A novel magnetic resonance imaging (MRI) technology can provide information about the nature and aggressiveness of a tumor without having to perform a biopsy.

Under development by researchers at the University of Texas (UT) Southwestern Medical Centre (Dallas, TX, USA), the renal multiparametric MRI (mpMRI) algorithm is designed to recognize clear cell carcinoma (ccRCC), the most common and aggressive form of kidney cancer, from MRI scans. The standardized diagnostic algorithm is largely based on the appearance of the renal mass on T2-weighted MRI, and images taken immediately after an intravenous contrast agent is administered. Other images are also used to indicate whether fat is present in the tumor.

To examine the efficacy of the algorithm, the researchers retrospectively reviewed the records of 110 patients with 121 small renal masses who underwent MRI and partial or radical nephrectomy. Seven radiologists who were blinded to final pathology findings independently reviewed the MRI images and applied a 5-level ccRCC likelihood score. The results showed that scores of 4 or greater demonstrated 78% sensitivity and 80% specificity, while scores of 3 or greater showed 95% sensitivity and 58% specificity. The study was published in the October 2017 issue of The Journal of Urology.

“Using mpMRI, multiple types of images can be obtained from the renal mass and each one tells us something about the tissue," said co-senior author Professor Ivan Pedrosa, MD, chief of MRI. “Based on the algorithm, doctors at UT Southwestern have a four-in-five chance of identifying clear cell cancer.”

“Biopsies are not entirely free of pain and discomfort. Patients, in fact, choose to observe the cancer simply to avoid the pain of the biopsy,” said co-senior author professor of urology and radiology Jeffrey Cadeddu, MD. “If we can avoid the anxiety and the fear and the rare, but possible complication of a biopsy, I think we're pushing medicine forward.”

mpMRI refers to the multiple sequences required to make the diagnosis, consisting of both anatomic T1-weighted and T2-weighted MRI sequences, as well as functional sequences, such as diffusion-weighted imaging MRI and dynamic contrast-enhanced MRI. By combining different types of scans, a clearer picture of the scanned area becomes available. Injecting a contrast agent also helps to enhance the image.
 

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