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Magnetic Resonance Perfusion Characteristics of Hypervascular Renal and Hypovascular Prostate Spinal Metastases: Clinical Utilities and Implications

Saha, Atin, MS*; Peck, Kyung K., PhD*,†; Lis, Eric, MD*; Holodny, Andrei I., MD*; Yamada, Yoshiya, MD; Karimi, Sasan, MD*

doi: 10.1097/BRS.0000000000000570
Diagnostics
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Study Design. A total of 40 patients with spinal metastases from renal cell carcinomas (RCCs) or prostate carcinomas (PCs) were studied using DCE-MRI (dynamic contrast-enhanced magnetic resonance imaging).

Objective. To evaluate spinal metastases from RCC and PC to assess the sensitivity and specificity of perfusion parameters obtained by quantitative and semiquantitative methods, which would allow for noninvasive discrimination between hypovascular and hypervascular lesions.

Summary of Background Data. Conventional MRI can be inconclusive in assessing diagnostically complex spinal lesions in patients with cancer in whom fibrosis, infarction, edema related to compression fractures, and infection may simulate malignant neoplasm. Conventional MRI is also of limited value in assessing tumor vascularity and identifying hypervascular tumors. DCE-MRI offers an advantage over conventional MRI in that it provides anatomical, physiological, and hemodynamic information about neoplastic lesions.

Methods. DCE perfusion parameters: vascular permeability, plasma volume (Vp), wash-in slope, and peak-enhancement parameter were measured to assess their potential as discriminators of tumor vascularity. A Mann-Whitney U test (at P ≤ 0.01), was performed to quantify and compare significance of perfusion parameters between the 2 groups.

Results. Of the 4 perfusion parameters studied, Vp was observed to have the largest difference in mean (μ) between PC (μ = 3.29/s) and RCC metastases (μ = 5.92/s). This was followed by the peak-enhancement, vascular permeability, and wash-in parameters. A Mann-Whitney U test showed a significant difference between Vp values for PC and RCC lesions (P ≤ 0.001). Similarly, peak-enhancement parameter showed a significant difference between the 2 histologies (P ≤ 0.001), as did vascular permeability (P ≤ 0.01). The receiver operating characteristic curve showed that Vp recorded the highest area under the curve (0.867).

Conclusion. Vp was shown to be the best discriminator between spinal metastases from PC and RCC with the mean Vp of RCC metastasis being 1.8 times that of the PC lesions, thus discriminating between hyper- and hypovascular metastases, which has important clinical implications.

Level of Evidence: N/A

Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) was performed to evaluate spinal metastases from prostate cancer and renal cell carcinoma. Of the 4 perfusion parameters studied, plasma volume was shown to be the best discriminator (P < 0.001) between spinal metastases. The ability of DCE-MRI to noninvasively characterize tumor vascularity has important clinical implications that can lead to changes in patient management and improve outcome.

Departments of *Radiology

Medical Physics; and

Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY.

Address correspondence and reprint requests to Sasan Karimi, MD, Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065; E-mail: karimis@mskcc.org

Acknowledgment date: March 13, 2014. Revision date: June 24, 2014. Acceptance date: July 31, 2014.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

Relevant financial activities outside the submitted work: consultancy, payment for lectures, travel/accommodations/meeting expenses.

© 2014 by Lippincott Williams & Wilkins