Advanced Diffusion Imaging for Management of Renal Cancer: Oncologic Control and Renal Functional Reserve - Resubmission - 1

项目概要 肾癌是严重死亡率和发病率的一个来源，这不仅是由于原发性恶性肿瘤，而且还由于 肾部分切除术后肾功能丧失（有时导致慢性肾病）。方法 因此，无创监测肾功能并预测其对这种功能下降的鲁棒性 高要求。弥散加权 MRI 已准备好发挥这一作用，作为肾癌患者的辅助手段 现有的临床 MR 检查。我们的团队一直处于先进肾脏扩散 MRI 研究的前沿 对比，包括将微结构与微循环分开的方法（像素内不相干运动 （IVIM））并评估微观各向异性（扩散张量成像（DTI））。最近的综合方法 (REFMAP) 联合收集这些对比，从而可以评估微结构和微循环 各向异性。我们建议应用这个复合数据集来对原发性肾脏的侵袭性进行分类 病变并评估和预测术后肾功能。 将进行 IVIM-MRI 来表征原发病变的侵袭性。 REFMAP-MRI 协议 将用于在手术前和 1 年随访时评估肾癌患者，并与标准进行比较 临床检查（测量肾小球滤过率、蛋白尿）。横截面相关性将验证 REFMAP-MRI 技术的标记物作为肾功能的探针，以及预测肾功能的基线值 出现肾功能下降的患者将被识别。

PROJECT SUMMARY Renal cancer is a source of severe mortality and morbidity, not only due to the primary malignancy but also due to loss of renal function (sometimes leading to chronic kidney disease) after partial nephrectomy. Methods to noninvasively monitor renal function and predict its robustness against this decline of function are therefore in high demand. Diffusion-weighted MRI is well poised to play this role as an adjunct to renal cancer patients' existing clinical MR workup. Our group has been at the forefront of research into advanced renal diffusion MRI contrast, including methods to separate microstructure from microcirculation (intravoxel incoherent motion (IVIM)) and assess microscopic anisotropy (diffusion tensor imaging (DTI)). A recent comprehensive approach (REFMAP) collects these contrasts jointly, allowing assessment of microstructural and microcirculation anisotropy. We propose to apply this composite dataset both to classify aggressiveness of the primary renal lesion and to assess and predict post-surgical renal function. IVIM-MRI will be performed to characterize the aggressiveness of the primary lesion. The REFMAP-MRI protocol will be used to evaluate renal cancer patients before surgery and at 1 year follow up, in comparison with standard clinical workup (measured glomerular filtration rate, proteinuria). Cross-sectional correlation will validate the markers of the REFMAP-MRI technique as probes of renal function, and those baseline values predicting which patients experience renal function decline will be identified.