CTA. At per-vessel analysis, FFRCT had a slightly lower sensitivity, similar NPV, but improved specificity, PPV, LR+, LR-, and DOR compared with those of CTA. The area under the summary receiver operating characteristic curves for FFRCT was 0.8909 at patient-level and 0.8865 at vessel-level, versus 0.7402 for CTA at patient-level. CONCLUSIONS FFRCT, which was associated with improved diagnostic accuracy versus CTA, is a viable alternative to FFR for detecting coronary ischaemic lesions.

Glycemic variability evaluated by continuous glucose monitoring system is associated with the 10-y cardiovascular risk of diabetic patients with well-controlled HbA1c.

BACKGROUND The present study aimed to identify the relationship between glycemic variability (GV) and the 10-y risk of cardiovascular disease (CVD) in type 2 diabetes mellitus (T2DM) patients with good glycemic control. METHODS Two-hundred forty consecutive T2DM patients (HbA1c≤7.0%) without CVD were included to calculate the 10-y CVD risk by Framingham risk score (FRS), and divided into 3 groups: low-risk group (FRS≤10%), intermediate-risk group (>10%, ≤20%) and high-risk group (>20%). Inter-group differences of GV were determined by comparing the SD of blood glucose (SDBG), mean amplitudes of glycemic excursion (MAGE), and mean of daily differences (MODD) gathered from 72-h continuous glucose monitoring system. RESULTS The levels of SDBG and MAGE significantly increased along with the raises of 10-y CVD risk of T2DM patients (p<0.01). FRS was positively correlated with age, systolic blood pressure, SDBG and MAGE (r=0.717, 0.525, 0.509 and 0.485 respectively, p<0.01), while negatively correlated with the level of HDL-C (r=-0.348, p<0.01). Furthermore, multivariate logistic regression analysis confirmed that increased MAGE [OR: 1.623(1.198-2.316), p<0.001] and patients with high urine albumin excretion rates [OR: 1.743(1.247-2.793), p<0.001] were independent predictors for high 10-y CVD risk. CONCLUSION GV predicts independently the 10-y CVD risk of T2DM patients with well-controlled HbA1c.

A head-to-head comparison of homocysteine and cystatin C as pre-procedure predictors for contrast-induced nephropathy in patients undergoing coronary computed tomography angiography

BACKGROUND Homocysteine is a potential predictor for contrast-induced nephropathy (CIN). We aimed to compare homocysteine with cystatin C as pre-procedure predictors for CIN in patients undergoing coronary computed tomography angiography (CCTA). METHODS A total of 580 consecutive patients were enrolled. Concentrations of plasma homocysteine and serum cystatin C were measured before CCTA. CIN is defined as an elevation of creatinine by ≥ 25% or ≥ 0.5mg/dl from baseline within 48h. Receiver operating characteristic curves, Pearson correlation coefficients and logistic regression analysis were used to evaluate the efficiency of potential predictors. RESULTS Fifty-seven (9.83%) patients developed CIN. Concentrations of homocysteine (19.35 ± 4.32 μmol/l vs. 13.42 ± 3.96 μmol/l, p<0.001) and cystatin C (1.20 ± 0.21 mg/dl vs. 0.99 ± 0.15 mg/dl, p<0.001) increased significantly in CIN subjects. CIN was predicted by homocysteine (AUC 0.829, p<0.001) and cystatin C (AUC 0.774, p<0.001), while creatinine was not predictive. Both homocysteine and cystatin C had positive correlation with ΔCreatinine48h-0 (p<0.001) and negative correlation with ΔeGFR48h-0 (p<0.001). Regression analysis confirmed that increased baseline homocysteine [OR: 1.262 (1.123, 2.554), p<0.001] and cystatin C [OR: 1.565 (1.380, 1.775), p<0.001] were independent predictors for CIN. CONCLUSIONS Homocysteine, with similar predictive value compared to cystatin C, was an independent biomarker for predicting CIN before CCTA examination.

Imaging features predict prognosis of patients with combined hepatocellular-cholangiocarcinoma

AIM To evaluate the prognostic value of imaging patterns in combined hepatocellular-cholangiocarcinoma. MATERIALS AND METHODS A total of 36 patients with histopathologically confirmed combined hepatocellular-cholangiocarcinoma were enrolled. Pretreatment imaging was conducted to evaluate the tumour enhancement patterns, based on which the disease was classified as two subtypes: radiographic hepatocellular carcinoma-dominant (n=26) and radiographic cholangiocarcinoma-dominant (n=10). Moreover, based on the proportion of components, all combined hepatocellular-cholangiocarcinoma cases were divided into histopathological hepatocellular carcinoma-dominant (n=26) or histopathological cholangiocarcinoma-dominant (n=10). The Kaplan-Meier method was used to compare patient outcome between the two subtypes of each classification. Univariate Cox regression analysis were employed to evaluate the prognostic relevance of the imaging and histopathological classification. RESULTS Consistency between histopathological and imaging classification was not high. Only 66.7% of patients had consistent classification. Moreover, the median overall survival of the radiographic cholangiocarcinoma-dominant and radiographic hepatocellular carcinoma-dominant population was 15.03 and 40.4 months, respectively (p=0.012); however, no significant difference was observed between histopathological type, with median overall survival being 32.07 and 40.4 months in the histopathological cholangiocarcinoma-dominant group and histopathological hepatocellular carcinoma-dominant group, respectively (p=0.784). CONCLUSION There was an association between imaging patterns and overall survival in combined hepatocellular-cholangiocarcinoma. Postoperative re-evaluation of imaging patterns could help to assess patient outcome.

Trimetazidine improves exercise tolerance in patients with ischemic heart disease : A meta-analysis.

AimThis study aimed to evaluate the effect of trimetazidine (TMZ) in addition to standard treatment on exercise tolerance in patients with ischemic heart disease (IHD).MethodsStudies were identified via a systematic search of PubMed, Embase, Cochrane Library, and the Chinese CNKI databases from January 1978 to January 2015. Data extraction, synthesis, and statistical analysis were performed by standard meta-analysis methods. Random or fixed effects models were used to estimate pooled mean differences in total exercise duration (TED), peak oxygen uptake (pVO2), metabolic equivalent system (METS), and 6-minute walking test (6-MWT).ResultsIn all, 16 randomized controlled trials (RCTs) consisting of 2,004 participants were included. Pooled results showed that TMZ treatment significantly improved TED (WMD: 37.35, 95 % CI: 25.58–49.13, p < 0.00001), pVO2 (WMD: 2.41, 95 % CI: 1.76–3.06, p < 0.00001), METS (WMD: 1.33, 95 % CI: 0.38–2.28, p = 0.006), and 6-WMT (WMD: 62.46, 95 % CI: 35.86–89.05, p < 0.001) in all patients with IHD. Subgroup analysis showed that TMZ significantly increased TED in nondiabetic participants (WMD 34.77, 95 % CI: 22.28–47.25, p < 0.001), but not in diabetic participants (WMD: 40.36, 95 % CI: − 18.76–99.48, p = 0.18). And, subgroup analysis of TED by intervention duration suggested that there is no statistically difference between the 3-month and 6-month periods (WMD: 35.47, 95 %CI: 18.35–52.60, p < 0.0001 and WMD: 49.94, 95 %CI: 44.69–55.19, p < 0.00001). In addition, TMZ improved TED (WMD: 50.01, 95 % CI: 44.77–55.25 and WMD: 24.20, 95 % CI: 12.72–35.68) in IHD patients with or without heart failure (HF), respectively.ConclusionAddition of TMZ to standard treatment significantly improved exercise tolerance in patients with IHD, and IHD patients with HF may experience even more benefits. However, there is insufficient evidence to show that TMZ has beneficial effects in participants with diabetes.ZusammenfassungZielZiel der vorliegenden Studie war es, die Wirkung von Trimetazidin (TMZ) zusätzlich zu der Standardtherapie auf die Belastungstoleranz bei Patienten mit ischämischer Herzerkrankung („ischemic heart disease“, IHD) zu untersuchen.MethodenStudien wurden über eine systematische Suche in den Datenbanken PubMed, Embase, Cochrane Library und in der chinesischen CNKI (China National Knowledge Infrastructure) von Januar 1978 bis Januar 2015 gesucht. Die Datenerfassung, -synthese und statistische Analyse erfolgten mit Standardmethoden der Metaanalyse. Random- oder Fixed-Effects-Modelle wurden eingesetzt, um die gepoolten mittleren Differenzen bei der Gesamtbelastungsdauer („total exercise duration“, TED), der Spitzensauerstoffaufnahme („peak oxygen uptake“, pVO2), dem metabolischen Äquivalentsystem („metabolic equivalent system“, METS) und dem 6-min-Gehtest („6-minute walking test“, 6-MWT) abzuschätzen.ErgebnisseEs wurden 16 randomisierte kontrollierte Studien (RCT) mit 2004 Teilnehmern in die Auswertung eingeschlossen. Die gepoolten Ergebnisse zeigten, dass die TMU-Behandlung zu einer signifikanten Verbesserung der TED (gewichtete mittlere Differenz, WMD: 37,35; 95 %-Konfidenzintervall, 95%-KI: 25,58–49,13; p < 0,00001), der pVO2 (WMD: 2,41; 95 %-KI: 1,76–3,06; p < 0,00001), des METS (WMD: 1,33; 95 %-KI: 0,38–2,28; p = 0,006) und des 6-WMT (WMD: 62,46; 95 %-KI: 35,86–89,05; p < 0,001) bei allen Patienten mit IHD führte.Die Subgruppenanalyse ergab, dass TMZ die TED bei Teilnehmern ohne Diabetes mellitus signifikant erhöhte (WMD 34,77; 95 %-KI: 22,28–47,25; p < 0,001), nicht aber bei Teilnehmern mit Diabetes (WMD: 40,36; 95 %-KI: − 18,76–99,48; p = 0,18). Und aus der Subgruppenanalyse der TED nach Interventionsdauer ergaben sich Hinweise darauf, dass statistisch kein Unterschied zwischen der 3-monatigen und der 6-monatigen Dauer bestehe (WMD: 35,47; 95 %-KI: 18,35–52,60; p < 0,0001 bzw. WMD: 49,94; 95 %-KI: 44,69–55,19; p < 0,00001). Außerdem zeigte sich eine Verbesserung der TED unter TMZ (WMD: 50,01; 95 %-KI: 44,77–55,25 bzw. WMD: 24,20; 95 %-KI: 12,72–35,68) bei IHD-Patienten mit bzw. ohne Herzinsuffizienz.SchlussfolgerungDie zusätzliche Gabe von TMZ zur Standardbehandlung verbesserte die Belastungstoleranz signifikant bei Patienten mit ischämischer Herzerkrankung. IHD-Patienten mit Herzinsuffizienz haben möglicherweise noch einen größeren Nutzen. Es gibt jedoch keine ausreichende Evidenz dafür, dass TMZ einen Nutzeffekt bei Teilnehmern mit Diabetes mellitus habe.

Preprocedure and Postprocedure Predictive Values of Serum β2-Microglobulin for Contrast-Induced Nephropathy in Patients Undergoing Coronary Computed Tomography Angiography: A Comparison With Creatinine-Based Parameters and Cystatin C.

Objective This study aimed to investigate the values of serum &bgr;2-microglobulin to predict contrast-induced nephropathy (CIN) before and early after coronary computed tomography angiography (CCTA), comparing with creatinine-based parameters and cystatin C. Methods A total of 424 patients were enrolled. Serum &bgr;2-microglobulin, cystatin C, and creatinine were measured at 0, 24, and 48 hours of CCTA. Contrast-induced nephropathy was defined as an elevation of serum creatinine level by 25% or higher or 0.5 mg/dL or greater from baseline within 48 hours. The estimated glomerular filtration rate (eGFR) was calculated by the Modification of Diet in Renal Disease study equation. Receiver operating characteristic curves and multivariate logistic regression analysis were used to detect the efficiency of biomarkers in predicting CIN. Results Fifty-two subjects (12.26%) developed CIN. Before CCTA, CIN was predicted by both baseline &bgr;2-microglobulin (area under the receiver operating characteristic curve [AUC], 0.791; P < 0.001) and cystatin C (AUC, 0.781; P < 0.001), whereas creatinine and eGFR were not predictive. After CCTA, CIN was predicted by both the absolute post-CCTA levels of &bgr;2-microglobulin, cystatin C, creatinine, and eGFR (AUC, 0.842 vs 0.961 vs 0.691 vs 0.688 at 24 hours, P < 0.001; and 0.937 vs 1.000 vs 0.908 vs 0.898 at 48 hours, P < 0.001) and their relative changes (&Dgr;) to baseline (AUC, 0.677 vs 0.846 vs 0.850 vs 0.844 at 24 hours, P < 0.001; and 0.731 vs 0.968 vs 0.984 vs 0.966 at 48 hours, P < 0.001). Multivariate regression analysis confirmed that baseline &bgr;2-microglobulin (odds ratio, 2.137; 95% confidence interval, 1.805–3.109; P < 0.001) and cystatin C (odds ratio, 1.873; 95% confidence interval, 1.667–2.341; P = 0.003) were independent predictors for CIN. Conclusions Serum &bgr;2-microglobulin, with values superior to creatinine-based parameters and similar with cystatin C, was a useful biomarker for the prediction of CIN at pre-CCTA and early post-CCTA.

Effect of potassium supplementation on vascular function: A meta-analysis of randomized controlled trials

BACKGROUND Effects of potassium supplementation on vascular function remain conflicting. This meta-analysis aimed to summarized current literature to fill the gaps in knowledge. METHODS A literature search was performed on PubMed database through April, 2016. The measurements of vascular function included pulse wave velocity (PWV), augmentation index (AI), pulse pressure (PP), flow mediated dilatation (FMD), glycerol trinitrate responses (GTN), and intercellular cell adhesion molecule-1 (ICAM-1). Data were pooled as standardized mean difference (SMD) with 95% confidence intervals. RESULTS Seven randomized controlled trials examining 409 participants were included, with dosage of potassium ranging from 40 to 150mmol/day, and duration of intervention from 6days to 12months. Pooling results revealed a significant improvement in PP (SMD -0.280, 95% CI -0.493 to -0.067, p=0.010), but no improvement in PWV (SMD -0.342, 95% CI -1.123 to 0·440, p=0.391), AI (SMD -0.114, 95% CI -0.282 to 0.054, p=0.184), FMD (SMD 0·278, 95% CI -0.321 to 0.877, p=0.363), GTN (SMD -0.009, 95% CI -0.949 to 0.930, p=0.984), and ICAM-1 (SMD -0.238, 95% CI -0.720 to 0.244, p=0.333). CONCLUSIONS Potassium supplementation was associated with significant improvement of PP, rather than other measurements of vascular function. However, the small number of researches and wide variation of evidences make it difficult to make a definitive conclusion.

Trimetazidine improves exercise tolerance in patients with ischemic heart disease

AimThis study aimed to evaluate the effect of trimetazidine (TMZ) in addition to standard treatment on exercise tolerance in patients with ischemic heart disease (IHD).MethodsStudies were identified via a systematic search of PubMed, Embase, Cochrane Library, and the Chinese CNKI databases from January 1978 to January 2015. Data extraction, synthesis, and statistical analysis were performed by standard meta-analysis methods. Random or fixed effects models were used to estimate pooled mean differences in total exercise duration (TED), peak oxygen uptake (pVO2), metabolic equivalent system (METS), and 6-minute walking test (6-MWT).ResultsIn all, 16 randomized controlled trials (RCTs) consisting of 2,004 participants were included. Pooled results showed that TMZ treatment significantly improved TED (WMD: 37.35, 95 % CI: 25.58–49.13, p < 0.00001), pVO2 (WMD: 2.41, 95 % CI: 1.76–3.06, p < 0.00001), METS (WMD: 1.33, 95 % CI: 0.38–2.28, p = 0.006), and 6-WMT (WMD: 62.46, 95 % CI: 35.86–89.05, p < 0.001) in all patients with IHD. Subgroup analysis showed that TMZ significantly increased TED in nondiabetic participants (WMD 34.77, 95 % CI: 22.28–47.25, p < 0.001), but not in diabetic participants (WMD: 40.36, 95 % CI: − 18.76–99.48, p = 0.18). And, subgroup analysis of TED by intervention duration suggested that there is no statistically difference between the 3-month and 6-month periods (WMD: 35.47, 95 %CI: 18.35–52.60, p < 0.0001 and WMD: 49.94, 95 %CI: 44.69–55.19, p < 0.00001). In addition, TMZ improved TED (WMD: 50.01, 95 % CI: 44.77–55.25 and WMD: 24.20, 95 % CI: 12.72–35.68) in IHD patients with or without heart failure (HF), respectively.ConclusionAddition of TMZ to standard treatment significantly improved exercise tolerance in patients with IHD, and IHD patients with HF may experience even more benefits. However, there is insufficient evidence to show that TMZ has beneficial effects in participants with diabetes.ZusammenfassungZielZiel der vorliegenden Studie war es, die Wirkung von Trimetazidin (TMZ) zusätzlich zu der Standardtherapie auf die Belastungstoleranz bei Patienten mit ischämischer Herzerkrankung („ischemic heart disease“, IHD) zu untersuchen.MethodenStudien wurden über eine systematische Suche in den Datenbanken PubMed, Embase, Cochrane Library und in der chinesischen CNKI (China National Knowledge Infrastructure) von Januar 1978 bis Januar 2015 gesucht. Die Datenerfassung, -synthese und statistische Analyse erfolgten mit Standardmethoden der Metaanalyse. Random- oder Fixed-Effects-Modelle wurden eingesetzt, um die gepoolten mittleren Differenzen bei der Gesamtbelastungsdauer („total exercise duration“, TED), der Spitzensauerstoffaufnahme („peak oxygen uptake“, pVO2), dem metabolischen Äquivalentsystem („metabolic equivalent system“, METS) und dem 6-min-Gehtest („6-minute walking test“, 6-MWT) abzuschätzen.ErgebnisseEs wurden 16 randomisierte kontrollierte Studien (RCT) mit 2004 Teilnehmern in die Auswertung eingeschlossen. Die gepoolten Ergebnisse zeigten, dass die TMU-Behandlung zu einer signifikanten Verbesserung der TED (gewichtete mittlere Differenz, WMD: 37,35; 95 %-Konfidenzintervall, 95%-KI: 25,58–49,13; p < 0,00001), der pVO2 (WMD: 2,41; 95 %-KI: 1,76–3,06; p < 0,00001), des METS (WMD: 1,33; 95 %-KI: 0,38–2,28; p = 0,006) und des 6-WMT (WMD: 62,46; 95 %-KI: 35,86–89,05; p < 0,001) bei allen Patienten mit IHD führte.Die Subgruppenanalyse ergab, dass TMZ die TED bei Teilnehmern ohne Diabetes mellitus signifikant erhöhte (WMD 34,77; 95 %-KI: 22,28–47,25; p < 0,001), nicht aber bei Teilnehmern mit Diabetes (WMD: 40,36; 95 %-KI: − 18,76–99,48; p = 0,18). Und aus der Subgruppenanalyse der TED nach Interventionsdauer ergaben sich Hinweise darauf, dass statistisch kein Unterschied zwischen der 3-monatigen und der 6-monatigen Dauer bestehe (WMD: 35,47; 95 %-KI: 18,35–52,60; p < 0,0001 bzw. WMD: 49,94; 95 %-KI: 44,69–55,19; p < 0,00001). Außerdem zeigte sich eine Verbesserung der TED unter TMZ (WMD: 50,01; 95 %-KI: 44,77–55,25 bzw. WMD: 24,20; 95 %-KI: 12,72–35,68) bei IHD-Patienten mit bzw. ohne Herzinsuffizienz.SchlussfolgerungDie zusätzliche Gabe von TMZ zur Standardbehandlung verbesserte die Belastungstoleranz signifikant bei Patienten mit ischämischer Herzerkrankung. IHD-Patienten mit Herzinsuffizienz haben möglicherweise noch einen größeren Nutzen. Es gibt jedoch keine ausreichende Evidenz dafür, dass TMZ einen Nutzeffekt bei Teilnehmern mit Diabetes mellitus habe.

Efficacy of 3D VIBE Dixon fat quantification for differentiating clear-cell from non-clear-cell renal cell carcinoma

AIM To assess the efficacy of three-dimensional (3D) volumetric interpolated breath-hold examination (VIBE) magnetic resonance imaging (MRI) with Dixon quantification for differentiating clear-cell from non-clear-cell types of renal cell carcinoma (RCC). MATERIALS AND METHODS The 3D VIBE Dixon renal MRI examinations of 44 patients with 45 histologically confirmed RCCs was analysed. The fat fractions and signal intensity indexes (SIindex) of the solid portions of clear-cell and non-clear-cell RCCs were measured and compared using Students t-test and receiver operating characteristic (ROC) curves. The agreement of measurements among observers was evaluated by the intraclass correlation coefficient (ICC), and Bland-Altman plots. RESULTS The mean values of fat fraction (13.16±7.16%) and SIindex (22.64±15.7%) in clear-cell RCCs were significantly higher than that in non-clear-cell RCCs (7.7±2% and 7.9±4.8%; p<0.001, respectively). With the area under the ROC curve (AUC) of the fat fraction at 0.811, 75% (95% CI: 55.1-89.43%) sensitivity and 76.5% (95% CI: 50.1-93.2%) specificity for diagnosing clear-cell RCC were obtained at a cut-off fat fraction value of 8.9%. With a cut-off value of 8.89%, the diagnostic sensitivity and specificity were 85.7% (95% CI: 67.3-96%) and 70.6% (95% CI: 44-89.7%), respectively. The AUC of the SIindex was 0.870 (0.766-0.973). ICC and Bland-Altman plots show excellent agreement of the tumour fat fraction and SIindex measurement between the two observers. CONCLUSION Intracellular lipid content analysis using the 3D Dixon technique can help to differentiate clear-cell from non-clear-cell RCCs.