Evaluation of Lipid Poor Renal Masses with Magnetic Resonance Spectroscopy in Tuberous Sclerosis Complex
Abstract
People with tuberous sclerosis complex (TSC) have a high risk of tumors growing in their kidneys. Many of these tumors will be non-cancerous; however, some will be kidney cancer. Non-cancerous tumors, called angiomyolipomas, can sometimes look exactly like a kidney cancer on imaging studies of the kidneys, including magnetic resonance imaging (MRI). Many of these patients will have biopsies of these tumors, and many of these patients will also have surgical removal of these tumors, sometimes only to find out that the tumors were not cancer. Magnetic resonance spectroscopy (MRS) is a method that can be used to look at the levels of metabolites in tissue. This method can be used non-invasively on organs in the body, but also can be performed on tissue after surgical removal of tumors. MRS has been used to evaluate several types of cancer and is currently used clinically in some brain cancers. The scientific objective and rationale for this study is to investigate MRS as a novel method to evaluate suspicious tumors of the kidney in patients with TSC and to distinguish between those that are cancer and those that are not cancer. During the study, all consented patients with TSC who have suspicious kidney tumors will have MRS of their kidneys and kidney tumors. This study is non-invasive and will be performed at the same time as routine MRI. By our current standard of care, these patients suspicious kidney tumors will then be biopsied by needle biopsy through the skin for routine diagnosis to assess if the tumor is cancerous or not. Tissue from the needle biopsy will then be assessed by a slightly different type of MRS to again assess its metabolite levels. Those patients found to have kidney cancer on biopsy often undergo surgery to remove the cancer. Those who do will again have MRS performed on the tumor tissue once it is surgically removed. The metabolite levels measured from these studies will be compared with the diagnosis of cancer or non-cancer such that we can identify specific metabolite levels or signatures, which can non-invasively distinguish kidney cancer from non-cancerous growths in the kidney. The pre-biopsy MRS results will also be compared with the metabolic data obtained on the biopsy and surgical tissue to assess for consistency of results. In addition, we will directly measure the levels of metabolites in these tissues to assess the accuracy of these MRS techniques. If successful, this research will be applicable to and help all patients with TSC who have these suspicious kidney tumors. Up to 80%-85% of patients with TSC have involvement of their kidneys, and thus this represents a large proportion of this group who would stand to benefit from this research project. The clinical application of this research would be to improve the way in which we can evaluate these tumors of the kidney. If this method can accurately distinguish kidney cancer from non-cancerous kidney growths, the findings of this research project would benefit many people with TSC. This study poses minimal risk to patients who agree to be in the study. The only difference in their care under this study will be the additional 15-30 minutes needed in the MRI scanner to obtain the metabolic data. No additional medications need to be given other than what would routinely be given during their standard MRI. All other components of this study will also be part of their routine care. We anticipate that we will be able to recruit sufficient numbers of patients in the 2 years of this study to achieve meaningful results and to demonstrate that we can use this method to differentiate between cancerous and non-cancerous kidney tumors in these patients. If successful, this study would then lead to a larger confirmatory study including multiple centers and more patients. Therefore, although we think we could achieve a real patient-related outcome in the 2 years of this study, we anticipate that it would take a few additional
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Oct 29, 2018
- Source ID
- W81XWH1710468
Entities
People
- Adam Feldman
Organizations
- Massachusetts General Hospital
- United States Army