Dynamic Contrast-enhanced Magnetic Resonance Imaging in the Early Evaluation of Anti-angiogenic Therapy in Metastatic Renal Cell Carcinoma

MRI of a female patient showing a metastatic lesion in the VII-VIII segment before treatment (a-c) and after four weeks of treatment (d-f). a: T2-weighted sequences show a inhomogeneous hyperintense mass of 4 cm in maximum diameter. b: Qualitative assessment of perfusion images show the same lesion as a hypointense zone with peripheral vascularization; regions of interest were plotted on the lesion, abdominal aorta, liver and muscle. c: Semi-quantitave analysis using intensity/time curves highlights the grade of vascularization of the lesion. d: T2-weighted sequences showing a slight dimensional reduction of approximately 0.5 cm of the metastatic lesion after four weeks of treatment. e: Qualitative assessment using perfusion images depicting the reduction of vascularization of the lesion; regions of interest were plotted on the metastasis, aorta, liver and muscle. f: Semi-quantitative approach revealing the lesion's behavior compared to the aorta, liver and muscle. The semi-quantitave analysis by means of intensity/time curves adds important functional information to morphological criteria, which only indicates dimensional reduction; the former highlights the reduction of neoangiogenesis and therefore the response to anti-angiogenic therapy.