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30.11.2018 | Urogenital

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

verfasst von: Wendy Tu, Abdulrahman Alzahrani, Stephen Currin, Cindy Walsh, Sabarish Narayanasamy, Matthew D. F. McInnes, Nicola Schieda

Erschienen in: European Radiology | Ausgabe 5/2019

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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.

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Titel: 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
verfasst von: Wendy Tu
Abdulrahman Alzahrani
Stephen Currin
Cindy Walsh
Sabarish Narayanasamy
Matthew D. F. McInnes
Nicola Schieda
Publikationsdatum: 30.11.2018
Verlag: Springer Berlin Heidelberg
Erschienen in: European Radiology / Ausgabe 5/2019
Print ISSN: 0938-7994
Elektronische ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-018-5839-7

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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