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European Radiology

, Volume 29, Issue 5, pp 2507–2517 | Cite as

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

  • Wendy Tu
  • Abdulrahman Alzahrani
  • Stephen Currin
  • Cindy Walsh
  • Sabarish Narayanasamy
  • Matthew D. F. McInnes
  • Nicola SchiedaEmail author
Urogenital

Abstract

Objectives

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.

Results

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).

Conclusions

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.

Key Points

• 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.

Keywords

Magnetic resonance imaging Kidney Neoplasms Renal cell carcinoma Image enhancement 

Abbreviations

% SI Change

Percentage of signal intensity difference

AMLs

Angiomyolipomas

BH-LAVA

Breath-hold 3-D T1-weighted MRI

BH

Breath-hold

FS

Fat-suppressed

FSE

Fast spin echo

GRE

Gradient recalled echo

HU

Hounsfield units

IgG4

Immunoglobulin G4-related disease

LAVA

Gradient recalled echo sequence

NAV-LAVA

Navigator-triggered 3-D T1-weighted MRI

NAV

Free-breathing Navigator

PACS

Picture archiving and communication system

RCC

Renal cell carcinoma

ReKAM

Repeated K-t-subsampling and artifact-minimization

ROI

Region of interest

T1W

T1-weighted MRI

T2W

T2-weighted MRI

VIBE

Volumetric interpolated breath-hold examination

Notes

Funding

The authors state that this work has not received any funding.

Compliance with ethical standards

Guarantor

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.

Informed consent

Written informed consent was waived by the institutional review board.

Ethical approval

Institutional review board approval was waived under a quality assurance waiver.

Methodology

• Retrospective

• Cross-sectional study

• Performed at one institution

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Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  • Wendy Tu
    • 1
  • Abdulrahman Alzahrani
    • 1
  • Stephen Currin
    • 1
  • Cindy Walsh
    • 1
  • Sabarish Narayanasamy
    • 1
  • Matthew D. F. McInnes
    • 1
  • Nicola Schieda
    • 1
    Email author
  1. 1.The Ottawa HospitalThe University of OttawaOttawaCanada

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