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Kidney cancer with retroperitoneal lymph nodes metastases

Case Study
Kownacki, Lukasz, M.D., Ph.D. lukasz.kownacki@ecz-otwock.pl - European Centre of Health Otwock • Poland

Patient History

78-year-old male with diagnosed kidney cancer. CT was inconclusive (due to suboptimal imaging phase) on inferior vena cava infiltration by metastases. The patient was then sent for an abdominal exam on Achieva 3.0T TX at European Centre of Health Otwock, Poland.

MR examination

The patient consumed 3-4 liters of pineapple juice within 24 hours prior to examination. The high concentration of (paramagnetic) manganese in pineapple juice helps to obtain a good delineation of intestines on 3D T1-weighted images (eg. mDIXON), as well as suppressing unwanted “shining” of intestinal fluid content on T2-weighted images.

16-channel SENSE XL Torso coil was carefully positioned to cover abdomen.

During the entire examination oxygen was given (flow rate of 4l/min.) to make breath holding easier for the patient.

The following sequences were performed:

MR Images and interpretation

T2W, single shot TSE T2-SPAIR, single shot TSE
T2W, single shot TSE
T2-SPAIR, single shot TSE
A large mass in the kidney and two cysts are seen on the left side.
Giant retroperitoneal lymph nodes are seen as well as cysts in both kidneys.
ADC ADC
ADC
ADC
The ADC map derived from 6 b-values DWI SE shows restricted diffusion in the large mass in left kidney as well as smaller lesions in the lymph nodes.
The ADC map derived from 6 b-values DWI SE shows restricted diffusion in the retroperitoneal lymph nodes.
DWIBS, MPR reconstruction (inversed) DWIBS, MIP reconstruction (inversed)
DWIBS, MPR reconstruction (inversed)
DWIBS, MIP reconstruction (inversed)
The large mass and the spread of abnormalities to lymph nodes is clearly seen.

   
Arterial phase dynamic mDIXON (MPR) Second phase dynamic mDIXON (MPR)
Arterial phase dynamic mDIXON (MPR)
Second phase dynamic mDIXON (MPR)
First phase dynamic mDIXON Second phase dynamic mDIXON
First phase dynamic mDIXON
Second phase dynamic mDIXON
The oblique MPR images are reconstructed from a 3-dynamic 3D T1 FFE mDIXON (water only) axial dataset acquired during Gd contrast administration. The abnormalities seen on previous images are also well visualized. The original axial images (bottom row) are from the first and second dynamic at the level where the largest lesions are seen.




Third phase dynamic mDIXON (MPR) Third phase dynamic mDIXON (MPR)
Third phase dynamic mDIXON (MPR)
Third phase dynamic mDIXON (MPR)
The mass and the spread of retroperitoneal abnormalities in the lymph nodes is clearly seen. Also a renal cyst is very well delineated.
Image shows compression of inferior vena cava lumen by retropritoneal abnormalities. No infiltration of venal lumen is seen. 

Diagnosis

Kidney cancer and metastases diffused to retroperitoneal lymph nodes are confirmed by histology. MRI does not reveal any infiltration of the inferior vena cava, but it is compressed by retroperitoneal abnormalities.

Impact of mDIXON, MultiTransmit, diffusion weighted imaging

Post-gadolinium 3D T1-FFE mDIXON allows very high spatial resolution in dynamic contrast-enhanced abdominal scans.  In this case all the lesions could be very well visualized with Gd-enhanced mDIXON. The requested information about the inferior vena cava was easily obtained using MPR reconstructions.

The dynamic mDIXON approach allows for a highly clear delineation of the lesion. The quality obtained is superb with higher SNR and CNR. Thanks to the MultiTransmit, high quality TSE images can be obtained even in a single-shot mode during breath holding.

This approach markedly reduces scanning time and avoids breathing artifacts. DWI with ADC mapping as well as DWIBS clearly delineated regions of restricted diffusion. This may potentially be useful as marker of tumor response to chemotherapy.


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Feb 5, 2013

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Case Study
Achieva 3.0T TX
Release 3
Quasar Dual
Abdomen, ADC, Body, DWIBS, Kidney, mDIXON, MultiTransmit, Oncology, Pelvis, SENSE XL Torso coil
 

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