Obstructive nephropathy: evaluation with dynamic Gd-DTPA-enhanced MR imaging

The potential of dynamic gadolinium diethylenetriaminepentaacetic acid (DTPA)-enhanced magnetic resonance (MR) imaging for the examination of obstructive nephropathy was analyzed in 27 subjects (five healthy subjects, seven patients with dilated nonobstructed kidneys, six patients with acute obstruction, and nine patients with chronic obstruction) with use of a 1.5-T magnet. Morphologic findings were compared with quantitative analysis of temporal changes in signal intensity. Dynamic postcontrast images of the normal kidney demonstrated four phases of enhancement; cortical enhancement phase, early tubular phase, ductal phase, and excretory phase. The pattern of enhancement in dilated nonobstructed kidneys was similar to that in normal kidneys. In acutely obstructed kidneys, cortical enhancement was similar to that in normal kidneys (17% increase), but medullary enhancement was higher than normal, resulting in diminished corticomedullary differentiation. The early tubular phase was prolonged (until 2.5 minutes after injection), with delayed appearance of the ductal and excretory phases. In chronically obstructed kidneys, the increase in cortical intensity was less than that in normal kidneys (13% increase). The early tubular phase was prolonged, and the ductal phase was diminished or absent.