Arterial spin labeling blood flow magnetic resonance imaging for the characterization of metastatic renal cell carcinoma(1).
OBJECTIVE
This study sought to assess the feasibility of arterial spin labeling (ASL) blood flow (BF) magnetic resonance imaging (MRI) for the study of metastatic renal cell carcinoma (RCC) in the body, where the respiratory, cardiac, and peristaltic motions present challenges when applying ASL.


METHODS
ASL was performed using a background-suppressed single-section flow-alternating inversion recovery (FAIR) preparation and a single-shot fast spin-echo imaging sequence on a 3.0-T whole body imager. Tumor BF was evaluated for 26 patients with RCC metastatic to the liver, bone, lung, or lymph nodes before VEGF receptor inhibitor therapy. Two cases with tumor size change after treatment were also scanned 1 month after therapy. For validation, kidney cortex BF in five normal volunteers was measured with the same technique and compared with literature values.


RESULTS
ASL was successfully performed in all normal volunteers and in 20 of 26 patients. The six failures resulted from a systematic error, which can be avoided in future studies. For normal volunteers, measured kidney cortex BF was 275 +/- 14 mL/min/100 g, a value consistent with the literature. ASL determined tumor BF averaged across tumor volume and subjects was 194 mL/min/100 g (intersubject SD = 100), resulting in high perfusion signal and conspicuity of lesions. Bright signal was also seen in large vessels and occasionally in bowel. In the two cases studied 1 month after therapy, ASL perfusion changes were consistent with tumor size changes.


CONCLUSIONS
With background suppression, ASL MRI is a feasible method for quantifying BF in patients with renal cell carcinoma. This technique may be useful for evaluating tumor response to antiangiogenic agents.
De Bazelaire
Cedric
C
Department of Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215.
Rofsky
Neil M
NM
Duhamel
Guillaume
G
Michaelson
M Dror
MD
George
Daniel
D
Alsop
David C
DC
D000970:Antineoplastic Agents / Q000627:therapeutic use; D001859:Bone Neoplasms / Q000098:blood supply / Q000556:secondary; D002292:Carcinoma, Renal Cell / Q000098:blood supply / Q000188:drug therapy / Q000556:secondary*; D015331:Cohort Studies; D003287:Contrast Media; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D007680:Kidney Neoplasms / Q000188:drug therapy / Q000473:pathology*; D008113:Liver Neoplasms / Q000098:blood supply / Q000556:secondary; D008175:Lung Neoplasms / Q000098:blood supply / Q000556:secondary; D008207:Lymphatic Metastasis / Q000473:pathology; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D010793:Phthalazines / Q000627:therapeutic use; D047428:Protein Kinase Inhibitors / Q000627:therapeutic use; D011725:Pyridines / Q000627:therapeutic use; D040262:Receptors, Vascular Endothelial Growth Factor / Q000037:antagonists & inhibitors; D012039:Regional Blood Flow / Q000502:physiology; D013113:Spin Labels
D000970:Antineoplastic Agents; D003287:Contrast Media; D010793:Phthalazines; D047428:Protein Kinase Inhibitors; D011725:Pyridines; D013113:Spin Labels; C404768:vatalanib; D040262:Receptors, Vascular Endothelial Growth Factor