Assessment of renal function after conformal radiotherapy and intensity-modulated radiotherapy by functional 1H-MRI and 23Na-MRI

• Published in: Strahlentherapie und Onkologie 2012-12, Vol.188 (12), p.1146-1154
• Main Authors: Haneder, S., Michaely, H.J., Schoenberg, S.O., Konstandin, S., Schad, L.R., Siebenlist, K., Wertz, H., Wenz, F., Lohr, F., Boda-Heggemann, J.
• Format: Article
• Language: English
• Subjects: Aged; Chemoradiotherapy, Adjuvant; Diffusion Magnetic Resonance Imaging - methods; Disease-Free Survival; Feasibility Studies; Female; Follow-Up Studies; Humans; Image Enhancement - methods; Image Interpretation, Computer-Assisted - methods; Kidney - radiation effects; Kidney Function Tests; Magnetic Resonance Imaging - methods; Male; Medicine; Medicine & Public Health; Middle Aged; Neoplasm Staging; Oncology; Oxygen - blood; Radiation Dosage; Radiation Injuries - diagnosis; Radiotherapy; Radiotherapy Planning, Computer-Assisted - methods; Radiotherapy, Conformal; Radiotherapy, Intensity-Modulated; Short Communication; Stomach Neoplasms - mortality; Stomach Neoplasms - pathology; Stomach Neoplasms - radiotherapy
• ISSN: 0179-7158; 1439-099X
• DOI: 10.1007/s00066-012-0254-5

Purpose Adjuvant radiochemotherapy (RCHT) improves survival of patients with locally advanced gastric cancer. Conventional three-dimensional conformal radiotherapy (3D-CRT) results in ablative doses to a significant amount of the left kidney, while image-guided intensity-modulated radiotherapy (IG-IMRT) provides excellent target coverage with improved kidney sparing. Few long-term results on IMRT for gastric cancer, however, have been published. Functional magnetic resonance imaging (fMRI) at 3.0 T including blood oxygenation-level dependent (BOLD) imaging, diffusion-weighted imaging (DWI) and, for the first time, 23 Na imaging was used to evaluate renal status after radiotherapy with 3D-CRT or IG-IMRT. Patients and methods Four disease-free patients (2 after 3D-CRT and 2 after IMRT; FU for all patients > 5 years) were included in this feasibility study. Morphological sequences, axial DWI images, 2D-gradient echo (GRE)-BOLD images, and 23 Na images were acquired. Mean values/standard deviations for ( 23 Na), the apparent diffusion coefficient (ADC), and R2* values were calculated for the upper/middle/lower parts of both kidneys. Corticomedullary 23 Na-concentration gradients were determined. Results Surprisingly, IG-IMRT patients showed no morphological alterations and no statistically significant differences of ADC and R2* values in all renal parts. Values for mean corticomedullary 23 Na-concentration matched those for healthy volunteers. Results were similar in 3D-CRT patients, except for the cranial part of the left kidney. This was atrophic and presented significantly reduced functional parameters (p = 0.001—p = 0.033). Reduced ADC values indicated reduced cell density and reduced extracellular space. Cortical and medullary R2* values of the left cranial kidney in the 3D-CRT group were higher, indicating more deoxygenated hemoglobin due to reduced blood flow/oxygenation. ( 23 Na) of the renal cranial parts in the 3D-CRT group was significantly reduced, while the expected corticomedullary 23 Na-concentration gradient was partially conserved. Conclusions Functional MRI can assess postradiotherapeutic renal changes. As expected, marked morphological/functional effects were observed in high-dose areas (3D-CRT), while, unexpectedly, no alteration in kidney function was observed in IG-IMRT patients, supporting the hypothesis that reducing total/fractional dose to the renal parenchyma by IMRT is clinically beneficial.