jats:titleAbstract</jats:title>jats:sec jats:titleBackground</jats:title> jats:pClinical 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 jats:italick</jats:italic>-t undersampling and reduced flip angles (TEMPURA) and tested their potential to quantify differences between renal tumour subtypes and grades.</jats:p> </jats:sec>jats:sec jats:titleMethods</jats:title> jats:pTwenty-four patients with treatment-naïve renal tumours were imaged: seven renal oncocytomas (RO); one eosinophilic/oncocytic renal cell carcinoma; two chromophobe RCCs (chRCC); three papillary RCCs (pRCC); and twelve 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.</jats:p> </jats:sec>jats:sec jats:titleResults</jats:title> jats:pHigh-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-resolutionjats:italic;</jats:italic> accelerated, jats:italicp</jats:italic> = 0.012) and ccRCC (high-resolution, jats:italicp</jats:italic> = 0.019; accelerated, jats:italicp</jats:italic> = 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 (grades 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 in comparison (jats:italicp</jats:italic> = 0.037).</jats:p> </jats:sec>jats:sec jats:titleConclusions</jats:title> jats:pBoth high-resolution and accelerated TEMPURA showed marked potential to quantify differences across renal tumour subtypes and between ccRCC grades.</jats:p> </jats:sec>jats:sec jats:titleTrial registration</jats:title> jats:pClinicalTrials.gov, <jats:ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="uri" xlink:href="https://clinicaltrials.gov/study/NCT03741426">NCT03741426</jats:ext-link>. Registered on 13 November 2018.</jats:p> </jats:sec>jats:sec jats:titleRelevance statement</jats:title> jats:pThe newly developed Tjats:sub2</jats:sub> mapping methods have improved resolution, shorter acquisition times, and promising quantifiable readouts to characterise incidental renal masses.</jats:p> </jats:sec>jats:sec jats:titleGraphical Abstract</jats:title>

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