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. Patients and 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/mm2) 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.

Repeatability of derived parameters from histograms following non-Gaussian diffusion modelling of diffusion-weighted imaging in a paediatric oncological cohort

“…Diffusion-weighted imaging (DWI) is a functional magnetic resonance imaging technique that is widely used in adult clinical trials of novel anticancer therapeutics that may have cytostatic rather than cytotoxic effect [1–5]. There is less experience of implementing DWI in paediatric oncology, where introduction of new targeted anticancer therapeutics is a priority [6–8].…”

Early Response Monitoring of Receptor Tyrosine Kinase Inhibitor Therapy in Metastatic Renal Cell Carcinoma Using [F-18]Fluorothymidine-Positron Emission Tomography-Magnetic Resonance

“…Cell death by dehydration while preserving intact cellular membranes as well as the influx of inflammatory cells involved in necrotic processes may also contribute to the diffusion restriction of water molecules. 15 Furthermore, associated intralesional microhemorrhages could play a role by generating local magnetic field inhomogeneity and thus susceptibility artifacts in the ADC map. Thirdly, the ADC map was generated from the 3 b-values applied (0, 400, and 800), thus leading to low ADC values related to blood flow reduction.…”

Magnetic Resonance Imaging as a Biomarker for Renal Cell Carcinoma

“…Desar et al investigated early vascular changes after sunitinib was given to 10 patients with RCC [ 47 ]. At day 3 and day 10, the relative tumor blood volume and relative tumor blood flow were significantly decreased based on DSC pMRI, supporting their roles as potential early treatment response biomarkers.…”

“…However, there was no significant decrease in mean Ktrans. DWI showed a significant increase in ADC, followed by a decrease, indicating a change in cellularity, edema, and necrosis [ 47 ]. Thus, use of multiparametric MRI could provide more comprehensive information for personalized therapies, combining the strengths of both DWI and pMRI.…”