assessing focal renal lesions in pediatric patients with tuberous sclerosis complex

Performance of simultaneous multi-slice accelerated diffusion-weighted imaging for assessing focal renal lesions in pediatric patients with tuberous sclerosis complex:

Abstract

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.