Functional evaluation of transplanted kidneys by Gd-DTPA enhanced turbo FLASH MR imaging.
We evaluated the usefulness of dynamic turbo FLASH MR imaging in the differential diagnosis of complications after renal transplantation in 17 patients (10 from living relatives and 7 from cadavers). Coronal turbo FLASH dynamic images were obtained every 5 sec for 5 min after an intravenous bolus injection of Gd-DTPA. Corticomedullary differentiation (CMD) on spin echo coronal T1-weighted images and MR renogram patterns of the renal cortex and medulla were obtained for quantitative analysis of the Gd-DTPA-enhanced dynamic turbo-FLASH images. The signal intensity ratio of the medulla to cortex after Gd-DTPA enhancement was compared among four groups: normal (n = 9), acute tubular necrosis (ATN) or cyclosporine A (CyA) tubulopathy (n = 6), acute rejection (AR) in the living related donor kidney (n = 4), and AR in the cadaveric kidney (n = 5). Although loss of CMD was seen in severe renal dysfunction in the transplanted kidneys, there was considerable overlap among the four groups. On dynamic study, there was significant differences in the signal intensity ratio of the medulla to cortex between normally functioning kidneys or ATN/CyA tubulopathy and AR (p < 0.01). In patients with severe renal dysfunction, the arterial cortical peak was indistinct. In conclusion, MR renograms obtained from dynamic turbo FLASH MR imaging played a significant role in evaluating dysfunction of the renal transplant.
Nakashima
R
R
Department of Radiology, Kumamoto University School of Medicine, Japan.
Yamashita
Y
Y
Tomiguchi
S
S
Tsuji
A
A
Takahashi
M
M
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D002102:Cadaver; D002648:Child; D003287:Contrast Media / Q000008:administration & dosage; D016572:Cyclosporine / Q000009:adverse effects; D003937:Diagnosis, Differential; D005260:Female; D005682:Gadolinium / Q000008:administration & dosage; D019786:Gadolinium DTPA; D006084:Graft Rejection / Q000175:diagnosis / Q000209:etiology; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D007166:Immunosuppressive Agents / Q000009:adverse effects; D007275:Injections, Intravenous; D007672:Kidney Cortex / Q000473:pathology; D007674:Kidney Diseases / Q000139:chemically induced / Q000175:diagnosis; D007679:Kidney Medulla / Q000473:pathology; D016030:Kidney Transplantation / Q000009:adverse effects / Q000473:pathology / Q000502:physiology*; D007683:Kidney Tubular Necrosis, Acute / Q000175:diagnosis / Q000209:etiology; D007684:Kidney Tubules / Q000187:drug effects; D019520:Living Donors; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009942:Organometallic Compounds / Q000008:administration & dosage; D004369:Pentetic Acid / Q000008:administration & dosage / Q000031:analogs & derivatives*
D003287:Contrast Media; D007166:Immunosuppressive Agents; D009942:Organometallic Compounds; D004369:Pentetic Acid; D016572:Cyclosporine; D005682:Gadolinium; D019786:Gadolinium DTPA