Utility of virtual unenhanced images and split-bolus injection using spectral multidetector CT for the assessment of renal cell carcinoma conspicuity and radiation dose

PURPOSE Since 1985, multiple centers have demonstrated that interleukin-2 (IL-2) and lymphokine-activated killer (LAK) cells produce durable anticancer responses in patients with metastatic renal cell carcinoma. High-dose recombinant IL-2 (rIL-2) has been administered by intravenous bolus injection (Rosenberg SA, et al: N Engl J Med 313:1485-1492, 1985) and by continuous intravenous infusion (West WH, et al: N Engl J Med 316:898-905, 1987) combined with lymphokine-activated killer (LAK) cells, with both methods producing responses in patients with advanced renal cell carcinoma. The Extramural IL-2/LAK Working Group has conducted a randomized phase II trial of two intravenous high-dose rIL-2 regimens (bolus three times daily or 24-hour continuous infusion) to determine if either one manifests greater anticancer activity or a more acceptable toxicity profile. PATIENTS AND METHODS Ninety-four patients with measurable advanced renal cell carcinoma were enrolled on this study: 46 to the bolus injection arm and 48 to the continuous infusion arm. On both arms, patients underwent a priming phase of rIL-2 administration, four daily lymphocytaphereses to harvest mononuclear cells that were placed in 3- to 4-day culture for generation of LAK cells, and an rIL-2/LAK coadministration phase. Patients were then observed monthly for evidence of response to this therapy and were offered up to two additional courses of treatment every 3 months if evidence of response was detected. RESULTS Twenty percent of patients on the bolus injection arm experienced objective responses (three complete responses and six partial responses); 15% of patients on the continuous infusion arm responded (two complete responses and five partial responses). Complete responses were durable, persisting for 310+ to 700+ days. The incidence of severe life-threatening toxicities typical of high-dose rIL-2 therapy was similar in both arms (eg, patients with hypotension requiring pressors: bolus 71%, continuous 63%; oliguria less than or equal to 200 mL/8 hours: bolus 65%, continuous 71%). More episodes of fever, infection, and serum alkaline phosphatase elevation were associated with the continuous infusion arm, while more thrombocytopenia occurred on the bolus injection arm. Four patients (three bolus injection, one continuous infusion) died of respiratory and circulatory failure while under treatment. No clinical or laboratory parameter accompanying treatment on either arm was, by univariate or multivariate analysis, associated with an increased likelihood of response. CONCLUSIONS Both methods of high-dose rIL-2/LAK cell administration produce nearly equivalent anticancer activity and toxicity in the treatment of renal cell carcinoma. The ability to predict responding patients based on patient or treatment characteristics is not possible.

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Iodine Quantification to Distinguish Clear Cell from Papillary Renal Cell Carcinoma at Dual-Energy Multidetector CT: A Multireader Diagnostic Performance Study

Radiology ◽

10.1148/radiol.14140171 ◽

2014 ◽

Vol 273 (3) ◽

pp. 813-820 ◽

Cited By ~ 90

Author(s):

Achille Mileto ◽

Daniele Marin ◽

Marcela Alfaro-Cordoba ◽

Juan Carlos Ramirez-Giraldo ◽

Christian D. Eusemann ◽

...

Keyword(s):

Renal Cell Carcinoma ◽

Cell Carcinoma ◽

Renal Cell ◽

Diagnostic Performance ◽

Clear Cell ◽

Multidetector Ct ◽

Papillary Renal Cell Carcinoma ◽

Dual Energy ◽

Performance Study ◽

Iodine Quantification

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Preoperative differentiation of chromophobe renal cell carcinoma from oncocytoma: Aorta-lesion-attenuation difference on multiphasic multidetector computed tomography.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.6_suppl.627 ◽

2020 ◽

Vol 38 (6_suppl) ◽

pp. 627-627

Author(s):

Melina Hosseiny ◽

Justin Ching ◽

Soheil Kooraki ◽

Steven Raman

Keyword(s):

Renal Cell Carcinoma ◽

Ct Scan ◽

Cell Carcinoma ◽

Renal Cell ◽

Renal Mass ◽

Multidetector Ct ◽

Hounsfield Unit ◽

Chromophobe Renal Cell Carcinoma ◽

Imaging Biomarker ◽

The Difference

627 Background: Differentiation of benign oncocytoma from chromophobe renal cell carcinoma (chRCC) remains a challenge. This study aimed to investigate whether Aorta-lesion-attenuation difference (ALAD) on multiphasic multidetector CT scan (MDCT) can aid to distinguish oncocytoma from chRCC. Methods: This IRB-approved, HIPAA-compliant study consisted MDCT of 111 patients with pathologically proven chRCC (N: 37) or oncocytoma (N: 74). Regions of interest (ROIs) were placed over the renal mass and Aorta on the same axial MDCT slice of un-enhanced (UE), corticomedullary (CM), nephrographic (NP) and excretory (EX) phases. ROIs were devoid of calcification, necrosis and hemorrhage in lesion or atherosclerotic plaque in Aorta. The difference between Aorta and renal mass Hounsfield unit was calculated in all available phases. SPSS v.18 was used to draw receiver-operating characteristic (ROC) curve to calculate accuracy and optimal cutoff values for differentiation of chRCC from oncocytoma. Results: Mean ALAD was significantly higher in chRCC compared to oncocytoma in CM(P: 0.04), NP (P<0.01) and EX (P<0.01) phases. The area under the curves for ALAD in UE, CM, NP and EX phases were 0.47 (95% CI: 0.36- 0.59, p: 0.68), 0.64 (95% CI: 0.51-0.77, p: 0.03), 0.87 (95% CI: 0.79- 0.95, p< 0.01) and 0.80 (0.70-0.90, P<0.001), respectively. ALAD threshold of 19 in nephrographic phase had sensitivity and specificity of 79% and 78%, respectively, for differentiation of chRCC from oncocytoma. Conclusions: ALAD measured in the nephrogenic phase showed the highest accuracy for differentiation of chRCC from oncocytoma on multidetector CT scan. If validated prospectively, ALAD may act as a useful imaging biomarker to distinguish chRCC from oncocytoma.

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Multidetector CT Characteristics of Fumarate Hydratase-Deficient Renal Cell Carcinoma and Papillary Type II Renal Cell Carcinoma

Korean Journal of Radiology ◽

10.3348/kjr.2021.0212 ◽

2021 ◽

Vol 22 ◽

Author(s):

Ling Yang ◽

Xue-Ming Li ◽

Ya-Jun Hu ◽

Meng-Ni Zhang ◽

Jin Yao ◽

...

Keyword(s):

Renal Cell Carcinoma ◽

Cell Carcinoma ◽

Renal Cell ◽

Multidetector Ct ◽

Fumarate Hydratase ◽

Type Ii ◽

Papillary Type

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High-Resolution Multidetector CT in the Preoperative Evaluation of Patients with Renal Cell Carcinoma

American Journal of Roentgenology ◽

10.2214/ajr.180.5.1801271 ◽

2003 ◽

Vol 180 (5) ◽

pp. 1271-1277 ◽

Cited By ~ 133

Author(s):

C. Catalano ◽

F. Fraioli ◽

A. Laghi ◽

A. Napoli ◽

F. Pediconi ◽

...

Keyword(s):

Renal Cell Carcinoma ◽

High Resolution ◽

Cell Carcinoma ◽

Renal Cell ◽

Multidetector Ct ◽

Preoperative Evaluation

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Metastatic Renal Cell Carcinoma: Radiologic Findings and Assessment of Response to Targeted Antiangiogenic Therapy by Using Multidetector CT

Radiographics ◽

10.1148/rg.336125110 ◽

2013 ◽

Vol 33 (6) ◽

pp. 1691-1716 ◽

Cited By ~ 65

Author(s):

Blanca Paño Brufau ◽

Carmen Sebastià Cerqueda ◽

Laura Buñesch Villalba ◽

Rafael Salvador Izquierdo ◽

Begoña Mellado González ◽

...

Keyword(s):

Renal Cell Carcinoma ◽

Cell Carcinoma ◽

Metastatic Renal Cell Carcinoma ◽

Renal Cell ◽

Multidetector Ct ◽

Antiangiogenic Therapy ◽

Radiologic Findings

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Usefulness of multidetector computed tomography to differentiate between renal cell carcinoma and oncocytoma. A model validation

British Journal of Radiology ◽

10.1259/bjr.20200064 ◽

2020 ◽

Vol 93 (1115) ◽

pp. 20200064 ◽

Cited By ~ 1

Author(s):

Blanca Paño ◽

Alexandre Soler ◽

Debra A Goldman ◽

Rafael Salvador ◽

Laura Buñesch ◽

...

Keyword(s):

Renal Cell Carcinoma ◽

Cell Carcinoma ◽

Predictive Model ◽

Renal Cell ◽

Multidetector Ct ◽

Multivariable Analysis ◽

Final Diagnosis ◽

Lesion Size ◽

Renal Tumors ◽

Surgical Biopsy

Objective: The purpose of this study is to validate a multivariable predictive model previously developed to differentiate between renal cell carcinoma (RCC) and oncocytoma using CT parameters. Methods and materials: We included 100 renal lesions with final diagnosis of RCC or oncocytoma studied before surgery with 4-phase multidetector CT (MDCT). We evaluated the characteristics of the tumors and the enhancement patterns at baseline, arterial, nephrographic and excretory MDCT phases. Results: Histopathologically 15 tumors were oncocytomas and 85 RCCs. RCCs were significantly larger (median 4.4 cm vs 2.8 cm, p = 0.006). There were significant differences in nodule attenuation in the excretory phase compared to baseline (median: 31 vs 42, p = 0.015), with RCCs having lower values. Heterogeneous enhancement patterns were also more frequent in RCCs (85.9% vs 60%, p = 0.027). Multivariable analysis showed that the independent predictors of malignancy were the enhancement pattern, with oncocytomas being more homogeneous in the nephrographic phase [Odds Ratio (OR) 0.16 (95% CI 0.03 to 0.75, p = 0.02)], nodule enhancement in the excretory phase compared to baseline, with RCCs showing lower enhancement [OR 0.96 (95% CI 0.93 to 0.99, p = 0.005)], and a size > 4 cm, with RCCs being larger [OR 5.89 (95% CI 1.10 to 31.58), p = 0.038]. Conclusion: The multivariable predictive model previously developed which combines different MDCT parameters, including lesion size > 4 cm, lesion enhancement in the excretory phase compared to baseline and enhancement heterogeneity, can be successfully applied to distinguish RCC from oncocytoma. Advances in knowledge: This study confirms that multiparametric assessment using MDCT (including parameters such as size, homogeneity and enhancement differences between the excretory and the baseline phases) can help distinguish between RCCs and oncocytomas. While it is true that this multiparametric predictive model may not always correctly classify renal tumors such as RCC or oncocytoma, it can be used to determine which patients would benefit from pre-surgical biopsy to confirm that the tumor is in fact an oncocytoma, and thereby avoid unnecessary surgical treatments.

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