Renal transplant failure due to urologic complications: Comparison of static fluid with contrast-enhanced magnetic resonance urography.
OBJECTIVE
Postrenal reasons of renal transplant failure can be assessed by magnetic resonance urography. This study was designed to retrospectively compare the diagnostic accuracy of static fluid (T2-)MRU compared to contrast enhanced (CE-)MRU in patients with renal transplant failure.


METHODS
Thirty-five consecutive patients (14 female, 21 men; mean age 48.6 years) with renal transplant failure and sonographically detected hydronephrosis were examined both with T2-MRU as well as CE-MRU resulting in 39 MRU examinations. MRU was performed both using T2-weighted HASTE-sequence (T2-MRU) as well as Gadolinium-enhanced 3D-FLASH-sequence (CE-MRU) on a 1.5-T clinical MRI scanner (Magnetom Vision, Siemens Medical Solutions). Subjective image quality of resulting maximum intensity projection was assessed in consensus by two readers blinded to the final diagnosis, using a five point scale. MRU findings were correlated to sonography, operative results or clinical follow up.


RESULTS
CE-MRU yielded a sensitivity of 85.7% (T2-MRU 76.2%), and a specificity of 83.3% (T2-MRU: 73.7%), however statistical significance was not reached. The subjective image quality was significantly better in CE-MRU.


CONCLUSIONS
Only concerning subjective image quality CE-MRU proved superior to T2-MRU. Yet, there was no significant difference in diagnostic accuracy between T2- and CE-MRU. Thinking of incipient nephrogenic systemic fibrosis, T2-MRU can be used as reliable alternative in patients with decreased renal transplant function due to urological complications.
Institute of Diagnostic Radiology, University Hospital Duesseldorf, Duesseldorf, Germany. blondin@med.uni-duesseldorf.de
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Blondin
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Koester
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Andersen
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Kurz
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Moedder
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Cohnen
D003287:Contrast Media; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D006869:Hydronephrosis / Q000175:diagnosis* / Q000209:etiology*; D007089:Image Enhancement / Q000379:methods*; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000473:pathology*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D014567:Urography / Q000379:methods
D003287:Contrast Media; D019786:Gadolinium DTPA