Short summary

Renal cancer, also called renal cell carcinoma (RCC), occurs in various forms of which the subtype clear cell carcinoma is most common. The various subtypes of RCC have different behaviour in terms of growth rate and treatment response. For now, the only way to diagnose RCC is histo-pathologically. Recent studies have shown that MRI are able to differ between benign and malignant renal tumors and provide structural information of the composition of the tumor. This offers the possibility to subgrade the renal tumors using non-invasive imaging. This could potentially provide new information regarding tumor behaviour and risk of metastasis, thus predicting prognosis and aid the planning of relevant treatment.

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Rationale

Introduction:

In Denmark the yearly prevalence of renal cancer is 600-700 persons. Every year, roughly 300 patients in Denmark die due to renal cancer. Renal cancer, also called renal cell carcinoma (RCC), occurs in various forms, of which the subtype clear cell carcinoma is most common (75%). The various subtypes of RCC have different behaviour in terms of growth rate and treatment response. Approximately 80% of all renal tumors are malignant.

More than 50% of those who are diagnosed with renal cancer are incidentally diagnosed. Approximately half of the patients diagnosed with RCC have localized cancer at the time of diagnosis and the majority of these will be cured. At the present time, the only way to diagnose RCC is histo-pathologically, consequently patients with renal tumor will have to undergo a percutaneous biopsy.

RCC is classified using the TNM system. Tumor grading expresses how aggressive the individual cancer is. Histo-pathology for renal clear cell cancer is graded according to the Fuhrman grading system, on a scale from 1 to 4. Grade 1 have cells with a nucleus that looks very similar to the normal renal cells, whereas Grade 4 renal cancer are very aggressive and has cells with a nucleus that look very different from normal renal cells.

Recent studies have shown that Multi Planar MRI with contrast (mpMRI) are able to differ between benign and malignant renal tumors. In addition, new experimental MRI sequences, have shown promising results by providing structural information of the composition of the tumor, on a molecular level. This offers the possibility to subgrade the renal tumors using non-invasive imaging. This could potentially provide new information regarding tumor behaviour and risk of metastasis, thus predicting prognosis and aid the planning of relevant treatment).

Hypothesis and aim:

With regards to diagnosis, we hypothesize that mpMRI examinations of renal tumors are comparable to histo-pathology examinations of renal tumor biopsies. Furthermore, we hypothesize that mpMRI can be a tool to distinguish malignant renal tumors from benign and to subdividing the different malignant renal tumors.

The aim of this present study is:

1) To conduct a literature study concerning MRI as a diagnostic tool for renal tumors

2) To design and implement a new mpMRI-protocol for renal tumors

3) To develop and test experimental MRI sequences to evaluate renal tumor's structural composition 

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Description of the cohort

All adult patients diagnosed with renal tumor at Odense University Hospital, Denmark between marts 2017 and February 2018 referred to image-guided biopsy, will have a supplementary mpMRI scan. The mpMRI will be performed on the same day as the secluded imaged-guided biopsy and at the same department. 

Data and biological material

Information regarding the patient's treatment and medical background, histopathological diagnose and MRI and CT scans.

Collaborating researchers and departments

University of Southern Denmark

• Medical student Janni Lynggård Bo Madsen

Department of Radiology, Odense University Hospital and Department of Clinical Medicine, University of Southern Denmark

• Associate professor Ole Graumann, PhD, MD

Department of Urology, Odense University Hospital and Department of Clinical Medicine, University of Southern Denmark

• Professor Lars Lund, PhD, MD

Comparative Medicine Lab and Department of Clinical Medicine, Aarhus University Hospital

• Professor Michael Petersen, PhD, MSc

Department of Urology, Aarhus University Hospital, Denmark

• Tommy Kjærgaard Nielsen, MD, PhD