| Renal cell carcinoma is the most common tumor that origins from the renal tubular cell malignancies, the incidence of which has increased year by year, mainly dueing to the development of modern medical imaging technology and universal, thus imaging on the diagnosis of kidney cancer has a decisive significance. How to accurately determine the renal blood supply and distribution of tumor characteristics early befor surgery has very important significance of the treatment and and prognosis of the tumor.Radical nephrectomy is the standard treatment for the limitated kidney cancer, but in the cases whit renal cell carcinoma of isolated kidney and both kidneys, you need to retain the functional kidney organization, which does not apply radical nephrectomy. Nephron sparing surgery is the treatment for the isolated kidney and both kidneys'cancer at the first stage; and it achieved good effect, and later applied to the limitated renal cell carcinoma that the contralateral kidney is completely normal, also received a satisfactory long-term efficacy. Traditionally, it is believed that Nephron sparing surgery has no clinical value in maintaining the kidney's long-term function, which is based on the line side of the kidney transplant donor nephrectomy, after a long-term the contralateral kidney has normal renal function, or the limitated renal cell carcinoma in middle-aged patients whose renal function is normal in long-term follow-up after radical nephrectomy.Today, the incidence of renal cell carcinoma tend to be younger, for the younger patients have a risk of disease damaging the renal function such as potential high blood pressure, diabetes, high serum uric acid and so on. Paul matching of the long-term follow-up of radical nephrectomy compared with nephron sparing surgery statistics shows that nephrectomy sparing surgery is more prone to proteinuria and renal dysfunction. It has been reported that, based on a selection of patients, the recurrence rate and survival results of the patients with kidney-line partial nephrectomy and the radical nephrectomy have no significant difference. The nephron sparing surgery has extensively conducted in China and abroad.MRI functional imaging with high textural resolution and spatial resolution, can accurately show renal morphological changes, and provide information on kidney function is a function which is an important method of a function of imaging examination taday. Blood oxygenation level-dependent functional magnetic resonance imaging (Blood Oxygen Level Dependent Function Magnetic Resonance Imaging, BOLD MRI) is a kind of MRI functional imaging which can be used to respond hemoglobin oxygen content within the organization. Renal blood supply is rich in renal, medulla hypoxia-ischemiaplaying an important role in a number of the occurrence and development of kidney disease. In recent years,BOLD studies have becomed the clinical research hot spot. Studies have shown that, BOLD imaging data measured at different observers and the same observer has good repeatability. Thus, most scholars believe that BOLD imaging in the diagnosis and evaluation of renal disease has great potential value. However, up to now, the application of BOLD imaging evaluation of renal cell carcinoma reported in the literature is rare.PurposeBy the study of the MR BOLD imaging of the patients with renal cell carcinoma, we understand the characteristics of BOLD imaging to analyze blood oxygen status of renal cell carcinoma tissues, and explore the BOLD imaging in renal cancer and adjacent tissues of the clinical application value.Materials and MethodsUsing 3. OT GE HDx MRI in 38 cases of renal lesions in patients with cancer (no history of primary and secondary renal disease and renal dysfunction risk factors) to MRI BOLD imaging examination to obtain coronal R2* map. The original BOLD image is inputed to workstation (GE ADW4.4) applications FUNCTOOL software post-processing.25 patients of renal cell carcinoma have an operation after the MR examination. Gaining the pathological information, dyeing to the corresponding parts of HE staining, measuring the degree of tubulointerstitial lesions and the protein 1 of water channel and ant-smooth muscle actin of the tumor,analying the R2* values and pathological results.ResultsResults 1:renal cell carcinoma lesions and cancer tumor tissue and contralateral renal medulla have statistical sense (P<0.05), and adjacent tissues, distal kidney, contralateral kidney cortex and distal nephron medullary tissue has no significant different (P>0.05). R2* value of renal cell carcinoma with tumor has correlation with the vessel densityof the tumor (r=0.507, P<0.05). Results 2:renal clear cell carcinoma and adjacent tissues, kidney and contralateral distal renal cortex and medulla's R2* value comparison:cortical R2* values were significantly lower than the medulla, and was statistically significant (P<0.01). Adjacent tissue and contralateral kidney and distal renal medullary's R2* values were significantly (P<0.01), but the distal renal medulla and the contralateral renal R2* has no significant difference between the values (P<0.05). Adjacent tissue, kidney tissue and the contralateral distal renal cortex and medulla R2* value/cortical R2* values has the ratio of no significant difference. Adjacent tissues and the distal renal tubular-interstitial lesions were significantly (P<0.01). Tubular-interstitial lesions and renal medulla of the R2* value has no correlation (P>0.05). Adjacent tissues and the distal renal AQP1 values:there was significantly (P<0.01). Renal medulla of AQP1 values and R2* value have no correlation (P>0.05).ConclusionFirst time, we explore the role of the BOLD-MRI techniques in predicting the function of kidney cancer and adjacent tissues for the first time. BOLD MRI as a relatively new method of functional magnetic resonance imaging examination may be non-invasive evaluation of the oxygen levels of the tissue of tumor and the renal function in cancer tissues changes, R2* color pictures can be more intuitive to provide information, combined with conventional magnetic resonance imaging can simultaneously obtain information on morphology and function. |
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