Abstract 311P
Background
Fumarate hydratase-deficient renal cell carcinoma (FH-RCC) and high-grade clear cell renal cell carcinoma (ccRCC) are both highly aggressive tumors with distinct molecular biological features and therapeutic options. However, their atypical CT imaging presentations make early diagnosis challenging. This study aimed to evaluate the feasibility of using blood oxygenation level-dependent (BOLD) MRI to differentiate between these two types of renal cell carcinoma.
Methods
Patients with suspected FH-RCC or high-grade ccRCC (ISUP grade 3 or 4), which could not be differentiated on CT according to preoperative multi-disciplinary treatment discussions, were included in this study. These patients prospectively underwent BOLD MRI scans and were ultimately confirmed by pathology between April 2020 and June 2024. Regions of interest were manually annotated on three continuous images showing the largest tumor area while avoiding hemorrhage and necrosis, and the weighted mean R2* values (R2*tumor) were calculated. Additionally, the mean R2* values of the contralateral renal cortex (R2*cortex) were also calculated.
Results
A total of 101 patients were included in the study, comprising 25 with FH-RCC and 76 with high-grade ccRCC. The mean (±SD) R2*tumor for FH-RCC and high-grade ccRCC were 24.38±14.33 and 40.11±27.80 1/s, respectively (p < 0.0001). The mean (±SD) R2*tumor/ R2*cortex ratio for FH-RCC and high-grade ccRCC were 1.11±0.07 and 2.04±0.13, respectively (p < 0.0001). The R2*tumor/ R2*cortex ratio demonstrated significantly better discrimination between FH-RCC and high-grade ccRCC compared to the R2*tumor value alone (AUC = 0.860 vs. 0.765).
Conclusions
Renal BOLD MRI is a feasible tool and can be used to differentiate FH-RCC from high-grade ccRCC, providing important clues for preclinical warning.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.