Top

Published in:

01-02-2012 | Urogenital

Arterial spin labeling MR imaging for characterisation of renal masses in patients with impaired renal function: initial experience

Authors: Ivan Pedrosa, Khashayar Rafatzand, Philip Robson, Andrew A. Wagner, Michael B. Atkins, Neil M. Rofsky, David C. Alsop

Published in: European Radiology | Issue 2/2012

Abstract

Objectives

To retrospectively evaluate the feasibility of arterial spin labeling (ASL) magnetic resonance imaging (MRI) for the assessment of vascularity of renal masses in patients with impaired renal function.

Methods

Between May 2007 and November 2008, 11/67 consecutive patients referred for MRI evaluation of a renal mass underwent unenhanced ASL-MRI due to moderate-to-severe chronic or acute renal failure. Mean blood flow in vascularised and non-vascularised lesions and the relation between blood flow and final diagnosis of malignancy were correlated with a 2-sided homogeneous variance t-test and the Fisher Exact Test, respectively. A p value <0.05 was considered statistically significant.

Results

Seventeen renal lesions were evaluated in 11 patients (8 male; mean age = 70 years) (range 57–86). The median eGFR was 24 mL/min/1.73 m² (range 7–39). The average blood flow of 11 renal masses interpreted as ASL-positive (134 +/− 85.7 mL/100 g/min) was higher than that of 6 renal masses interpreted as ASL-negative (20.5 +/− 8.1 mL/100 g/min)(p = 0.015). ASL-positivity correlated with malignancy (n = 3) or epithelial atypia (n = 1) at histopathology or progression at follow up (n = 7).

Conclusions

ASL detection of vascularity in renal masses in patients with impaired renal function is feasible and seems to indicate neoplasia although the technique requires further evaluation.

Key Points

Arterial spin labeling may help to characterise renal masses in patients with renal failure
Detection of blood flow on ASL in a renal mass supports the presence of a neoplasm
Renal masses with high blood-flow levels on ASL seem to progress rapidly

Bosniak MA (1986) The current radiological approach to renal cysts. Radiology 158:1–10PubMed

Bosniak MA (1991) The small (less than or equal to 3.0 cm) renal parenchymal tumor: detection, diagnosis, and controversies. Radiology 179:307–317PubMed

Cowper SE, Robin HS, Steinberg SM, Su LD, Gupta S, LeBoit PE (2000) Scleromyxoedema-like cutaneous diseases in renal-dialysis patients. Lancet 356:1000–1001PubMedCrossRef

Kuo PH, Kanal E, Abu-Alfa AK, Cowper SE (2007) Gadolinium-based MR contrast agents and nephrogenic systemic fibrosis. Radiology 242:647–649PubMedCrossRef

American College of Radiology Committee on Drugs and Contrast Media. Manual on contrast media. Version 7, 2010. www.acr.org/…/quality_safety/contrast_manual/FullManual.aspx

European Medicines Agency. Questions and answers on the review of gadolinium contrast agents. July 1st, 2010. London UK

Detre JA, Leigh JS, Williams DS, Koretsky AP (1992) Perfusion imaging. Magn Reson Med 23:37–45PubMedCrossRef

Williams DS, Detre JA, Leigh JS, Koretsky AP (1992) Magnetic resonance imaging of perfusion using spin inversion of arterial water. Proc Natl Acad Sci U S A 89:212–216PubMedCrossRef

Roberts DA, Detre JA, Bolinger L et al (1995) Renal perfusion in humans: MR imaging with spin tagging of arterial water. Radiology 196:281–286PubMed

10.

Karger N, Biederer J, Lusse S et al (2000) Quantitation of renal perfusion using arterial spin labeling with FAIR-UFLARE. Magn Reson Imag 18:641–647CrossRef

11.

Martirosian P, Klose U, Mader I, Schick F (2004) FAIR true-FISP perfusion imaging of the kidneys. Magn Reson Med 51:353–361PubMedCrossRef

12.

De Bazelaire C, Rofsky NM, Duhamel G, Michaelson MD, George D, Alsop DC (2005) Arterial spin labeling blood flow magnetic resonance imaging for the characterization of metastatic renal cell carcinoma(1). Acad Radiol 12:347–357PubMedCrossRef

13.

de Bazelaire C, Alsop DC, George D et al (2008) Magnetic resonance imaging-measured blood flow change after antiangiogenic therapy with PTK787/ZK 222584 correlates with clinical outcome in metastatic renal cell carcinoma. Clin Canc Res 14:5548–5554CrossRef

14.

Schor-Bardach R, Alsop DC, Pedrosa I et al (2009) Does arterial spin-labeling MR imaging-measured tumor perfusion correlate with renal cell cancer response to antiangiogenic therapy in a mouse model? Radiology 251:731–742PubMedCrossRef

15.

Dai W, Garcia D, de Bazelaire C, Alsop DC (2008) Continuous flow-driven inversion for arterial spin labeling using pulsed radio frequency and gradient fields. Magn Reson Med 60:1488–1497PubMedCrossRef

16.

Robson PM, Madhuranthakam AJ, Dai W, Pedrosa I, Rofsky NM, Alsop DC (2009) Strategies for reducing respiratory motion artifacts in renal perfusion imaging with arterial spin labeling. Magn Reson Med 61:1374–1387PubMedCrossRef

17.

Chalela JA, Alsop DC, Gonzalez-Atavales JB, Maldjian JA, Kasner SE, Detre JA (2000) Magnetic resonance perfusion imaging in acute ischemic stroke using continuous arterial spin labeling. Stroke 31:680–687PubMedCrossRef

18.

Israel GM, Hindman N, Bosniak MA (2004) Evaluation of cystic renal masses: comparison of CT and MR imaging by using the Bosniak classification system. Radiology 231:365–371PubMedCrossRef

19.

Zhang J, Pedrosa I, Rofsky NM (2003) MR techniques for renal imaging. Radiol Clin North Am 41:877–907PubMedCrossRef

20.

Pedrosa I, Sun MR, Spencer M et al (2008) MR imaging of renal masses: correlation with findings at surgery and pathologic analysis. Radiographics 28:985–1003PubMedCrossRef

21.

Bydder M, Larkman DJ, Hajnal JV (2002) Combination of signals from array coils using image-based estimation of coil sensitivity profiles. Magn Reson Med 47:539–548PubMedCrossRef

22.

Sun MR, Ngo L, Genega EM et al (2009) Renal cell carcinoma: dynamic contrast-enhanced MR imaging for differentiation of tumor subtypes–correlation with pathologic findings. Radiology 250:793–802PubMedCrossRef

23.

Adey GS, Pedrosa I, Rofsky NM, Sanda MG, DeWolf WC (2008) Lower limits of detection using magnetic resonance imaging for solid components in cystic renal neoplasms. Urology 71:47–51PubMedCrossRef

24.

Pedrosa I, Chou MT, Ngo L et al (2008) MR classification of renal masses with pathologic correlation. Eur Radiol 18:365–375PubMedCrossRef

Title: Arterial spin labeling MR imaging for characterisation of renal masses in patients with impaired renal function: initial experience
Authors: Ivan Pedrosa
Khashayar Rafatzand
Philip Robson
Andrew A. Wagner
Michael B. Atkins
Neil M. Rofsky
David C. Alsop
Publication date: 01-02-2012
Publisher: Springer-Verlag
Published in: European Radiology / Issue 2/2012
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-011-2250-z

At a glance: The STEP trials

Springer Medicine

Arterial spin labeling MR imaging for characterisation of renal masses in patients with impaired renal function: initial experience

Abstract

Objectives

Methods

Results

Conclusions

Key Points

At a glance: The STEP trials

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusions

Key Points

Please log in to get access to this content

Other articles of this Issue 2/2012

Diagnostic accuracy of contrast-enhanced MR angiography and unenhanced proton MR imaging compared with CT pulmonary angiography in chronic thromboembolic pulmonary hypertension

Is there a role for dynamic swallowing MRI in the assessment of gastroesophageal reflux disease and oesophageal motility disorders?

CT image quality improvement using adaptive iterative dose reduction with wide-volume acquisition on 320-detector CT

Comparison of image quality and radiation dose of different pulmonary CTA protocols on a 128-slice CT: high-pitch dual source CT, dual energy CT and conventional spiral CT

Radiology of advanced EVAR techniques in complex abdominal aortic aneurysms

Severity assessment of pulmonary embolism using dual energy CT – correlation of a pulmonary perfusion defect score with clinical and morphological parameters of blood oxygenation and right ventricular failure