Measuring perfusion and permeability in renal cell carcinoma with dynamic contrast-enhanced MRI: a pilot study

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.

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)).

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.

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.