Background
The aim of this work is to study the role of non-contrast MRI in pre-surgical evaluation of renal masses in renal impairment patients as confirmed by both intraoperative and histopathological findings. Intraoperative and histopathological findings were correlated with radiological data.
Methods
This prospective study included 20 patients comprising 25 renal masses. The data were collected in a period from April 2018 to September 2019. All patients underwent partial or radical nephrectomy by the same surgeon.
Results
Based on MRI findings, 9 masses (36%) and 8 masses (32%) were found to be associated with collecting system invasion and perinephric fat invasion, respectively. Histopathological assessment confirmed only 6 cases (24%) with collecting system invasion and 7 cases (28%) demonstrated perinephric fat. Seven masses (28%) had intralesional hemorrhage detected by MRI and confirmed by pathological findings. The MRI detected 6 cases (24%) with lymph nodes invasion, while the histopathological assessment confirmed lymphatic invasion in 7 cases (28%). Only 2 cases (8%) had vascular invasion detected by preoperative MRI and confirmed by histopathology and surgery. The final histopathological examination confirmed 20 malignant neoplasms (80%: RCC = 18, leiomyosarcoma = 2), 3 benign neoplasms (12%: angiomyolipoma = 1, oncocytoma = 2) and 2 non-neoplastic benign masses (8%: renal abscess = 1, xanthogranulomatous pyelonephritis = 1).
Conclusion
Non-contrast MRI is a crucial imaging tool in renal impairment patients who cannot be examined with contrast-enhanced CT or MRI. It assesses the extent of the renal sinus fat and the perinephric fat invasion.
Background
One of the drawbacks in contrast-enhanced T1-weighted imaging (CE-T1WI) is the enhancing cortical vessels which can be confused with meningeal enhancement. Previous studies reported that post-contrast FLAIR could be better for diagnosing the superficial brain abnormalities. So the purpose of this study was to evaluate the role of delayed post-contrast FLAIR, in comparison with post-contrast T1, in the detection and evaluation of brain metastases.
Results
The study was conducted on 40 patients with suspected/known brain metastases scanned in order to detect and evaluate brain metastases. All patients were subjected to the following: full history taking, review of clinical examination reports, and other imaging modalities whenever available, followed by brain MRI examination using 1.5 T closed magnet including pre-contrast series, axial and sagittal T1-weighted spin echo (SE), axial and coronal T2-weighted turbo spin echo (TSE) and axial FLAIR, while post-contrast series included axial, coronal and sagittal T1-weighted spin echo (SE) and lastly DPC-FLAIR sequence 10 min after contrast administration. This study included 18 males and 22 females, ranging in age from 26 to 75 years. Six out of a total of 40 patients had brain metastases of unknown origin, while 34 of them were presented with different types of known primary tumors. The detected lesions were subdivided into five groups according to their detectability by DPC-FLAIR and contrast-enhanced T1WI: Group (I): lesions detected only by DPC-FLAIR: 16 lesions; Group (II): lesions detected only by CE-T1WI: 1 lesion; Group (III): lesions detected by both DPC-FLAIR and CE-T1WI with equal conspicuity by both: 28 lesions; Group (IV): lesions detected by both, showing more obvious enhancement with DPC-FLAIR: 43 lesions; and Group (V): lesions detected by both, showing more obvious enhancement with CE-T1WI: 11 lesions. DPC-FLAIR had a sensitivity of 98.98% and a specificity of 100% for the detection of metastatic brain lesions and for CE-T1WI; sensitivity of 83.83%; and a specificity of 50%.
Conclusions
Delayed post-contrast FLAIR is a reliable sequence for the detection of metastatic brain lesions as it can detect more metastatic brain lesions compared to contrast-enhanced T1WI.
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