PD10-03 IN-VIVO MULTIPARAMETRIC MAGNETIC RESONANCE STUDIES IN RENAL CELL CARCINOMA AND CORRELATION WITH HISTOPATHOLOGY

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You have accessJournal of UrologyKidney Cancer: Evaluation/Staging I1 Apr 2014PD10-03 IN-VIVO MULTIPARAMETRIC MAGNETIC RESONANCE STUDIES IN RENAL CELL CARCINOMA AND CORRELATION WITH HISTOPATHOLOGY Girdhar Bora, Rajeev Kumar, Durgesh Dwivedi, Naranamangalam Jagannathan, and Prabhjot Singh Girdhar BoraGirdhar Bora More articles by this author , Rajeev KumarRajeev Kumar More articles by this author , Durgesh DwivediDurgesh Dwivedi More articles by this author , Naranamangalam JagannathanNaranamangalam Jagannathan More articles by this author , and Prabhjot SinghPrabhjot Singh More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.479AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Over 20% of incidentally detected renal lesions are benign. However, current imaging modalities are often unable to definitively rule out malignancy. Functional magnetic resonance (MR) methods have been used to identify malignancy in various organs. As a first step in evaluating their role in kidney cancer, we evaluated their ability to differentiate renal cell carcinoma from normal kidney parenchyma. METHODS In an IRB approved protocol, 32 patients with suspected renal cell carcinoma (RCC) on computerized tomography were enrolled for pre-surgery multiparametric MR studies. Using a 1.5T whole body MR scanner, single voxel spectroscopy (MRS) and diffusion weighted imaging (DWI) was carried out with tumor identification based on conventional MR images. The MR data obtained from the malignant lesion was compared with normal kidney parenchyma and the final histology of the nephrectomy specimen. RESULTS Mobile lipid resonances at 0.9, 1.3, 2.2 and 5.4 ppm were seen in both cancers and healthy tissue. Metabolite resonance at 0.9ppm (L0.9) was due to the terminal methyl group of fatty acids,at 1.3-1.35 ppm (L1.3) due to methylene of fatty acid originating from lipids,at 2.2ppm (T2.2) due to methylene of unsaturated fatty acids in triglycerides and 5.4ppm (C5.4) due to unsaturated lipid (cholesterol). Resonance at 3.2ppm (C3.2) was attributed to choline containing compounds. On ratio analysis, there was an increase in mobile lipids in RCC and the C5.4/L1.3 ratio and C3.2/L1.3 ratio was significantly higher in RCC (Table 1). These mobile lipids also correlated with the aggressiveness of the RCC (Table 2). On DWI, there was significant restriction of diffusion in RCC (1.51±0.61x10-3 mm2/s) compared to the normal parenchyma(2.25±0.29x10-3 mm2/s) (p=0.00). CONCLUSIONS In vivo MR visible mobile lipids could reliably differentiate malignant tissue from normal kidney parenchyma. These may form the basis for differentiating malignant small renal masses in future studies. Table 1. MRS data from malignant and normal parenchyma Signal to noise ratio RCC (n=26) Normal (n=22) P value C5.4/L1.3 1.61±2.92 0.18±0.25 0.029 T2.2/L1.3 0.32±0.44 0.09±0.09 0.240 L0.9/L1.3 0.21±0.24 0.18±0.16 0.983 C3.2/L1.3 1.51±2.54(n=20) 0.11±0.17(n=16) 0.009 L0.9: Lipid at 0.9ppm; L1.3: Lipid at 1.3ppm; T2.2: Triglycerides at 2.2ppm; C3.2: Choline at 3.2ppm; C5.4: Cholesterol at 5.4ppm Table 2. MRS ratios varying by tumor grade Signal to noise ratio Low grade RCC High grade RCC P value C5.4/L1.3 0.41±0.88 4.94±3.63 0.001 T2.2/L1.3 0.14±0.19 0.61±0.18 0.003 L0.9/L1.3 0.24±0.26 0.49±0.47 0.566 L0.9: Lipid at 0.9ppm; L1.3: Lipid at 1.3ppm; T2.2: Triglycerides at 2.2ppm; C3.2: Choline at 3.2ppm; C5.4: Cholesterol at 5.4ppm © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e282-e283 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Girdhar Bora More articles by this author Rajeev Kumar More articles by this author Durgesh Dwivedi More articles by this author Naranamangalam Jagannathan More articles by this author Prabhjot Singh More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...