Evaluation of a free-breathing respiratory-triggered (Navigator) 3-D T1-weighted (T1W) gradient recalled echo sequence (LAVA) for detection of enhancement in cystic and solid renal masses
To evaluate free-breathing Navigator-triggered 3-D T1-weighted MRI (NAV-LAVA) compared to breath-hold (BH)-LAVA among cystic and solid renal masses.
Materials and methods
With an IRB waiver, 44 patients with 105 renal masses (71 non-enhancing cysts and 14 cystic and 20 solid renal masses) underwent MRI between 2016 and 2017 where BH-LAVA and NAV-LAVA were performed. Subtraction images were generated for BH-LAVA and NAV-LAVA using pre- and 3-min post-gadolinium-enhanced images and were evaluated by two blinded radiologists for overall image quality, image sharpness, motion artifact, and quality of subtraction (using 5-point Likert scales) and presence/absence of enhancement. Percentage signal intensity change (Δ%SI) = ([SI.post-gadolinium-SI.pre-gadolinium]/SI.pre-gadolinium)*100, was measured on BH-LAVA and NAV-LAVA. Likert scores were compared using Wilcoxon’s sign-rank test and accuracy for detection of enhancement compared using receiver operator characteristic (ROC) analysis.
Overall image quality (p = 0.002–0.141), image sharpness (p = 0.002–0.031), and motion artifact were better (p = 0.002) comparing BH-LAVA to NAV-LAVA for both radiologists; however, quality of image subtraction did not differ between groups (p = 0.09–0.14). Sensitivity/specificity/area under ROC curve for enhancement in cystic and solid renal masses using subtraction and %SIΔ were (1) BH-LAVA: 64.7%/98.6%/0.82 (radiologist 1), 61.8%/95.8%/0.79 (radiologist 2), and 70.6%/81.7%/0.76 (%SIΔ) versus 2) NAV-LAVA: 58.8%/95.8%/0.79 (radiologist 1, p = 0.16), 58.8%/88.7%/0.73 (radiologist 2, p = 0.37), and 73.5%/76.1%/0.75 (%SIΔ, p = 0.74).
NAV-LAVA showed similar quality of subtraction and ability to detect enhancement compared to BH-LAVA in renal masses albeit with lower image quality, image sharpness, and increased motion artifact. NAV-LAVA may be considered in renal MRI for patients where BH is suboptimal.
• Free-breathing Navigator (NAV) 3-D subtraction MRI is comparable to breath-hold (BH) images.
• Accuracy for subjective and quantitative diagnosis of enhancement in renal masses on NAV 3-D T1W is comparable to BH MRI.
• NAV 3-D T1W renal MRI is useful in patients who may not be able to adequately BH.
KeywordsMagnetic resonance imaging Kidney Neoplasms Renal cell carcinoma Image enhancement
- % SI Change
Percentage of signal intensity difference
Breath-hold 3-D T1-weighted MRI
Fast spin echo
Gradient recalled echo
Immunoglobulin G4-related disease
Gradient recalled echo sequence
Navigator-triggered 3-D T1-weighted MRI
Picture archiving and communication system
Renal cell carcinoma
Repeated K-t-subsampling and artifact-minimization
Region of interest
Volumetric interpolated breath-hold examination
The authors state that this work has not received any funding.
Compliance with ethical standards
The scientific guarantor of this publication is Nicola Schieda, MD.
Conflict of interest
The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.
Statistics and biometry
One of the authors has significant statistical expertise: Nicola Schieda, the Ottawa Hospital -University of Ottawa, corresponding author.
Written informed consent was waived by the institutional review board.
Institutional review board approval was waived under a quality assurance waiver.
• Cross-sectional study
• Performed at one institution
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