Initial experience of combined microstructural and functional magnetic resonance imaging for the characterisation of renal tumours.

Motivation: Accurate differentiation of renal tumour subtype and grade is not currently possible using standard of care imaging. Goal(s): To use combined functional and microstructural MRI in the form of diffusion weighted imaging with VERDICT, proton density fat fraction and hyperpolarised [1-13C]pyruvate to detect the different histological and metabolic features of different renal tumours. Two patients with histologically proven renal tumours (grade 2 clear cell and grade 3 papillary) underwent MRI imaging. Approach: Two patients with histologically proven renal tumours (grade 2 clear cell and grade 3 papillary) underwent MRI imaging. Results: Combined function and microstructural MRI differentiated tumour types and normal kidney. Impact: This study demonstrates the first combined use of VERDICT, PDFF and hyperpolarised [1-13C]pyruvate. The differentiation of renal tumours has proven difficult on imaging and this combination is a promising approach to this significant clinical problem.