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The value of blood oxygen level dependent (BOLD) imaging in evaluating post-operative renal function outcomes after
Guangyu Wu1, Ruiyun Zhang2, Haiming Mao1
1Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No. 1630, Dongfang Road, Pudong, Shanghai, 200120, China.
Objectives:
To assess the ability of renal blood oxygen level dependent (BOLD) MRI metrics to predict post-operative renal function.
Methods:
We studied 152 patients who underwent laparoscopic partial nephrectomy (LPN) and renal MRI examination including BOLD. Short-term and long-term renal function was evaluated using the glomerular filtration rate (GFR) derived from renal scintigraphy. Renal function decline was assessed as the absolute decline (AD), percentage decline (PD) and optimal renal function preservation (OP). T2* values were analysed in the renal cortex and medulla ipsilateral and contralateral to the tumour. Clinical characteristics and imaging metrics were evaluated using univariate and multivariate linear regression analyses. Risk factors obtained using BOLD metrics (determined by multivariate regression) were then combined and compared with RENAL scores to predict OP.
Results:
Increasing warm ischaemia time (WIT), resected and ischaemic volume (RAIV), larger tumour size, higher RENAL score and lower preoperative GFR were short-term risk factors for AD, while increasing WIT and lower preoperative GFR were significant for long-term outcomes. Increasing WIT, RAIV, lower T2* value in the cortex and higher T2* value in the medulla on the ipsilateral side were short-term risk factors for PD, while all of the above factors (except WIT and RAIV) were significant for long-term outcomes. The performance of the combination of T2* values in the cortex and medulla on the ipsilateral side to tumour in predicting OP was better than RENAL score (AUC 0.762 vs 0.634, p = 0.013).
Conclusions:
Renal BOLD-MRI metrics could provide useful information to the clinician in predicting post-operative renal function outcomes.
Key Points:
• Renal fMRI metrics may be useful for prediction of renal functional outcomes and merit further study. • Renal fMRI metrics may reflect degree of baseline disease and ability to tolerate warm ischaemia. • Combination of T2* values was better than RENAL score for predicting OP.
Insights
Renal blood oxygen level dependent (BOLD) MRI metrics show promise in predicting kidney function after surgery. Combining T2* values from MRI was more effective than the RENAL score for predicting optimal renal function preservation.
Area of Science:
- Nephrology
- Radiology
- Surgical Oncology
Background:
- Laparoscopic partial nephrectomy (LPN) is a common procedure for kidney tumors.
- Assessing post-operative renal function is crucial for patient outcomes.
- Predictive tools for renal function post-LPN are needed.
Purpose of the Study:
- To evaluate the predictive capability of renal blood oxygen level dependent (BOLD) MRI metrics for post-operative renal function.
- To compare the efficacy of BOLD MRI metrics with the RENAL score in predicting renal function preservation.
Main Methods:
- 152 patients undergoing LPN had pre-operative renal MRI including BOLD sequences.
- Glomerular filtration rate (GFR) from renal scintigraphy assessed short- and long-term renal function.
- T2* values were analyzed in renal cortex and medulla.
- Multivariate regression identified risk factors; BOLD metrics were combined to predict optimal renal function preservation (OP).
Main Results:
- Warm ischaemia time (WIT), resected and ischaemic volume (RAIV), tumor size, RENAL score, and preoperative GFR were short-term risk factors for absolute decline (AD).
- Increasing WIT and lower preoperative GFR predicted long-term outcomes.
- BOLD MRI metrics (T2* values in cortex and medulla) combined to predict OP with higher accuracy (AUC 0.762) than the RENAL score (AUC 0.634).
Conclusions:
- Renal BOLD-MRI metrics offer valuable insights for predicting post-operative renal function.
- BOLD MRI metrics may reflect baseline kidney disease and tolerance to warm ischaemia.
- A combination of T2* values demonstrated superior predictive performance for optimal renal function preservation compared to the RENAL score.
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