Renal cell carcinoma (RCC) is a major global health issue with an increasing incidence and mortality rate. Current diagnostic methods are either invasive or limited in their ability to accurately differentiate between benign and malignant tumours and to predict early treatment response. This can lead to incorrect diagnosis, delayed treatment, patient anxiety, and suboptimal outcomes. RCC subtypes are known to exhibit distinct metabolic alterations, for example in glucose metabolism. These metabolic phenotypes offer potential targets for non-invasive imaging techniques to improve diagnosis and treatment, but current clinically available metabolic imaging tools such as18F-FDG-PET and99mTc-sestamibi SPECT have limitations. Therefore, new approaches are required to assess this metabolism, and novel metabolic MRI techniques including hyperpolarised [1-13C]pyruvate MRI and deuterium metabolic imaging offer promising alternatives. These techniques are non-radioactive, demonstrate spatial metabolic heterogeneity, and can probe metabolic flux beyond tracer uptake. This review aims to explore the potential of metabolic MRI in the clinical management of RCC by (1) summarising current clinical guidelines; (2) reviewing metabolic heterogeneity across RCC subtypes; (3) discussing the potential of metabolic MRI to advance the understanding of in vivo metabolism; (4) and finally suggesting future directions for research in this field.
肾细胞癌（RCC）是一个全球性的重大健康问题，其发病率和死亡率持续上升。目前的诊断方法要么具有侵入性，要么在准确区分良恶性肿瘤及预测早期治疗反应方面存在局限，可能导致误诊、延误治疗、增加患者焦虑并影响治疗效果。已知RCC不同亚型表现出独特的代谢改变，例如葡萄糖代谢异常。这些代谢表型为非侵入性成像技术提供了潜在的靶点，有助于改善诊断和治疗，但目前临床可用的代谢成像工具如¹⁸F-FDG-PET和⁹⁹ᵐTc-sestamibi SPECT存在局限性。因此，需要新的方法来评估这种代谢活动，而新型代谢磁共振成像技术，包括超极化[1-¹³C]丙酮酸磁共振成像和氘代谢成像，提供了有前景的替代方案。这些技术无放射性、能展示空间代谢异质性，并可探测示踪剂摄取之外的代谢通量。本综述旨在探讨代谢磁共振成像在RCC临床管理中的潜力，具体通过：（1）总结当前临床指南；（2）回顾RCC不同亚型的代谢异质性；（3）讨论代谢磁共振成像在推进对体内代谢理解方面的潜力；（4）最后提出该领域未来的研究方向。
Potential of Metabolic MRI to Address Unmet Clinical Needs in Localised Kidney Cancer
肿瘤(癌症)患者之家