Faculty Bibliography

PURPOSE: To compare image quality of monopolar and bipolar diffusion-weighted imaging (DWI) sequences of the liver at 3T. METHODS: 32 healthy volunteers (mean 27 +/- 8 years; 27 M/5F) and 11 patients (mean age 58 +/- 14 years; 8 M/3F) underwent liver MRI using a 3T system incorporating 2-channel parallel transmission for B1-shimming and reduced B1-inhomogeneity. Scans included free-breathing DWI sequences (b-value 0, 400, 800 s/mm2) acquired using both monopolar and bipolar techniques. Estimated signal-to-noise ratio (eSNR), apparent diffusion coefficient (ADC), and measures of subjective image quality on b-800 images, scored on a 1-5 scale by two independent radiologists, were compared between sequences. RESULTS: Monopolar sequence demonstrated significantly higher eSNR (volunteers: 12.7 +/- 4.0 vs. 11.3 +/- 3.5, patients: 11.4 +/- 4.0 vs. 10.2 +/- 3.3; p /= 0.191). Hepatic ADC was significantly lower using monopolar technique only in volunteers (1.28 +/- 0.12 vs. 1.43 +/- 0.15, p < 0.001). CONCLUSION: In comparison with past studies performed at 1.5T, when using a modern 3T system, we observed improved image quality of liver DWI using a monopolar, rather than a bipolar, acquisition scheme, largely attributed to higher eSNR.

BACKGROUND: The purpose of this study was to describe the clinicopathologic characteristics and oncologic outcomes of patients who underwent nephrectomy for cystic renal masses. PATIENTS AND METHODS: Using an institutional review board-approved database, we retrospectively reviewed the clinical, pathologic, radiologic, and oncologic outcome data of patients who received nephrectomy for a complex cystic renal mass. RESULTS: Sixty-one patients were identified who received nephrectomy for a complex cystic lesion. Average age was 64 years. Thirty-nine (64%) patients were male. At the time of resection, 1 (1.6%), 3 (4.8%), 53 (86.8%), and 4 (6.5%) had a Bosniak category II, IIF, III, and IV cystic lesion, respectively. Nineteen (31.1%) patients were initially managed expectantly but underwent surgery because of progression of complexity on follow-up. Mean pathologic tumor size was 3.3 cm (range, 0.7-12 cm). Forty-eight (78.6%) of the lesions were found to be malignant. Thirty-seven (77.1%), 5 (10.4%), 4 (8.3%), and 2 (4.1%) were stage T1a, T1b, T2a, and T3a, respectively. Clear cell was the most common histologic subtype (44%), followed by papillary (21.3%), and unclassified RCC (4.9%). With a mean and median follow-up of 48.4 and 43.0 months, respectively, no patients developed a local or metastatic recurrence. All patients were alive at last follow-up. CONCLUSION: In our series with moderate follow-up, cystic RCCs do not appear to recur or progress regardless of size, histologic subtype, or grade. These findings suggest the malignant potential of cRCCs is significantly less than solid RCCs. Further investigation is required to determine if cRCCs should be classified and managed independently from solid RCCs.

PURPOSE: To assess impact of two-channel parallel transmission (pTx) with focused excitation [zoomed echo-planar imaging (EPI)] on image quality of prostate diffusion-weighted imaging (DWI) at 3T. METHODS: 27 male volunteers (27 +/- 8 years) underwent 3T prostate MRI using 2-channel radiofrequency-transmit system and 18-channel torso receive coil. Scans included EPI-DWI sequence (b values 50, 500, 1000 s/mm2) acquired both with standard sinc pulse and 2-channel pTX with focused excitation, each acquired at large-field-of-view (FOV) (20 x 20 cm) and small-FOV (14 x 14 cm). An abdominal radiologist scored b-1000 images and ADC maps for image quality measures. Sequences were compared using paired Wilcoxon tests. RESULTS: pTx with focused excitation showed significant improvements compared with standard DWI on b-1000 images at large-FOV for the absence of wrap and overall image quality (p /= 0.175), while showing significant improvements on the ADC maps in terms of reduced distortion, absence of ghosting, and absence of wrap (p = 0.010-0.030). CONCLUSION: Zoomed DWI using 2-channel pTx reduced artifacts and improved image quality for 3T prostate DWI; benefit was most apparent for small-FOV images.

PURPOSE: To demonstrate dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) of the prostate with both high spatial and temporal resolution via a combination of golden-angle radial k-space sampling, compressed sensing, and parallel-imaging reconstruction (GRASP), and to compare image quality and lesion depiction between GRASP and conventional DCE in prostate cancer patients. MATERIALS AND METHODS: Twenty prostate cancer patients underwent two 3T prostate MRI examinations on separate dates, one using standard DCE (spatial resolution 3.0 x 1.9 x 1.9 mm, temporal resolution 5.5 sec) and the other using GRASP (spatial resolution 3.0 x 1.1 x 1.1 mm, temporal resolution 2.3 sec). Two radiologists assessed measures of image quality and dominant lesion size. The experienced reader recorded differences in contrast arrival times between the dominant lesion and benign prostate. RESULTS: Compared with standard DCE, GRASP demonstrated significantly better clarity of the capsule, peripheral/transition zone boundary, urethra, and periprostatic vessels; image sharpness; and lesion conspicuity for both readers (P < 0.001-0.020). GRASP showed improved interreader correlation for lesion size (GRASP: r = 0.691-0.824, standard: r = 0.495-0.542). In 8/20 cases, only GRASP showed earlier contrast arrival in tumor than benign; in no case did only standard DCE show earlier contrast arrival in tumor. CONCLUSION: High spatiotemporal resolution prostate DCE is possible with GRASP, which has the potential to improve image quality and lesion depiction as compared with standard DCE.J. Magn. Reson. Imaging 2014. (c) 2014 Wiley Periodicals, Inc.

PURPOSE: We used a combined intravoxel incoherent motion-diffusion tensor imaging (IVIM-DTI) methodology to distinguish structural from flow effects on renal diffusion anisotropy. METHODS: Eight volunteers were examined with IVIM-DTI at 3T with 20 diffusion directions and 10 b-values. Mean diffusivity (MD) and fractional anisotropy (FA) from DTI analysis were calculated for low (b 200 s/mm2 ), and full b-value ranges. IVIM-parameters perfusion-fraction fP , pseudo-diffusivity Dp , and tissue-diffusivity Dt were first calculated independently on a voxelwise basis for all directions. After estimating a fixed isotropic fp from these data, global anisotropies of Dt and Dp in the cortex and medulla were determined in a constrained cylindrical description and visualized using polar plots and cosine scatterplots. RESULTS: For all b-value ranges, medullary FA was significantly higher than that of the cortex. The corticomedullary difference was smaller for the high b-value range. Significantly higher fp and Dt were determined for the cortex and showed a significantly higher directional variance in the medulla. Polar plot analysis displayed nearly isotropic Dp and Dt in the cortex and anisotropy in the medulla. CONCLUSION: Both flow and microstructure apparently contribute to the medullary diffusion anisotropy. The described novel method may be useful in separating decreased tubular flow from irreversible structural tubular damage, for example, in diabetic nephropathy or during allograft rejection. Magn Reson Med, 2014. (c) 2014 Wiley Periodicals, Inc.

The precision, accuracy, and efficiency of a novel semi-automated renal segmentation technique for volumetric interpolated breath-hold sequence (VIBE) MRI sequences was analyzed using 7 clinical datasets (14 kidneys). Two observers performed whole-kidney segmentation using EdgeWave segmentation software based on constrained morphological growth. Ground truths were prepared by manual tracing of kidney on each of approximately 40 slices. Using the software, the average inter-observer disagreement was 2.7%+/- 2.1% for whole kidney volume, 2.1%+/- 1.8% for cortex, and 4.1%+/- 3.2% for medulla. In comparison to the ground truth kidney volume, the error was 2.8%+/- 2.5% for whole kidney volume, 3.1%+/- 1.7% for cortex, and 3.6%+/-.3.1% for medulla. It took an average of 4:14 +/- 1:42 minutes of operator time, plus 2:56 +/- 1:23 minutes of computer time to perform segmentation of one whole kidney, cortex, and medulla. Segmentation speed, inter-observer agreement and accuracy were several times better than those of our existing graph-cuts segmentation technique requiring approximately 20 minutes per case and with 7-10% error. With the expedited image processing, high inter-observer agreement, and volumes closely matching true values, kidney volumetry becomes a reality in many clinical applications.

OBJECTIVE. The purpose of this article is to evaluate differences in texture measures on apparent diffusion coefficient (ADC) maps between low- and high-stage clear cell renal cell carcinomas (RCCs). MATERIALS AND METHODS. In this retrospective study, 61 patients with clear cell RCC at pathologic examination and who underwent preoperative MRI with diffusion-weighted imaging were included. Clear cell RCCs were clinically staged on review of preoperative MRI by a board-certified radiologist blinded to the pathologic findings. Whole lesions were segmented on ADC maps by two readers independently, from which first-order texture features (i.e., mean and skewness) and second-order texture features (i.e., cooccurrence matrix measures) were calculated. Texture metrics were compared between low- and high-stage clear cell RCC. RESULTS. In 61 patients, there were 62 clear cell RCCs (33 low stage [stages I and II] and 29 high stage [stages III and IV]) at pathologic examination. Staging accuracy of qualitative interpretation was 100% for low-stage lesions and 37.9% (11/29) for high-stage lesions. There was no statistically significant difference in mean ADC between high- and low-stage clear cell RCCs (1.77 x 10(-3) vs 1.80 x 10(-3) mm(2)/s; p = 0.7). However, high-stage clear cell RCCs were larger (6.96 +/- 2.93 vs 3.49 +/- 1.57 cm; p < 0.0001) and had statistically significantly (p