Ulrike I. Attenberger MD, Presenter: Nothing to Disclose

Steven Sourbron PhD, Abstract Co-Author: Nothing to Disclose

Stefan Oswald Schoenberg MD, PhD, Abstract Co-Author: Nothing to Disclose

Tim Leiner MD, PhD, Abstract Co-Author: Research grant, Bayer AG, Berlin, Germany

Maximilian F. Reiser MD, Abstract Co-Author: Nothing to Disclose

Henrik J. Michaely MD, Abstract Co-Author: Nothing to Disclose

Combining MR angiography and perfusion measurements allows the unique diagnostic work-up of vascular and parenchymal renal diseases in one single approach. The aim of this study is the evaluation of a combined MR perfusion and angiographic protocol for the assessment of renovascular (RVD) and renoparenchymal diseases (RPD).

27 patients included after informed consent underwent high-spatial resolution MRA (TR/TE [ms] 3.11/1.09, flip angle 23º, spatial resolution [mm3] 0.9x0.8x0.9) and renal perfusion measurements on a 3.0T scanner (Magnetom Tim Trio, Siemens). MR perfusion imaging was performed with a SR-TurboFLASH sequence (TR/TE/TI [ms] 203/0.90/101, flip angle 12º) and a temporal resolution of 5 slices/s after intravenous injection of 7 ml Gd-BOPTA (Multihance, Bracco) at 4 ml/s. MR perfusion measurements were analyzed with a two-compartment model, from which the plasma flow was calculated as characteristic quantitative parameter. Receiver operator characteristics analyses were performed to determine the threshold value for abnormal flow values. Based on sensitivity, specificity and overall diagnostic accuracy the diagnostic value of MRA, MRP and a combined approach were evaluated. In total, 47 kidneys were assessed considering the clinical diagnosis as the standard of reference.  

MRP achieves a higher sensitivity (sensitivity 100%) than MRA (sensitivity 66.7%) in differentiating healthy and non-healthy kidneys. Combining both with an equal impact on the diagnostic decision sensitivity is equal (100%), but specificity slightly decreases to 75% compared to single MRP (specificity 85%). Using MRP to detect non-healthy kidneys and MRA additionally to prove for an underlying vascular reason of impaired renal function reaches the highest diagnostic impact (sensitivity 100%, specificity 88% for RPD, sensitivity 100%, specificity 90% for RVD).  

MRP has a higher sensitivity and specificity for differentiating healthy from non-healthy kidneys compared to single MRA. Using both modalities in the developed order of decision offers a unique, diagnostic valuable tool for the evaluation of parenchymal and vascular renal diseases.

Combining MR-based quantification of renal perfusion values with high-resolution MRA might be a highly differentiating, radiation free alternative for the evaluation of renal diseases.

Attenberger, U, Sourbron, S, Schoenberg, S, Leiner, T, Reiser, M, Michaely, H, Comprehensive Diagnostic Value of Added MR Renal Perfusion Measurements.  Radiological Society of North America 2008 Scientific Assembly and Annual Meeting, February 18 - February 20, 2008 ,Chicago IL. http://archive.rsna.org/2008/6014899.html