title: Computed tomography perfusion imaging of renal cell carcinoma: systematic comparison with histopathological angiogenic and prognostic markers.
abstract: OBJECTIVE
  The aim of this study was to systematically analyze the correlation between computed tomography (CT) perfusion and histopathological angiogenic and prognostic markers in patients with renal cell carcinoma (RCC).
  
  
  METHODS
  Fifteen patients (12 men; mean age, 64.5 ± 9.4 years) with RCC underwent contrast-enhanced CT perfusion imaging (scan range, 10 cm; scan time, 40 seconds; dual-source 128-section CT) 1 day before surgery. The procedure for surgical specimen processing was modified to obtain an exact match with CT images. Microvessel density (MVD) was quantified by CD34 staining, and lymphatic vessel density (LVD) was stained with D2-40 antibodies. The CT perfusion values blood flow (BF), blood volume (BV), and flow extraction product (K(Trans)) were calculated using the maximum-slope and a delay-corrected modified Patlak approach and were correlated to MVD and LVD. The relationship between CT perfusion and the prognostic markers pT stage, Fuhrman grade, and tumor necrosis was evaluated.
  
  
  RESULTS
  Histopathology revealed varying high MVD but low or absent intratumoral LVD. The BF and BV of RCC, both including and excluding necrotic regions, showed significant correlations with MVD (r = 0.600-0.829, P < 0.05 each). Significant correlations between MVD and K(Trans) were found only in small tumor areas exhibiting no necrosis (r = 0.550, P < 0.05). No significant correlation was found between BF, BV, and K(Trans) with intratumoral LVD (P = 0.35-0.82). With higher pT stage and Fuhrman grade, BF, BV, and K(Trans) were lower, similar to the MVD, but without reaching statistical significance. Blood flow, BV, and K(Trans) were significantly higher in RCCs with less than 50% necrosis than in those with 50% or grater necrosis (P < 0.05 each).
  
  
  CONCLUSIONS
  Our study indicates that BF and BV from CT perfusion reflect blood vessels of RCC. Computed tompgraphic perfusion parameters differ significantly depending upon the degree of tumor necrosis.
authors: Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland.
authors: Caecilia S
authors: CS
authors: Reiner
authors: Matthias
authors: M
authors: Roessle
authors: Thore
authors: T
authors: Thiesler
authors: Daniel
authors: D
authors: Eberli
authors: Ernst
authors: E
authors: Klotz
authors: Thomas
authors: T
authors: Frauenfelder
authors: Tullio
authors: T
authors: Sulser
authors: Holger
authors: H
authors: Moch
authors: Hatem
authors: H
authors: Alkadhi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001783:Blood Flow Velocity; D001810:Blood Volume; D002292:Carcinoma, Renal Cell / Q000098:blood supply* / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D003287:Contrast Media; D005260:Female; D006801:Humans; D007472:Iohexol / Q000031:analogs & derivatives; D007680:Kidney Neoplasms / Q000098:blood supply* / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D009336:Necrosis; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D011379:Prognosis; D011857:Radiographic Image Interpretation, Computer-Assisted; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D003287:Contrast Media; D007472:Iohexol; C038192:iopromide