Effect of Intravenous Extracellular Gadolinium Based Contrast Medium on Renal Diffusion Weighted Images

Rationale and Objectives

The aim of this study was to compare precontrast and postcontrast renal diffusion-weighted images for signal intensity (SI), apparent diffusion coefficient (ADC), and lesion conspicuity.

Materials and Methods

In 62 patients (mean age, 54 ± 29; 29 men, 33 women) precontrast and postcontrast (0.1 mmol/kg of extracellular gadolinium-based contrast medium; mean, 3.3 ± 0.9 minutes], diffusion-weighted images at b values of 50 and 400 s/mm 2 were compared (3 T). The SI, signal-to-noise ratio, and ADC of the renal cortex, medulla, and lesions were measured. Lesion contrast-to-noise ratios (against the medulla and cortex) were calculated.

Results

Postcontrast medullary SI decreased by 50% and cortical SI decreased by 33% and 39% on images at b = 50 s/mm 2 and b = 400 s/mm 2 , respectively ( P < .0001). The SI and signal-to-noise ratio of lesions did not change significantly after contrast, but lesion-medullary contrast-to-noise ratio was increased by 50% at both b = 50 s/mm 2 and b = 400 s/mm 2 ( P < .005 and P = .0005, respectively) following contrast. Qualitative postcontrast lesion conspicuity was improved, with average scores of 2.8 ± 0.9 for all lesions (κ = 0.7 ± 0.08) and 3.2 ± 0.9 for solid lesions (κ = 0.82 ± 0.1). The ADC of renal cortex decreased ( P = .03), but the ADC of renal medulla or renal lesions did not significantly change.

Conclusion

Postcontrast diffusion-weighted imaging causes a significant decrease in renal parenchymal signal without a significant change in lesion signal, resulting in increased lesion conspicuity.

Recent technical innovations have expanded the application of diffusion-weighted imaging (DWI) in the field of abdominal imaging. These innovations include echo-planar imaging, parallel imaging, high-performance gradients, phased-array multichannel surface coils, and higher magnetic field strengths . Promising results have been obtained using DWI in the abdomen and pelvis, particularly for assessment of the liver, kidneys, and pelvic structures .

To date, DWI has been performed before intravenous extracellular gadolinium-based contrast medium (E-GdCM) administration . However, the images are not uncommonly degraded because of various technical limitations and thus need to be repeated at the end the study, by which time contrast material has already been administered. The effect of E-GdCM on image quality and apparent diffusion coefficient (ADC) values has been studied for the brain and liver, with no significant difference detected before and after the administration of contrast on DWI . In the assessment of the liver, one study concluded that contrast administration in diagnostic doses did not limit the utility of DWI . However, the accumulation of a larger amount of E-GdCM in tissues such as the kidneys may change the signal intensity (SI) of tissue in DWI sequences. This change in SI is mostly attributed to T2∗ shortening and susceptibility effects . The fact that the kidney excretes E-GdCM causes the organ’s signal characteristics to be influenced differently compared to the other soft tissues, such as on postcontrast diffusion-weighted images. In fact, it has been shown that renal excretion of E-GdCM will result in signal loss in the normal renal parenchyma on postcontrast diffusion-weighted images .

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Materials and methods

Patients

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Imaging Technique

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Image Analysis

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Statistical Analysis

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Results

General Observations

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SI and SNR

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Table 1

SI of Kidney (Cortex and Medulla), Renal Lesions, Liver, and Spleen on Diffusion-weighted Images at b = 50 s/mm 2 and b = 400 s/mm 2 Before and After Contrast Administration

SI at b = 50 s/mm 2 SI at b = 400 s/mm 2 Location Precontrast ∗ Postcontrast ∗ Difference Score † P Precontrast ∗ Postcontrast ∗ Difference Score † P ‡ Renal cortex 191 ± 62 128 ± 54 −63 ± 7 (−76 to −48) <.0001 87 ± 26 53 ± 22 −34 ± 3.3 (−40 to −27) <.0001 Renal medulla 146 ± 53 75 ± 43 −70 ± 6.6 (−83 to −56) <.0001 66 ± 21 33 ± 21 −33 ± 2.9 (−38 to −26) <.0001 Renal lesion (all) 240 ± 111 233 ± 115 −6.4 ± 12 (−31 to 18) 0.60 (NS) 96 ± 37 84 ± 39 −11 ± 4 (−19 to −3) .008 Solid renal lesion 165 ± 60 153 ± 45 −12 ± 19 (−56 to 32) 0.54 (NS) 91 ± 29 81 ± 28 −9.5 ± 12 (−36 to 17) .40 (NS) Liver 43 ± 21 42 ± 22 −1.2 ± 1.8 (−4.6 to 2.2) 0.50 (NS) 26 ± 18 21 ± 12 −4 ± 1.5 (−7.7 to −0.4) .03 Spleen 119 ± 61 138 ± 64 19.4 ± 4.3 (11 to 28) <.0001 92 ± 85 100 ± 79 8.8 ± 3 (2.7 to 15) .005

SI, signal intensity.

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Table 2

SNR of the Kidney (Cortex and Medulla), Renal Lesions, Liver, and Spleen on Diffusion-weighted Images at b = 50 s/mm 2 and b = 400 s/mm 2 Before and After Contrast Administration

SNR at b = 50 s/mm 2 SNR at b = 400 s/mm 2 Location Precontrast ∗ Postcontrast ∗ Difference Score † P Precontrast ∗ Postcontrast ∗ Difference Score † P ‡ Renal cortex 24 ± 13 15.5 ± 8.5 −8.3 ± 1.1 (−10 to −6) <.0001 21.6 ± 10 5.2 ± 3.4 −16 ± 1.2 (−18 to −14) <.0001 Renal medulla 18 ± 11 9.4 ± 6.6 −8.8 ± 1.1 (−11 to −6.6) <.0001 16 ± 7.6 8 ± 5.7 −8 ± 1 (−10 to −6) <.0001 Renal lesion 31 ± 19 30 ± 18 −1 ± 2 (−5.6 to 3.5) .65 (NS) 22 ± 11 21 ± 14 −1 ± 1.3 (−4 to 1.4) .36 (NS) Solid renal lesion 26 ± 14 25 ± 13 −1.4 ± 3 (−9 to 6.3) .67 (NS) 15 ± 3.9 14 ± 7.4 −1 ± 3 (−7 to 5.5) .74 (NS) Liver 5.3 ± 3.7 5.3 ± 4 −0.02 ± 0.3 (−0.6 to 0.6) .90 (NS) 6.2 ± 4 5.2 ± 3.4 −0.9 ± 0.4 (−1.8 to −0.1) .02 Spleen 15 ± 10 18 ± 14 3.2 ± 1.2 (0.7 to 5.6) .01 23.5 ± 28 25.4 ± 27 1.8 ± 1.3 (−0.7 to 4.4) .15 (NS)

SNR, signal-to-noise ratio.

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Lesion Conspicuity

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Table 3

CNR of Renal Lesions (Overall and for Solid Lesions Only) Relative to Cortex and Medulla on Diffusion-weighted Images at b = 50 s/mm 2 and b = 400 s/mm 2 Before and After Contrast Administration

CNR at b = 50 s/mm 2 CNR at b = 400 s/mm 2 Precontrast ∗ Postcontrast ∗ Difference Score † P Precontrast ∗ Postcontrast ∗ Difference Score † P ‡ Lesion-medulla 12 ± 15 18 ± 17 6.5 ± 2 (2 to 11) <.005 8 ± 7.4 12.5 ± 12 4.5 ± 1 (2 to 7) .0005 Lesion-cortex 6 ± 17 13 ± 17 6.8 ± 2 (2.4 to 11) <.003 2.5 ± 9 7.5 ± 12 5 ± 1.4 (2.2 to 8) .0008 Solid lesion-medulla 3.8 ± 6.4 11 ± 8.7 7.3 ± 3 (0.4 to 14) .04 4.6 ± 2.8 8.3 ± 5 3.7 ± 1.7 (−0.1 to 7.6) .05 Solid lesion-cortex 0.6 ± 7 7 ± 9 6 ± 2.4 (0.4 to 12) .03 2.4 ± 3.5 5.2 ± 5 2.9 ± 1.6 (−0.8 to 6.5) .11

CNR, contrast-to-noise ratio.

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ADC Results

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Table 4

ADCs (×10 −3 mm 3 /s) of the Kidney (Cortex and Medulla), Renal Lesions, Liver, and Spleen in ADC Images Before and After Contrast Administration

Location Precontrast ∗ Postcontrast ∗ Difference Score † P ‡ Renal cortex 1.853 ± 0.26 1.760 ± 0.25 −0.093 ± 0.04 (−0.17 to −0.07) .03 Renal medulla 1.627 ± 0.25 1.506 ± 1.12 −0.121 ± 0.14 (−0.4 to 0.14) .40 Renal lesion (all) 2.205 ± 0.6 2.090 ± 0.62 −0.115 ± 0.08 (−0.3 to 0.045) .17 Solid renal lesions 1.45 ± 0.4 1.48 ± 0.4 −0.035 ± 0.01 (−0.2 to 0.3) .70 Liver 0.919 ± 0.57 0.755 ± 0.32 −0.164 ± 0.06 (−0.2 to −0.05) .007 Spleen 0.711 ± 0.26 0.705 ± 0.21 −0.006 ± 0.07 (−0.08 to 0.07) .85

ADC, apparent diffusion coefficient.

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Discussion

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Limitations

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Conclusions

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References

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Effect of Intravenous Extracellular Gadolinium Based Contrast Medium on Renal Diffusion Weighted Images

Rationale and Objectives

Materials and Methods

Results

Conclusion

Materials and methods

Patients

Imaging Technique

Image Analysis

Statistical Analysis

Results

General Observations

SI and SNR

Lesion Conspicuity

ADC Results

Discussion

Limitations

Conclusions

References

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