Tumor response to non surgical therapies is closely related to tissue perfusion and local oxygen delivery after treatment, attributed in large part to neoangiogenesis [19, 35]. On the contrary, cryoablation destroys LXH254 tissue, indirectly erasing tumor perfusion by means of microvascular damage-induced ischemia, but to date this has not been demonstrated using pCT. Although actually no single test has been validated for neoangiogenesis measurements, in a previous study perfusion-CT positively

related with tumor MVD in neo-vascularised areas of RCC [36]. In the tumor response assessment, common imaging features, used to define successfully cryoablated tumors, relies on shrinkage and no focal contrast enhancement in the treated area at morphology evaluation [15, 30, 37]. Therefore, some Authors reported a threshold of enhancement (10 HU) to distinguish suspected residual

tumor (>10 HU) from successfully ablated zone buy HM781-36B (<10 HU), mostly after radio-frequency ablation rather than cryoablation [38–41]. This quantitative parameter of favourable imaging outcome has not been confirmed by pathology and only a few studies investigated cryoablated areas specimens during follow-up. Weight J.C. et al [42], provide the largest available series regarding the correlation between imaging findings and pathology results after renal tumors cryoablation with favourable agreement between imaging and pathological essays at a 6-months follow-up. Using the morphologic criterion of central nodular enhancement as a predictive feature of positive biopsy in their series, the sensitivity was 77.8% with a 95.1% specificity, 63.4% PPV and 97.7%

NPV. We found two different trend in Time/Density curves of successfully cryoablated area and residual tumour lesion that may be a practical approach during imaging follow-up in early Selleckchem Evofosfamide detection of not responsive disease. Overall, in successfully cryoablated area we identified a typical pattern of contrast-enhancement without arterial wash-in and slow wash-in with a plateau trend. Although just observed in one patient, the contrast enhancement curve of the residual tumour area is defined by a fast and early wash-in, a plateau trend and a slow, progressive and uniform wash-out. In line with these findings, our study many also provided a positive correlation between kinetics parameters measured Time/Density curves and quantitative measurement of contrast enhancement (BV, BF, MTT, PS). Successfully cryoablated area demonstrated decreased value of BV, BF and PS and increased value of MTT compared to the normal renal parenchyma. These two patterns can be useful to distinguish residual tumor from successfully treated area, which enhances and washes-out slowly. Thus, viable tumors tend to have high contrast-enhancement reflected as in colour scale on parametric images, whereas area responsive to treatment show no change in colour.