title: Functional MRI techniques demonstrate early vascular changes in renal cell cancer patients treated with sunitinib: a pilot study.
abstract: OBJECTIVE
  To assess the early vascular effects of sunitinib in patients with renal cell carcinoma (RCC) with diffusion-weighted magnetic resonance imaging (DWI), dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) and T2* perfusion MRI.
  
  
  METHODS
  In 10 patients with abdominal RCC lesions, DWI, DCE-MRI and T2* perfusion MRI measurements at 3 Tesla were performed at baseline, 3 and 10 days after start of sunitinib. VEGF-A plasma levels were measured on days 0, 3 and 10.
  
  
  RESULTS
  DWI showed a significant increase in the apparent diffusion coefficient (×10(-6) s/mm(2)) from baseline (mean 1158, range 814-2003) to day 3 (mean 1306, range 1008-2097, P = 0.015) followed by a decrease to baseline levels at day 10 (mean 1132, range 719-2005, P = 0.001). No significant changes were found in mean DCE-MRI parameters. T2* perfusion MRI showed a significant decrease in relative tumor blood volume (rBV) and relative tumor blood flow (rBF) at day 3 (rBV P = 0.037, rBF P = 0.018) and day 10 (rBV P = 0.006, rBF P = 0.009). VEGF-A plasma levels significantly increased after 10 days, but did not correlate with MRI parameters.
  
  
  CONCLUSIONS
  Sunitinib induces antiangiogenic effects as measured by DWI and T2*-perfusion MRI, 3 and 10 days after the start of the initial treatment. DCE-MRI did not show significant changes. In the near future, early functional MRI-based evaluation can play an important role in tailoring treatment to the individual patient with RCC. Further investigation is warranted.
authors.affiliation: Department of Medical Oncology, Radboud University Nijmegen Medical Centre, The Netherlands. i.desar@AIG.umcn.nl
authors.forename: I M E
authors.initials: IM
authors.lastname: Desar
authors.forename: E G W
authors.initials: EG
authors.lastname: ter Voert
authors.forename: Th
authors.initials: T
authors.lastname: Hambrock
authors.forename: J J A
authors.initials: JJ
authors.lastname: van Asten
authors.forename: D J
authors.initials: DJ
authors.lastname: van Spronsen
authors.forename: P F A
authors.initials: PF
authors.lastname: Mulders
authors.forename: A
authors.initials: A
authors.lastname: Heerschap
authors.forename: W T A
authors.initials: WT
authors.lastname: van der Graaf
authors.forename: H W M
authors.initials: HW
authors.lastname: van Laarhoven
authors.forename: C M L
authors.initials: CM
authors.lastname: van Herpen
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D002292:Carcinoma, Renal Cell / Q000098:blood supply* / Q000175:diagnosis / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007211:Indoles / Q000627:therapeutic use*; D007680:Kidney Neoplasms / Q000098:blood supply* / Q000175:diagnosis / Q000188:drug therapy*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011758:Pyrroles / Q000627:therapeutic use*; D000077210:Sunitinib; D013997:Time Factors
chemical_list: D000970:Antineoplastic Agents; D007211:Indoles; D011758:Pyrroles; D000077210:Sunitinib