title: MR renography with low-dose gadopentetate dimeglumine: feasibility.
abstract: OBJECTIVE
  To develop a low-dose magnetic resonance (MR) renographic method performed with and without an angiotensin converting enzyme (ACE) inhibitor and in conjunction with gadolinium-enhanced MR angiography in patients with suspected renovascular disease.
  
  
  METHODS
  Thirty-two patients underwent MR renography (turbo fast low-angle shot sequence: repetition time, 5 msec; echo time, 2.3 msec; flip angle, 15 degrees; one coronal image acquired every 2 seconds for 4 minutes) following intravenous injection of 2 mL of gadopentetate dimeglumine, which was repeated following intravenous injection of an ACE inhibitor. Contrast material-enhanced MR angiography was also performed. On the basis of renographic findings, renal cortex and renal medulla enhancement curves and normalized enhancement ratios were analyzed.
  
  
  RESULTS
  The cortex and medulla showed an early transient period of enhancement within 20 seconds (vascular phase). During 1-2 minutes, a second, gradual increase in medullary enhancement, reflecting transit of filtered contrast material, was observed that was significantly greater in patients with a serum creatinine level less than 2 mg/dL (177 micromol/L) than in those with a level of 2 mg/dL or greater (P < .01). After injection of the ACE inhibitor, patients with elevated creatinine levels showed low renal medullary enhancement regardless of the presence of renal artery stenosis (RAS). However, in patients with creatinine less than 2 mg/dL, medullary enhancement ratios after injection of the ACE inhibitor were consistently lower in patients with RAS of 50% or greater than in those without stenosis (P = .02 to .08).
  
  
  CONCLUSIONS
  Low-dose MR renography can be performed in the clinical setting before and after injection of an ACE inhibitor, and its potential use for evaluating decreased renal function as a consequence of RAS is promising.
authors.affiliation: Department of Radiology-MRI, New York University, 530 First Ave, HCC Basement, New York, NY 10016, USA. lee@mri.med.nyu.edu
authors.forename: V S
authors.initials: VS
authors.lastname: Lee
authors.forename: H
authors.initials: H
authors.lastname: Rusinek
authors.forename: G
authors.initials: G
authors.lastname: Johnson
authors.forename: N M
authors.initials: NM
authors.lastname: Rofsky
authors.forename: G A
authors.initials: GA
authors.lastname: Krinsky
authors.forename: J C
authors.initials: JC
authors.lastname: Weinreb
mesh_terms: D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage; D003287:Contrast Media / Q000008:administration & dosage*; D005240:Feasibility Studies; D005260:Female; D019786:Gadolinium DTPA / Q000008:administration & dosage*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011866:Radioisotope Renography / Q000379:methods*; D012078:Renal Artery Obstruction / Q000000981:diagnostic imaging*
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D003287:Contrast Media; D019786:Gadolinium DTPA