Comprehensive MR Evaluation of Renal Disease: Added Clinical Value of Quantified Renal Perfusion Values Over Single MR Angiography

Purpose: To evaluate the diagnostic accuracy of quantified renal perfusion parameters in identifying and differentiating renovascular from renal parenchymal disease. Materials and Methods: In all, 27 patients underwent renal perfusion measurements on a 3.0 T magnetic resonance imaging (MRI) system. Imaging was performed with a saturation recovery TurboFLASH sequence (TR/TE 177/0.93 msec, flip angle 12 degrees, 5 slices/sec). All patients also underwent high-resolution MR angiography (MRA) (TR/TE 3.1/1.09, flip angle 23 degrees, spatial resolution 0.9 x 0.8 x 0.9 mm(3)). MR perfusion measurements were analyzed with a two-compartment model, quantifying the plasma flow (F(p))-a characteristic renal first-pass perfusion parameter. A receiver-operator characteristic analysis was used to determine the optimal threshold value for distinguishing normal and abnormal plasma flow values. Utilizing this cutoff, sensitivity and specificity of solitary MR perfusion measurements. MRA, and a diagnostic strategy combining the two were evaluated. Results: Quantified MR perfusion values yielded a sensitivity of 100% and a specificity of 85% utilizing the optimal plasma flow threshold value of 150 mL/100 mL/min, whereas single MRA achieved a sensitivity of 51.9% and a specificity of 90%. Combining both methods enabled improved detection of renovascular and renoparenchymal disease with a sensitivity of 96.3% and specificity of 90%. Conclusion: In distinction to MRA, quantified MR perfusion measurements allow for the detection of pure renal parenchymal disorders. The combination of MRA with these perfusion measurements suggests an algorithm by which parenchymal and renovascular diseases may be reliably distinguished and the hemodynamic significance of the latter reliably determined.