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Optical Coherence Tomography as a Diagnostic Tool in Renal Transplant and Cancer Imaging
Wierwille, Jeremiah J.
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This dissertation aims to investigate optical coherence tomography (OCT) as a diagnostic technology in renal imaging through two main arenas: renal transplantation and renal cancer. Part 1: Ischemia-reperfusion injury, which frequently occurs after kidney transplant, is a major contributing factor in delayed-graft function leading to varying degrees of early renal dysfunction. Real-time assessment of graft morphological and hemodynamic changes could help to evaluate graft condition and offer valuable information to predict the prognosis of graft injury for patient-specific management strategies. Previous studies have shown the ability of OCT to monitor structural changes associated with ischemia-reperfusion injury in vivo. Therefore, we investigated the ability of Doppler OCT (DOCT) to image microcirculatory changes in real time in the kidney glomerulus in vivo in an animal model and quantified observed changes in blood flow in 3D. Then, we translated OCT/DOCT technology into clinical testing for renal imaging during transplantation procedures and demonstrated the ability of OCT/DOCT to reveal renal tubular morphology and blood flow immediately following reperfusion. Part 2: For solid renal masses, nephron sparing procedures have been developed as an alternative to radical nephrectomy. However, achieving a negative tumor margin is critical to ensuring the best oncological efficacy for precluding tumor recurrence. OCT is a high-resolution, real-time imaging technology that has shown the ability to distinguish cancerous tissue from normal in several systems of the body based on changes in tissue optical properties. Therefore, we investigated the capability of OCT to quantify differences in optical properties between tumor and normal renal tissue. However, we did not observe a significant difference in optical attenuation between tumor and normal tissue in ex vivo specimens. These results suggest that further studies or possible alternative metrics need to be investigated to determine if OCT is able to detect renal neoplasms.