Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Radiol. Jul 28, 2015; 7(7): 170-179
Published online Jul 28, 2015. doi: 10.4329/wjr.v7.i7.170
Perfusion computed tomography in renal cell carcinoma
Chandan J Das, Usha Thingujam, Ananya Panda, Sanjay Sharma, Arun Kumar Gupta
Chandan J Das, Usha Thingujam, Ananya Panda, Sanjay Sharma, Arun Kumar Gupta, Department of Radiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
Author contributions: Das CJ, Thingujam U and Panda A contributed equally to conception, article design, literature search, article drafting, critical revision and image preparation; Das CJ and Sharma S helped with the article concept and revision; Das CJ and Gupta AK helped in article preparation and final approval of version of article to be published.
Conflict-of-interest statement: None.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Dr. Chandan J Das, MD, DNB, MNAMS, Assistant Professor, Department of Radiology, All India Institute of Medical Sciences, Room No. 63, Ansari Nagar, New Delhi 110029, India.
Telephone: +91-11-26594889 Fax: +91-11-26588663
Received: December 1, 2014
Peer-review started: December 2, 2014
First decision: February 7, 2015
Revised: March 30, 2015
Accepted: June 4, 2015
Article in press: June 8, 2015
Published online: July 28, 2015

Various imaging modalities are available for the diagnosis, staging and response evaluation of patients with renal cell carcinoma (RCC). While contrast enhanced computed tomography (CT) is used as the standard of imaging for size, morphological evaluation and response assessment in RCC, a new functional imaging technique like perfusion CT (pCT), goes down to the molecular level and provides new perspectives in imaging of RCC. pCT depicts regional tumor perfusion and vascular permeability which are indirect parameters of tumor angiogenesis and thereby provides vital information regarding tumor microenvironment. Also response evaluation using pCT may predate the size criteria used in Response Evaluation Criteria in Solid Tumors, as changes in the perfusion occurs earlier following tissue kinase inhibitors before any actual change in size. This may potentially help in predicting prognosis, better selection of therapy and more accurate and better response evaluation in patients with RCC. This article describes the techniques and role of pCT in staging and response assessment in patients with RCCs.

Keywords: Angiogenesis, Anti-angiogenic therapy, Perfusion computed tomography, Renal cell carcinoma

Core tip: Perfusion computed tomography is a functional imaging technique. It can be used to predict the histologic grade and early as well as more accurate response evaluation in renal cell carcinoma (RCC). This has the potential to help in better selection of therapy and improve prognosis in RCC.