Renal cell carcinoma: preoperative evaluate the grade of histological malignancy using volumetric histogram analysis derived from magnetic resonance diffusion kurtosis imaging

Renal cell carcinoma (RCC) is the most common pathological type of kidney cancer. Its global morbidity and mortality increased at a rate of about 2–3% per decade (1). Histologic grade of RCC affects both patient’s prognosis and surgical planning. Consequently, an accurate preoperative assessment is essential (2,3). Histologic grade is mainly based on the Fuhrman classification system, which requires a needle biopsy or postoperative pathological examination. However, a biopsy is inherently invasive with multiple possible complications. Problems such as sampling errors and observer variability limit its application (4,5). Therefore, there is a need to develop non-invasive preoperative assessment methods