Urogenital

European Radiology

, Volume 22, Issue 2, pp 484-492

First online:

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

  • Ivan PedrosaAffiliated withDepartment of Radiology, Beth Israel Deaconess Medical Center and Harvard Medical SchoolDepartment of Radiology, UT Southwestern Medical Center Email author 
  • , Khashayar RafatzandAffiliated withDepartment of Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School
  • , Philip RobsonAffiliated withDepartment of Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School
  • , Andrew A. WagnerAffiliated withSurgery, Division of Urology, Beth Israel Deaconess Medical Center and Harvard Medical School
  • , Michael B. AtkinsAffiliated withHematology/Oncology, Beth Israel Deaconess Medical Center and Harvard Medical School
  • , Neil M. RofskyAffiliated withDepartments of Radiology, University of Texas Southwestern Medical Center
  • , David C. AlsopAffiliated withDepartment of Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School

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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

Keywords

Magnetic resonance imaging Kidney neoplasms Perfusion Renal insufficiency Nephrogenic systemic fibrosis