Multiparametric MRI of Solid Renal Masses: Principles and Applications of Advanced Quantitative and Functional Methods for Tumor Diagnosis and Characterization

Laothamatas, Indira; Mubarak, Haitham Al; Reddy, Arthi; Wax, Rebecca; Badani, Ketan K.; Taouli, Bachir; Bane, Octavia; Lewis, Sara

doi:10.1002/jmri.28718

Cited by 9 publications

(1 citation statement)

References 111 publications

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“…Functional MRI methods enable tumour biology to be probed beyond simple morphological evaluation and therefore aid differentiation and stratification, as exemplified by the recently developed clear cell likelihood scoring system (ccLS) 5 . While the ccLS requires qualitative interpretation by a radiologist, quantitative MRI biomarkers have the potential of providing objective, robust, quantitative comparisons between patients 6 . Despite the potential of these functional MRI metrics for clinical benefit, there have been few published studies in this field which mostly report surrogates for perfusion 7 , cellularity 8 , and hypoxia 9 , and all require further investigation.…”

Section: Introductionmentioning

confidence: 99%

Quantitative sodium-MRI detects differential sodium content in benign vs. malignant oncocytic renal tumours

Horvat-Menih,

Birchall,

Zamora-Morales

et al. 2024

Preprint

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BackgroundAccurate non-invasive subtyping of localised kidney tumours is an unmet clinical question in uro-oncology. Differentiation of benign renal oncocytomas (RO) from malignant chromophobe renal cell carcinomas (chRCC) is not possible using conventional imaging. Despite the importance of renal function for sodium regulation, little is known about sodium handling in kidney tumours.PurposeHere we used non-invasive sodium MRI (23Na-MRI) to quantify sodium concentration and relaxation dynamics across a range of different kidney tumour subtypes and have correlated these findings with imaging surrogates for perfusion, hypoxia, and cellularity.Materials and MethodsBetween January and April 2023, patients with localised renal masses were prospectively recruited and underwent23Na and proton (1H) MRI at 3T to acquire 3D maps of B1, total sodium concentration (TSC), proton and sodium relaxation rates (R2*), and diffusion weighted imaging (DWI). Statistical analysis included comparison and correlation of quantified imaging parameters across kidney tumour subtypes.ResultsTen patients were included in the final analysis (mean age±S.D. = 64±8 years; 7:3 male:female ratio) encompassing seven ROs, two chRCCs, two clear cell RCCs (ccRCC), and one papillary RCC (pRCC). The TSC was significantly higher in the ROs compared to the chRCCs: 162±58 mM vs. 71±2 mM (P< 0.05). The mean TSC in ccRCC was 135±59 mM, and 81 mM in pRCC. The23Na-derived and1H-derivedR2* values showed a weak correlation (Spearman r = 0.17;P= 0.50). There was a significant inverse correlation between TSC and1H-R2* (Spearman r = -0.39,P< 0.05), but TSC was independent of the DWI-derived imaging parameters.Conclusion23Na-MRI detected markedly different sodium concentrations within benign ROs and malignant chRCCs. In addition, the sodium signal inversely correlated with1H-R2* as a surrogate for hypoxia. Therefore we have shown the feasibility and potential of23Na-MRI for future research in renal tumours.Key results23Na-MRI was used to non-invasively assess kidney tumour subtypes for the first time.A significantly higher total sodium concentration was detected in benign renal oncocytoma (162±58 mM), compared to chromophobe renal cell carcinoma (71±2 mM), as the malignant counterpart:P< 0.05.Total sodium concentration showed a significant inverse correlation with1H-R2* (Spearman r = -0.39,P< 0.05), but it was independent of the diffusion-weighted imaging-derived parameters.Summary statement23Na-MRI showed potential for differentiating benign and malignant masses, to characterise kidney tumours, which may be linked to the underlying differences in deoxygenation as measured with1H-MRI.

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Section: Introductionmentioning

confidence: 99%

Quantitative sodium-MRI detects differential sodium content in benign vs. malignant oncocytic renal tumours

Horvat-Menih,

Birchall,

Zamora-Morales

et al. 2024

Preprint

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Probing Renal Microstructure and Function with Advanced Diffusion MRI: Concepts, Applications, Challenges, and Future Directions

Stabinska,

Wittsack,

Lerman

et al. 2023

Magnetic Resonance Imaging

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Diffusion measurements in the kidney are affected not only by renal microstructure but also by physiological processes (i.e., glomerular filtration, water reabsorption, and urine formation). Because of the superposition of passive tissue diffusion, blood perfusion, and tubular pre‐urine flow, the limitations of the monoexponential apparent diffusion coefficient (ADC) model in assessing pathophysiological changes in renal tissue are becoming apparent and motivate the development of more advanced diffusion‐weighted imaging (DWI) variants. These approaches take advantage of the fact that the length scale probed in DWI measurements can be adjusted by experimental parameters, including diffusion‐weighting, diffusion gradient directions and diffusion time. This forms the basis by which advanced DWI models can be used to capture not only passive diffusion effects, but also microcirculation, compartmentalization, tissue anisotropy. In this review, we provide a comprehensive overview of the recent advancements in the field of renal DWI. Following a short introduction on renal structure and physiology, we present the key methodological approaches for the acquisition and analysis of renal DWI data, including intravoxel incoherent motion (IVIM), diffusion tensor imaging (DTI), non‐Gaussian diffusion, and hybrid IVIM‐DTI. We then briefly summarize the applications of these methods in chronic kidney disease and renal allograft dysfunction. Finally, we discuss the challenges and potential avenues for further development of renal DWI.Level of Evidence5Technical EfficacyStage 2

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Evaluation of Kidney Injury Using Arterial Spin Labeling and Blood Oxygen Level‐Dependent MRI: An Experimental Study in Rats With Carbon Tetrachloride‐Induced Liver Cirrhosis

Qin,

Xie,

et al. 2024

Magnetic Resonance Imaging

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BackgroundSerum creatinine (Scr) may be not suited to timely and accurately reflect kidney injury related to chronic liver disease. Currently, the ability of arterial spin labeling (ASL) and blood oxygen level‐dependent (BOLD) sequences to evaluate renal blood flow (RBF) and blood oxygen in chronic liver disease remains to be verified.PurposeTo investigate the value of ASL and BOLD imaging in evaluating hemodynamics and oxygenation changes during kidney injury in an animal model of chronic liver disease.Study TypeProspective.Animal ModelChronic liver disease model was established by subcutaneous injection of carbon tetrachloride. Forty‐three male Sprague–Dawley rats (8 weeks) were divided into a pathological group (0, 2, 4, 6, 8, 12 weeks, each group: N = 6) and a continuous‐scanning group (N = 7).Field Strength/Sequence3‐T, ASL, BOLD, and T2W.AssessmentRegions of interest in the cortex (CO), outer stripe of the outer medulla (OSOM), and inner stripe of the outer medulla (ISOM) are manually delineated. The RBF and T2* values at each time point (0, 2, 4, 6, 8, 12 weeks) are measured and compared. Hematoxylin–eosin score (HE Score, damage area scoring method), alpha‐smooth muscle actin (α‐SMA), hypoxia‐inducible factor‐1alpha (HIF‐1α), peritubular capillar (PTC) density, Scr, and neutrophil gelatinase‐associated lipocalin were harvested.Statistical TestsAnalysis of variance, Spearman correlation analysis, Kruskal–Wallis tests, and receiver operating characteristic analysis with the area under the curve (AUC). A P‐value <0.05 was considered statistically significant.ResultsRenal RBF and T2* values of CO, OSOM, and ISOM were significantly different from baseline. Both RBF and T2* were significantly correlated with HE Score, α‐SMA, HIF‐1α, and PTC density (|r| = 0.406–0.853). RBF demonstrated superior diagnostic capability in identifying severe kidney injury in this model of chronic liver disease (AUC = 0.964).Data ConclusionImaging by ASL and BOLD may detect renal hemodynamics and oxygenation changes related to chronic liver disease early.Evidence Level5Technical EfficacyStage 2

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Multiparametric MRI of Solid Renal Masses: Principles and Applications of Advanced Quantitative and Functional Methods for Tumor Diagnosis and Characterization

Cited by 9 publications

References 111 publications

Quantitative sodium-MRI detects differential sodium content in benign vs. malignant oncocytic renal tumours

Quantitative sodium-MRI detects differential sodium content in benign vs. malignant oncocytic renal tumours

Probing Renal Microstructure and Function with Advanced Diffusion MRI: Concepts, Applications, Challenges, and Future Directions

Evaluation of Kidney Injury Using Arterial Spin Labeling and Blood Oxygen Level‐Dependent MRI: An Experimental Study in Rats With Carbon Tetrachloride‐Induced Liver Cirrhosis

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