Dual energy CT allows for improved characterization of response to antiangiogenic treatment in patients with metastatic renal cell cancer.
OBJECTIVE
To evaluate the potential role of dual energy CT (DECT) to visualize antiangiogenic treatment effects in patients with metastatic renal cell cancer (mRCC) while treated with tyrosine-kinase inhibitors (TKI).


METHODS
26 patients with mRCC underwent baseline and follow-up single-phase abdominal contrast enhanced DECT scans. Scans were performed immediately before and 10 weeks after start of treatment with TKI. Virtual non-enhanced (VNE) and colour coded iodine images were generated. 44 metastases were measured at the two time points. Hounsfield unit (HU) values for VNE and iodine density (ID) as well as iodine content (IC) in mg/ml of tissue were derived. These values were compared to the venous phase DECT density (CTD) of the lesions. Values before and after treatment were compared using a paired Student's t test.


RESULTS
Between baseline and follow up, mean CTD and DECT-derived ID both showed a significant reduction (p < 0.005). The relative reduction measured in percent was significantly greater for ID than for CTD (49.8 ± 36,3 % vs. 29.5 ± 20.8 %, p < 0.005). IC was also significantly reduced under antiangiogenic treatment (p < 0.0001).


CONCLUSIONS
Dual energy CT-based quantification of iodine content of mRCC metastases allows for significantly more sensitive and reproducible detection of antiangiogenic treatment effects.


CONCLUSIONS
• A sign of tumour response to antiangiogenic treatment is reduced tumour perfusion. • DECT allows visualizing iodine uptake, which serves as a marker for vascularization. • More sensitive detection of antiangiogenic treatment effects in mRCC is possible.
Department of Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Marchioninistr. 15, 81377, München, Germany.
K
K
Hellbach
Department of Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Marchioninistr. 15, 81377, München, Germany.
A
A
Sterzik
Department of Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Marchioninistr. 15, 81377, München, Germany.
W
W
Sommer
Department of Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Marchioninistr. 15, 81377, München, Germany.
M
M
Karpitschka
Department of Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Marchioninistr. 15, 81377, München, Germany.
N
N
Hummel
Department of Urology, Ludwig-Maximilians-University Hospital Munich, Marchioninistr. 15, 81377, München, Germany.
J
J
Casuscelli
Department of Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Marchioninistr. 15, 81377, München, Germany.
M
M
Ingrisch
Department of Palliative Care, Krankenhaus Barmherzige Brüder München, Romanstr. 93, 80639, München, Germany.
M
M
Schlemmer
Department of Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Marchioninistr. 15, 81377, München, Germany.
A
A
Graser
Department of Urology, Ludwig-Maximilians-University Hospital Munich, Marchioninistr. 15, 81377, München, Germany. michael.staehler@med.uni-muenchen.de.
Michael
M
Staehler
D000368:Aged; D020533:Angiogenesis Inhibitors / Q000627:therapeutic use*; D002292:Carcinoma, Renal Cell / Q000000981:diagnostic imaging / Q000188:drug therapy*; D003287:Contrast Media / Q000378:metabolism; D005260:Female; D006801:Humans; D007211:Indoles / Q000627:therapeutic use*; D007455:Iodine / Q000378:metabolism; D007680:Kidney Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D011446:Prospective Studies; D011505:Protein-Tyrosine Kinases / Q000037:antagonists & inhibitors; D011758:Pyrroles / Q000627:therapeutic use*; D000077210:Sunitinib; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome
D020533:Angiogenesis Inhibitors; D003287:Contrast Media; D007211:Indoles; D011758:Pyrroles; D007455:Iodine; D011505:Protein-Tyrosine Kinases; D000077210:Sunitinib
Antiangiogenic treatment; Dual energy computed tomography; Metastatic renal cell carcinoma; Response evaluation; Therapy monitoring
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