What does this research mean for the field?

Amide proton transfer-weighted (APTw) driven multiparametric MRI provides high diagnostic accuracy for evaluating split renal function in patients with renal cell carcinoma, offering a radiation-free and contrast-free alternative to traditional methods. Novelty: ClaimNovelty.METHODOLOGICAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To assess the clinical value of APTw-driven multiparameter MRI for evaluating split renal function in RCC patients.

March 26, 2026Open Access

Preoperative assessment of split renal function in patients with renal cell carcinoma by APTw driven multiparameter MRI

Key Points

To assess the clinical value of APTw-driven multiparameter MRI for evaluating split renal function in RCC patients.
Evaluated 25 healthy volunteers for APTw scanning stability and reproducibility.
Analyzed 95 RCC patients with 187 unilateral kidneys based on glomerular filtration rate from scintigraphy.
Used paired-sample t-tests and ANOVA for comparing imaging parameters across different renal function statuses.
Employed ROC curves and area under the curve calculations to assess diagnostic performance.
APTw imaging showed high stability and reproducibility in renal function assessment.
Significant differences in APTw were found between renal cortex and medulla in healthy individuals (p < 0.05).
APTw signal increased with renal function impairment, with diminishing differences between cortex and medulla (p < 0.05).
The combined multiparametric approach improved diagnostic performance (AUC = 0.864 for normal vs mild impairment; AUC = 0.934 for mild vs moderate-to-severe impairment).

Abstract

To investigate the clinical value of amide proton transfer-weighted (APTw) driven multiparameter magnetic resonance imaging (MRI) in evaluating split renal function in renal cell carcinoma (RCC) patients. Twenty-five healthy volunteers were recruited to evaluate the stability and reproducibility of renal APTw scanning and parameter measurements. Subsequently, 95 RCC patients were enrolled, with 187 unilateral kidneys analyzed. Based on glomerular filtration rate measured by renal dynamic scintigraphy, kidneys were categorized into normal function (n = 96), mild impairment (n = 69), and moderate-to-severe impairment (n = 22) groups. Paired-sample t-tests were performed to compare imaging parameters (APTw, apparent diffusion coefficient ADC, and fat fraction FF) between the renal cortex and medulla. One-way analysis of variance was used to compare imaging parameters across different renal function status, followed by Bonferroni correction for post-hoc pairwise comparisons. Receiver-operating characteristic curves and the area under the curve were employed to assess the diagnostic performance of each parameter in differentiating renal function status. Renal APTw imaging demonstrated high stability and reproducibility, with quantitative measurements unaffected by renal position or gender. In healthy volunteers, the renal cortex exhibited significantly higher APTw signal than medulla (p < 0.05). As renal function impairment progressed, renal APTw signal progressively increased, and the difference in APTw between the cortex and medulla gradually diminished (p < 0.05). APTw showed high diagnostic efficacy in differentiating renal function status. Multiparametric diagnosis combining APTw, ADC, and FF further improved diagnostic performance (AUC = 0.864 for distinguishing normal from mild impairment; AUC = 0.934 for distinguishing mild from moderate-to-severe impairment). Preliminary findings indicate that APTw driven multiparametric MRI demonstrates excellent diagnostic performance in evaluating split renal function in RCC patients, providing a potentially workflow-efficient, radiation-free and contrast-agent-free assessment method for clinical practice.

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