title: Measuring perfusion and permeability in renal cell carcinoma with dynamic contrast-enhanced MRI: a pilot study.
abstract: OBJECTIVE
  To retrospectively assess an improved quantitative methodology with separate assessment of perfusion and permeability for characterization of primary renal cell carcinoma (RCC) and monitoring antiangiogenic treatment.
  
  
  METHODS
  Fifteen RCC patients before surgery, 6 RCC patients before and after neoadjuvant antiangiogenic therapy, and 15 patients without renal disease underwent dynamic contrast-enhanced (DCE)-MRI of the kidney with integrated retrospective respiratory triggering and an individual arterial input function. Tracer kinetic analysis was performed with a two-compartment-filtration-model for the kidney data and a two-compartment-exchange-model for the tumor data, providing four independent parameters: the perfusion-parameters plasma flow (F(P)) and plasma volume (V(P)), and the permeability-parameters extraction flow (F(E)) and extravascular-extracellular volume (V(E)).
  
  
  RESULTS
  In tumors F(P) and F(E) were significantly lower than in normal kidneys. Tracer kinetic analysis displayed hemodynamic alteration caused by vessel infiltration or necrosis. Papillary RCC could be differentiated from clear-cell variants by a distinct perfusion pattern. In antiangiogenically treated RCC V(E) was not significantly decreased, while the perfusion parameters V(P) and F(P) were significantly diminished.
  
  
  CONCLUSIONS
  DCE-MRI with integrated motion compensation enables evaluation of primary RCC and detects distinct perfusion patterns. Quantification with a two-compartment-exchange-model produces a separate perfusion- and permeability characterization and may become a diagnostic tool to monitor antiangiogenic treatment.
authors.affiliation: Department of Clinical Radiology, University Hospitals Munich, Campus Grosshadern, Munich, Germany. mike.notohamiprodjo@med.uni-muenchen.de
authors.forename: Mike
authors.initials: M
authors.lastname: Notohamiprodjo
authors.forename: Steven
authors.initials: S
authors.lastname: Sourbron
authors.forename: Michael
authors.initials: M
authors.lastname: Staehler
authors.forename: Henrik J
authors.initials: HJ
authors.lastname: Michaely
authors.forename: Ulrike I
authors.initials: UI
authors.lastname: Attenberger
authors.forename: Gerwin P
authors.initials: GP
authors.lastname: Schmidt
authors.forename: Holger
authors.initials: H
authors.lastname: Boehm
authors.forename: Annie
authors.initials: A
authors.lastname: Horng
authors.forename: Christian
authors.initials: C
authors.lastname: Glaser
authors.forename: Christian
authors.initials: C
authors.lastname: Stief
authors.forename: Maximilian F
authors.initials: MF
authors.lastname: Reiser
authors.forename: Karin A
authors.initials: KA
authors.lastname: Herrmann
mesh_terms: D001783:Blood Flow Velocity; D002292:Carcinoma, Renal Cell / Q000175:diagnosis* / Q000503:physiopathology* / Q000628:therapy; D006801:Humans; D007680:Kidney Neoplasms / Q000175:diagnosis* / Q000503:physiopathology* / Q000628:therapy; D008279:Magnetic Resonance Imaging / Q000379:methods*; D010539:Permeability; D010865:Pilot Projects