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

项目总结 肾癌是严重死亡和发病率的来源，不仅是由于原发恶性肿瘤，而且是由于 肾部分切除后肾功能丧失(有时会导致慢性肾脏疾病)。方法，以 因此，无创监测肾功能和预测其对这种功能下降的稳健性是值得注意的 需求量很大。磁共振弥散加权成像可以作为肾癌患者的辅助检查发挥这一作用。 现有的临床核磁共振检查。我们团队一直处于先进的肾脏弥散磁共振研究的前沿 对比，包括分离微结构和微循环的方法(体素内非相干运动 (IVIM))和评估微观各向异性(扩散张量成像(DTI))。最近的一种综合方法 (REFMAP)联合收集这些对比，从而能够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 以评估和预测手术后的肾功能。 IVIM-MRI将被用来描述原发灶的侵袭性。REFMAP-MRI协议 将用于肾癌患者手术前和术后1年的评估，并与标准进行比较 临床检查(测量肾小球滤过率、蛋白尿)。横截面对比将验证 作为肾功能探针的REFMAP-MRI技术的标志物，以及那些预测 出现肾功能下降的患者将被确定。

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.