During the last decade embolization of renal artery (ERA) is used for preparation of patients with renal cell carcinoma (RCC) of large size or significant vascularization to surgical treatment. Currently there is no accurate method of prediction of intraoperative blood loss in patients with RCC after ERA, that may give possibility for more adequate pre- and postoperative patient management and to define the indications for re-embolization. Goal. The goal of the study was to evaluate the possibility of application of diffusion-weighted imaging (DWI) of MRI and of apparent diffusion coefficient (ADC) for the prediction of the estimated intraoperative blood loss (EIBL) during the open radical nephrectomy in patients with RCC and after ERA.

Materials and methods. The study enrolled 33 patients (main group, 18 males and 15 females) with solid RCC according to clinical and radiologic data and with the indications to selective ERA with subsequent radical nephrectomy. Mean size of the tumor was 8.6 ± 3.8 cm in greatest dimension. In all patients with RCC in the same day or day before ERA and 7 days after the ERA MRI with additional DWI sequence with b-value = 0.800 was performed. Subsequent measuring of the ADC over the tumor region was done in all cases. ADC values of the normal renal parenchyma for control were achieved during the examination of 15 healthy volunteers. In all patients with RCC 7–8 days after the ERA open radical nephrectomy with simultaneous EIBL measurement was executed.

Results. In patients with EIBL less than 500 ml and with no episodes of the hemotransfusions mean ADC value decreased by 18.4–31.9 % in comparison with initial ADC value. As opposed to that in patients with EIBL more than 500 ml and in selected cases with hemotransfusions mean ADC value increased by 4.91–65.64 % compared to baseline value. Analysis of the acquired data showed significant (р < 0.05) difference in main group of patients in whom no hemotransfusions were required in post-op period (n = 27, 81.82 %) in mean ADC values before and after ERA (decrease by 20.25 %): 1.63 ± 0.31•10–3 mm2/s vs 1.30 ± 0.19•10–3 mm2/s. In main group patients with hemotransfusions in post-op period this value increased by 28.83 %: 1.63 ± 0.31•10–3 mm2/s vs 2.10 ± 0.47•10–3 mm2/s (р < 0.05). Conclusions. In the result of our study strong direct relationship (correlation coefficient r = 0,96) between the volume of EIBL during open radical nephrectomy and ADC values in patients with RCC after ERA was detected. Application of MRI and its imaging biomarkers may be valuable clinical instrument for the prediction of the EIBL volume during the open radical nephrectomy in patients with RCC after ERA and need of the hemotransfusion in post-op period.

Received 02/11/16

Keywords: renal cell carcinoma, embolization, biomarker, blood loss, MRI

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