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
Similar content being viewed by others
References
Bosniak MA (1986) The current radiological approach to renal cysts. Radiology 158:1–10
Bosniak MA (1991) The small (less than or equal to 3.0 cm) renal parenchymal tumor: detection, diagnosis, and controversies. Radiology 179:307–317
Cowper SE, Robin HS, Steinberg SM, Su LD, Gupta S, LeBoit PE (2000) Scleromyxoedema-like cutaneous diseases in renal-dialysis patients. Lancet 356:1000–1001
Kuo PH, Kanal E, Abu-Alfa AK, Cowper SE (2007) Gadolinium-based MR contrast agents and nephrogenic systemic fibrosis. Radiology 242:647–649
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 23:37–45
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 89:212–216
Roberts DA, Detre JA, Bolinger L et al (1995) Renal perfusion in humans: MR imaging with spin tagging of arterial water. Radiology 196:281–286
Karger N, Biederer J, Lusse S et al (2000) Quantitation of renal perfusion using arterial spin labeling with FAIR-UFLARE. Magn Reson Imag 18:641–647
Martirosian P, Klose U, Mader I, Schick F (2004) FAIR true-FISP perfusion imaging of the kidneys. Magn Reson Med 51:353–361
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 12:347–357
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 14:5548–5554
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 251:731–742
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 60:1488–1497
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 61:1374–1387
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 31:680–687
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 231:365–371
Zhang J, Pedrosa I, Rofsky NM (2003) MR techniques for renal imaging. Radiol Clin North Am 41:877–907
Pedrosa I, Sun MR, Spencer M et al (2008) MR imaging of renal masses: correlation with findings at surgery and pathologic analysis. Radiographics 28:985–1003
Bydder M, Larkman DJ, Hajnal JV (2002) Combination of signals from array coils using image-based estimation of coil sensitivity profiles. Magn Reson Med 47:539–548
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 250:793–802
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 71:47–51
Pedrosa I, Chou MT, Ngo L et al (2008) MR classification of renal masses with pathologic correlation. Eur Radiol 18:365–375
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Pedrosa, I., Rafatzand, K., Robson, P. et al. Arterial spin labeling MR imaging for characterisation of renal masses in patients with impaired renal function: initial experience. Eur Radiol 22, 484–492 (2012). https://doi.org/10.1007/s00330-011-2250-z
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00330-011-2250-z