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Whole-body PET/MRI of Pediatric Patients: The Details That Matter
Published on: December 19, 2017
Performance of simultaneous multi-slice accelerated diffusion-weighted imaging for assessing focal renal lesions in
Azadeh Tabari1,2, Fedel Machado-Rivas3,4, John E Kirsch3
1Division of Pediatric Imaging, Department of Radiology, Massachusetts General Hospital, 55 Fruit St., Boston, MA, 02114, USA. atabari@mgh.harvard.edu.
Background:
Diffusion-weighted imaging (DWI) is a useful MRI technique to characterize abdominal lesions in children, but long acquisition times can lead to image degradation. Simultaneous multi-slice accelerated DWI is a promising technique to shorten DWI scan times.
Objective:
To test the feasibility of simultaneous multi-slice DWI of the kidneys in pediatric patients with tuberous sclerosis complex (TSC) and to evaluate the accelerated protocol regarding image quality and quantitative apparent diffusion coefficient (ADC) values compared to standard echoplanar DWI sequence.
Materials And Methods:
We included 33 children and adolescents (12 female, 21 male; mean age 10±5 years) with TSC and renal cyst or angiomyolipoma on 3-tesla (T) MRI from 2017 to 2019. All studies included both free-breathing standard echoplanar DWI and simultaneous multi-slice DWI sequences. Subjective and quantitative image quality was evaluated using a predefined 5-point scale. ADC values were obtained for all renal cysts and angiomyolipomas ≥5 mm. All statistical analysis was performed using Stata/SE v15.1.
Results:
Simultaneous multi-slice DWI ADC values were slightly lower compared to standard echoplanar DWI for both renal cysts and angiomyolipomas (mean difference 0.05×10-3 mm2/s, 95% confidence interval [CI] 0.40-0.50 and 0.024×10-3 mm2/s, 95% CI 0.17-0.21, respectively, with P>0.1). Our results showed that renal lesions with ADC values >1.69×10-3 mm2/s were all cysts, whereas lesions with values <1.16×10-3 mm2/s were all angiomyolipomas. However, ADC values could not discriminate between lipid-rich and lipid-poor angiomyolipomas (P>0.1, for both sequences).
Conclusion:
A 55% reduction in scan time was achieved using simultaneous multi-slice DWI for abdominal imaging in children with TSC, with near identical image quality as standard DWI. These results suggest that multi-slice techniques should be considered more broadly as an MRI acceleration technique in children.
Insights
Simultaneous multi-slice diffusion-weighted imaging (DWI) significantly reduces pediatric MRI scan times for tuberous sclerosis complex (TSC) patients. This accelerated technique maintains image quality, making it a valuable tool for abdominal imaging in children.
Area of Science:
- Pediatric Radiology
- Magnetic Resonance Imaging
- Medical Imaging Techniques
Background:
- Diffusion-weighted imaging (DWI) is crucial for characterizing pediatric abdominal lesions but is limited by long scan times.
- Simultaneous multi-slice (SMS) accelerated DWI offers a promising solution to reduce DWI acquisition duration.
- Tuberous sclerosis complex (TSC) in children often involves renal lesions requiring accurate characterization.
Purpose of the Study:
- To assess the feasibility of SMS DWI for kidney imaging in pediatric TSC patients.
- To compare the image quality and apparent diffusion coefficient (ADC) values of SMS DWI with standard DWI.
- To evaluate the diagnostic potential of ADC values in differentiating renal lesions in TSC.
Main Methods:
- A cohort of 33 pediatric patients with TSC and renal lesions underwent 3-Tesla MRI.
- Both free-breathing standard echoplanar DWI and SMS DWI sequences were acquired.
- Subjective and quantitative image quality was assessed, and ADC values were calculated for renal cysts and angiomyolipomas.
Main Results:
- SMS DWI achieved a 55% reduction in scan time with comparable image quality to standard DWI.
- ADC values showed slight differences between SMS DWI and standard DWI but were not statistically significant.
- Distinct ADC value ranges helped differentiate renal cysts from angiomyolipomas, though not lipid-rich from lipid-poor angiomyolipomas.
Conclusions:
- SMS DWI is a feasible and effective technique for accelerating abdominal MRI in children with TSC.
- The substantial reduction in scan time with preserved image quality supports broader adoption of SMS DWI in pediatric imaging.
- SMS DWI enhances efficiency in pediatric MRI without compromising diagnostic information for renal lesions.
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