Takahashi Naoki, Kawashima Akira, Glockner James F, Hartman Robert P, Leibovich Bradley C, Brau Anja C S, Beatty Philip J, King Bernard F
Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA.
Radiology. 2008 May;247(2):451-7. doi: 10.1148/radiol.2472070798. Epub 2008 Mar 27.
To retrospectively evaluate the detection of small (<2-cm) urothelial tumors by using gadolinium-enhanced three-dimensional (3D) spoiled gradient-recalled echo (GRE) magnetic resonance (MR) urography.
This HIPAA-compliant study received institutional review board approval. All patients included had previously consented to the use of their medical records for research purposes. Eleven of 110 patients (10 men, one woman; mean age, 73.5 years) who underwent MR urography were ultimately identified to have 23 upper-tract urothelial carcinomas smaller than 2 cm or carcinoma in situ. Breath-hold coronal T2-weighted single-shot fast spin-echo and breath-hold coronal 3D T1-weighted spoiled GRE images with fat suppression during nephrographic and excretory phases after intravenous injection of gadolinium-based contrast material were obtained in all patients with a 1.5-T imager. Two radiologists reviewed the MR images in consensus for the presence of tumors. Lesion detectability was compared between each sequence by using the McNemar test.
Of 23 tumors, 17 (74%) were detected by using at least one sequence, eight (35%) were detected with T2-weighted imaging, 15 (65%) were detected on nephrographic phase images, and 15 (65%) were detected on excretory phase images. Two lesions each were detected only on either nephrographic or excretory phase images. Detectability was significantly higher on nephrographic and excretory phase images compared with T2-weighted images (P < .05).
Gadolinium-enhanced 3D spoiled GRE MR urography helped detect 74% of small urothelial carcinomas. Nephrographic and excretory phase images are essential for helping detect small urothelial carcinomas.
回顾性评估钆增强三维（3D）扰相梯度回波（GRE）磁共振（MR）尿路造影对小（<2 cm）尿路上皮肿瘤的检测情况。
本符合健康保险流通与责任法案（HIPAA）的研究获得了机构审查委员会的批准。所有纳入的患者此前均已同意将其病历用于研究目的。在110例行MR尿路造影的患者中，最终确定11例（10名男性，1名女性；平均年龄73.5岁）患有23处小于2 cm的上尿路尿路上皮癌或原位癌。所有患者均使用1.5-T成像仪，在静脉注射钆基对比剂后的肾实质期和排泄期，获取屏气冠状位T2加权单次激发快速自旋回波图像以及屏气冠状位3D T1加权扰相GRE脂肪抑制图像。两名放射科医生共同对MR图像进行审查以确定肿瘤的存在。使用McNemar检验比较每个序列之间的病变可检测性。
在23处肿瘤中，至少一个序列检测出17处（74%），T2加权成像检测出8处（35%），肾实质期图像检测出15处（65%），排泄期图像检测出15处（65%）。各有两处病变仅在肾实质期或排泄期图像上被检测出。与T2加权图像相比，肾实质期和排泄期图像的可检测性显著更高（P < .05）。
钆增强3D扰相GRE MR尿路造影有助于检测74%的小尿路上皮癌。肾实质期和排泄期图像对于检测小尿路上皮癌至关重要。
