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High-resolution and highly accelerated MRI T2 mapping as a novel tool to characterise renal tumour subtypes and grades

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Horvat Menih, Ines 
Li, Hao 
Priest, Andrew 


Background: Clinical imaging tools to probe aggressiveness of renal masses are lacking, and T2-weighted imaging as an integral part of magnetic resonance imaging protocol only provides qualitative information. We developed high-resolution and accelerated T2 mapping methods based on echo merging and using k-t undersampling and reduced flip angles (TEMPURA), and tested their potential to quantify differences between renal tumour subtypes and grades. Methods: Twenty-four patients with treatment-naïve renal tumours were imaged: 7 renal oncocytomas (RO); 1 eosinophilic/oncocytic renal cell carcinoma; 2 chromophobe RCCs (chRCC); 3 papillary RCCs (pRCC); and 12 clear cell RCCs (ccRCC). Median, kurtosis and skewness of T2 were quantified in tumours and in the normal-adjacent kidney cortex, and were compared across renal tumour subtypes and between ccRCC grades. Results: High-resolution TEMPURA depicted the tumour structure at improved resolution compared to conventional T2-weighted imaging. The lowest median T2 values were present in pRCC (high-resolution, 51 ms; accelerated, 45 ms), which was significantly lower than RO (high-resolution; accelerated, p = 0.012) and ccRCC (high-resolution, p = 0.019; accelerated, p = 0.008). ROs showed the lowest kurtosis (high-resolution, 3.4; accelerated, 4.0), suggestive of low intratumoural heterogeneity. Lower T2 values were observed in higher compared to lower grade ccRCCs (grade 2, 3 and 4 on high-resolution, 209 ms, 151 ms, and 106 ms; on accelerated, 172 ms, 160 ms, and 102 ms, respectively), with accelerated TEMPURA showing statistical significance on comparison (p = 0.037). Conclusions: Both, high-resolution and accelerated TEMPURA showed marked potential to quantify differences across renal tumour subtypes and between ccRCC grades.



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European radiology experimental

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Cancer Research UK (CTRQQR-2021\100012)