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Dual energy CT allows for improved characterization of response to antiangiogenic treatment in patients with metastatic renal cell cancer



To evaluate the potential role of dual energy CT (DECT) to visualize antiangiogenic treatment effects in patients with metastatic renal cell cancer (mRCC) while treated with tyrosine-kinase inhibitors (TKI).


26 patients with mRCC underwent baseline and follow-up single-phase abdominal contrast enhanced DECT scans. Scans were performed immediately before and 10 weeks after start of treatment with TKI. Virtual non-enhanced (VNE) and colour coded iodine images were generated. 44 metastases were measured at the two time points. Hounsfield unit (HU) values for VNE and iodine density (ID) as well as iodine content (IC) in mg/ml of tissue were derived. These values were compared to the venous phase DECT density (CTD) of the lesions. Values before and after treatment were compared using a paired Student’s t test.


Between baseline and follow up, mean CTD and DECT-derived ID both showed a significant reduction (p < 0.005). The relative reduction measured in percent was significantly greater for ID than for CTD (49.8 ± 36,3 % vs. 29.5 ± 20.8 %, p < 0.005). IC was also significantly reduced under antiangiogenic treatment (p < 0.0001).


Dual energy CT-based quantification of iodine content of mRCC metastases allows for significantly more sensitive and reproducible detection of antiangiogenic treatment effects.

Key Points

A sign of tumour response to antiangiogenic treatment is reduced tumour perfusion.

DECT allows visualizing iodine uptake, which serves as a marker for vascularization.

More sensitive detection of antiangiogenic treatment effects in mRCC is possible.

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Fig. 1
Fig. 2
Fig. 3





Dual energy CT density (venous phase)


Dual energy computed tomography


Dose-length product


Follow up


Gastrointestinal stromal tumours


Hounsfield unit


Iodine concentration


Iodine density


Iodine related attenuation


(metastatic) renal cell cancer


Region of interest


Tyrosine-kinase inhibitor


Vascular endothelial growth factor


Virtual non-enhanced


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The scientific guarantor of this publication is Michael Staehler, MD, PhD. The authors of this manuscript declare relationships with the following companies: Bayer, Braco, GSK, Novartis, Pfizer, and Roche. The authors state that this work has not received any funding. No complex statistical methods were necessary for this paper. Institutional Review Board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. No study subjects or cohorts have been previously reported. Methodology: prospective, case-control study, performed at one institution.

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Correspondence to Michael Staehler.

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Hellbach, K., Sterzik, A., Sommer, W. et al. Dual energy CT allows for improved characterization of response to antiangiogenic treatment in patients with metastatic renal cell cancer. Eur Radiol 27, 2532–2537 (2017). https://doi.org/10.1007/s00330-016-4597-7

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  • Metastatic renal cell carcinoma
  • Therapy monitoring
  • Response evaluation
  • Antiangiogenic treatment
  • Dual energy computed tomography