Use of patient outcome endpoints to identify the best functional CT imaging parameters in metastatic renal cell carcinoma patients

Abstract

Patient outcome was used to identify the best functional imaging parameters in patients with metastatic renal cell carcinoma. Taking patient outcome and reproducibility into account, BV, BV and BF provide the most clinically meaningful information, whereas PS seems to be treatment dependent. Standardization of acquisition protocols and post-processing software is necessary for future clinical utilization. Advances in knowledge: Taking patient outcome and reproducibility into account, BV, BV and BF provide the most clinically meaningful information. PS seems to be treatment dependent.

Early Changes in CT Perfusion Parameters: Primary Renal Carcinoma Versus Metastases After Treatment with Targeted Therapy

“…We observed that early changes in BF and BV in advanced RCC patients were of greater magnitude in patients with stable disease compared to progressive disease. While we were unable to demonstrate statistical significance, our result is consistent with preclinical data in which successful anti-angiogenic treatment has been shown to inhibit VEGFR2, decrease tumor vessel number and density based on immunohistochemistry in xenograft and preclinical models [30,31,32,33]. In clinical studies of RCC, CT perfusion has been performed at five- and 10-week time points after initiating treatment, but we are the first to demonstrate that changes can be detected as early as eight days after treatment; however, whether early changes can reliably predict clinical outcome will need to be validated in a larger study.…”

Baseline blood volume identified by dynamic contrast-enhanced computed tomography as a new independent prognostic factor in metastatic renal cell carcinoma

“…All analyses were performed by a radiologist blinded to treatment and outcomes. Excellent interobserver correlations have been shown for this method ( 9 ).…”

“…Preliminary results have been published on 69 patients (DaRenCa-1, n = 50 and AIS, n = 19) evaluating various DCE-CT parameters ( 10 , 11 ) identifying BV as the best DCE-CT parameter using patient outcome as endpoint ( 9 ). For this study, more patients have been included, survival data has been updated, and all DCE-CT assessments have been fully repeated by an independent radiologist (ADN).…”

“…Dynamic data using DCE-CT VOI were loaded and analyzed in MATLAB (v. R2015b, MathWorks Inc., Natick, MA, USA), where histogram values of BV were extracted based on DCE-CT VOI using in-house software. The median BV was calculated for each histogram, as this parameter was the most reproducible and had best correlation with patient outcome ( 9 ). Furthermore, Hounsfield Units for each target lesion was assessed at PE.…”

“…The best way to analyze the tumor histogram has been analyzed in detail; among seven different assessment methods (median, mean, mode, standard deviation, interquartile range, skewness and kurtosis) the median value was the best parameter to reflect the histogram ( 9 ). In patients with metastatic renal cell carcinoma (mRCC), previous studies have identified baseline DCE-CT assessed BV as the strongest functional imaging parameter to correlate with patient outcome, based on univariate analyses ( [9] , [10] , [11] ). However, the strength of the functional imaging parameter BV has not formally been tested against established clinical prognostic factors.…”