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MR evaluation of retroperitoneal fibrosis
L Kamper1, A S Brandt, C Scharwächter
1Klinik für diagnostische und interventionelle Radiologie, HELIOS-Klinik Wuppertal, Klinikum der Privaten Universität Witten/Herdecke. lars.kamper@helios-kliniken.de
Purpose:
Retroperitoneal fibrosis (RPF) is a rare fibrosing process. The relation of contrast enhancement within the fibrosis and the psoas muscle was suggested for the evaluation of disease activity and response to treatment, but no standardized method for the quantification of the disease activity is currently available. We introduce an MR parameter for the evaluation of RPF.
Materials And Methods:
29 patients with untreated idiopathic RPF were examined before medical therapy and after three months of treatment. MR analyses included quotients of T 1 and T 2-signal intensities between the RPF and the psoas muscle. Furthermore, we examined the dynamic contrast enhancement of the fibrous tissue. The respective data were compared with the extent of the RPF after 3 months.
Results:
In the follow-up examinations we observed a significant regression in 37.9 % (n = 11) of cases, a mild regression in 48.3 % (n = 14) and a stable extent in 13.8 % (n = 4). Patients with a significantly reduced extent showed the highest mean values for the applied MR quotients in the initial examination. The lowest mean values for the respective parameters were found for the group with a stable extent. Only dynamic enhancement quotients showed statistically significant differences (p = 0.011) between the groups of response.
Conclusion:
We observed a significant reduction in the fibrous tissue after pharmacological treatment in patients with an elevated dynamic enhancement quotient in the initial examination.
Insights
Dynamic contrast enhancement on MRI may predict treatment response in retroperitoneal fibrosis (RPF). Patients with higher initial enhancement showed significant RPF reduction after medical therapy, suggesting a new MR parameter for disease activity evaluation.
Area of Science:
- Radiology
- Medical Imaging
- Fibrotic Diseases
Background:
- Retroperitoneal fibrosis (RPF) is a rare condition.
- Assessing RPF disease activity and treatment response lacks standardized methods.
- Previous studies suggested a link between contrast enhancement and RPF activity.
Purpose of the Study:
- To introduce and evaluate a novel magnetic resonance (MR) parameter for quantifying RPF disease activity.
- To assess the relationship between MR signal intensities and dynamic contrast enhancement with RPF regression.
- To establish a standardized method for evaluating RPF activity and treatment response.
Main Methods:
- 29 patients with untreated idiopathic RPF underwent MR imaging before and after 3 months of therapy.
- MR analysis included T1 and T2 signal intensity quotients between RPF and psoas muscle.
- Dynamic contrast enhancement of fibrotic tissue was assessed and correlated with RPF extent.
Main Results:
- Significant RPF regression occurred in 37.9% of patients, mild regression in 48.3%, and stability in 13.8%.
- Higher initial MR quotients correlated with greater RPF reduction.
- Dynamic enhancement quotients showed statistically significant differences between response groups (p=0.011).
Conclusions:
- Elevated dynamic enhancement quotients in initial MR examinations predict significant fibrous tissue reduction after pharmacological treatment.
- This MR parameter offers a potential tool for evaluating RPF disease activity and treatment response.
- Further standardization of this MR parameter is warranted for clinical application.
