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MR findings in diffuse renal parenchymal disease
U Kettritz1, R C Semelka, E D Brown
1Department of Radiology, University of North Carolina at Chapel Hill 27599-7510, USA.
Abstract:
This study evaluates the MR appearance of the kidney in diffuse renal parenchymal diseases, using precontrast, and immediate and delayed postgadolinium chelate (Gd), spoiled gradient echo (SGE), and pre- and post-Gd, T1-weighted, fat-suppressed spin-echo MR images to determine if characteristic findings exist for various types of renal disease. One hundred twenty-one patients with renal disease underwent MRI. Underlying diagnoses included: (a) glomerular disease (GD), (b) tubulointerstitial disease (TID), (c) microvascular disease (MVD), (d) ischemic nephropathy (INP), (e) obstructive nephropathy (ON), (f) infectious renal disease (IRD), (g) sickle cell disease (SCD), (h) renal cortical necrosis (CN), and (i) renal insufficiency of unknown etiology (UE). MR examinations of 22 patients with normal kidneys (NK) were evaluated as a control group. The presence of corticomedullary differentiation (CMD) demonstrated strong inverse correlation with serum creatinine concentration (SCr) (r = -.568, P < .001). Mean thickness of the renal cortex was 8.4 and 7.8 mm in patients with NK and Gd, respectively. The mean cortical thickness in patients with MVD, TID/Chemo, INP, and ON was 5.2, 5.6, 5.5, and 4.3 mm, respectively, significantly thinner than the renal cortex in the NK and GD groups (P < .01). Irregularity of the renal cortex was more frequent in MVD (60.9%), IRD (62.5%), ON (55.6%), and TID/other (53.8%) than in GD (3.8%) and NK (0%) (P < .01). Diffuse high SI of the entire medulla on delayed postcontrast images was observed in 25 (20.7%) of the patients with renal disease and none of the NK group. Although no pathognomonic features were found, certain findings were observed that may correlate with the etiology of the kidney disease and, therefore, assist in the differential diagnosis of renal parenchymal disease.
Insights
This study used MRI to examine kidney appearance in diffuse renal parenchymal diseases. While no single feature is definitive, specific MRI findings may help differentiate various kidney conditions.
Area of Science:
- Radiology
- Nephrology
- Medical Imaging
Background:
- Diffuse renal parenchymal diseases encompass a wide range of kidney conditions affecting the functional tissue.
- Accurate diagnosis is crucial for effective management and treatment of kidney disease.
- Magnetic Resonance Imaging (MRI) offers detailed anatomical visualization of the kidneys.
Purpose of the Study:
- To evaluate the characteristic MR appearance of kidneys in various diffuse renal parenchymal diseases.
- To determine if specific MRI findings can aid in the differential diagnosis of these conditions.
- To correlate imaging findings with disease etiology and severity.
Main Methods:
- One hundred twenty-one patients with diagnosed renal diseases and 22 healthy controls underwent MRI.
- Utilized precontrast, immediate and delayed postgadolinium T1-weighted fat-suppressed spin-echo and gradient echo sequences.
- Evaluated parameters included corticomedullary differentiation (CMD), cortical thickness, and cortical irregularity.
Main Results:
- A strong inverse correlation was found between CMD and serum creatinine concentration (r = -.568, P < .001).
- Renal cortical thickness was significantly reduced in microvascular disease, tubulointerstitial disease, ischemic nephropathy, and obstructive nephropathy compared to controls (P < .01).
- Cortical irregularity was more frequent in microvascular disease, infectious renal disease, and obstructive nephropathy (P < .01). Diffuse high signal intensity in the medulla was noted in 25% of patients.
Conclusions:
- No single pathognomonic MR feature definitively identifies specific renal parenchymal diseases.
- However, observed MRI findings such as reduced cortical thickness and increased cortical irregularity may assist in differentiating between various kidney conditions.
- MRI can provide valuable information for the differential diagnosis of diffuse renal parenchymal diseases, complementing clinical and laboratory data.