4.7 Article

Mapping Hypoxia in Renal Carcinoma with Oxygen-enhanced MRI: Comparison with Intrinsic Susceptibility MRI and Pathology

Journal

RADIOLOGY
Volume 288, Issue 3, Pages 739-747

Publisher

RADIOLOGICAL SOC NORTH AMERICA
DOI: 10.1148/radiol.2018171531

Keywords

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Funding

  1. NIHR Manchester Biomedical Research Centre
  2. Cancer Research UK [C19221/A15267, C19221/A22746, C1090/A10334, C1090/A16464]
  3. Cancer Research UK
  4. Engineering and Physical Sciences Research Council [C1060/10334, C8742/A18097]
  5. Wellcome Trust [091763Z/10/Z]
  6. Children with Cancer UK [2014/176]
  7. Breakthrough Breast Cancer Senior Fellowship

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Purpose: To cross-validate T1-weighted oxygen-enhanced (OE) MRI measurements of tumor hypoxia with intrinsic susceptibility MRI measurements and to demonstrate the feasibility of translation of the technique for patients. Materials and Methods: Preclinical studies in nine 786-0-R renal cell carcinoma (RCC) xenografts and prospective clinical studies in eight patients with RCC were performed. Longitudinal relaxation rate changes (Delta R1) after 100% oxygen inhalation were quantified, reflecting the paramagnetic effect on tissue protons because of the presence of molecular oxygen. Native transverse relaxation rate (R2*) and oxygen-induced R2* change (Delta R2*) were measured, reflecting presence of deoxygenated hemoglobin molecules. Median and voxel-wise values of Delta R1 were compared with values of R2* and Delta R2*. Tumor regions with dynamic contrast agentenhanced MRI perfusion, refractory to signal change at OE MRI (referred to as perfused Oxy-R), were distinguished from perfused oxygen-enhancing (perfused Oxy-E) and nonperfused regions Delta R2* and Delta R2* values in each tumor subregion were compared by using one-way analysis of variance. Results: Tumor-wise and voxel-wise Delta R1 and Delta R2* comparisons did not show correlative relationships. In xenografts, parcellation analysis revealed that perfused Oxy-R regions had faster native R2* (102.4 sec(-1) vs 81.7 sec(-1)) and greater negative Delta R2* (222.9 sec(-1) vs 25.4 sec(-1)), compared with perfused Oxy-E and nonperfused subregions (all P<.001), respectively. Similar findings were present in human tumors (P<.001). Further, perfused Oxy-R helped identify tumor hypoxia, measured at pathologic analysis, in both xenografts (P =.002) and human tumors (P =.003). Conclusion: Intrinsic susceptibility biomarkers provide cross validation of the OE MRI biomarker perfused Oxy-R. Consistent relationship to pathologic analyses was found in xenografts and human tumors, demonstrating biomarker translation.

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