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MR Renography Using a Dynamic Gradient-Echo Sequence and Low-Dose Gadopentetate Dimeglumine as an Alternative to Radionuclide Renography

Hui Seong Teh1, Ee Sin Ang2, Weng Cheong Wong1, Say Beng Tan3, Andrew Gee Seng Tan1, Soke Miang Chng1, Michael Beng Kiang Lin1 and Jeffery Seow Kuang Goh4

1 Department of Radiology, Changi General Hospital, 2, Simei St. 3, S, 529889 Singapore.
2 Department of Nuclear Medicine, Singapore General Hospital, Outram Rd., S169610, Singapore.
3 Biostatistics Unit, Division of Clinical Trials and Epidemiological Sciences, National Cancer Centre Singapore, 11, Hospital Dr., 169610, Singapore.
4 Department of Diagnostic Radiology, Tan Tock Seng Hospital, 11 Jln Tan Tock Seng, S308433, Singapore.



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  		Fig. 1A. —66-year-old man with right ureteropelvic junction obstruction. Graph of parenchymal MR renographic curve (A) generated from dynamic T1-weighted gradient-echo MR renographic image (TR/TE, 21.9/4.2; flip angle, 60°) with region of interest (ROI) drawn around renal parenchyma (B) shows symmetric parenchymal uptake with prompt contrast material excretion bilaterally. {diamondsuit} = right kidney, {blacksquare} = left kidney.

 


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  		Fig. 1B. —66-year-old man with right ureteropelvic junction obstruction. Graph of parenchymal MR renographic curve (A) generated from dynamic T1-weighted gradient-echo MR renographic image (TR/TE, 21.9/4.2; flip angle, 60°) with region of interest (ROI) drawn around renal parenchyma (B) shows symmetric parenchymal uptake with prompt contrast material excretion bilaterally. {diamondsuit} = right kidney, {blacksquare} = left kidney.

 


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  		Fig. 1C. —66-year-old man with right ureteropelvic junction obstruction. Graph of whole-kidney renographic curve (C) generated from dynamic T1-weighted gradient-echo MR renographic image (21.9/4.2; flip angle, 60°) with whole-kidney ROI (D), including dilated renal pelvis, shows obstructive pattern with increasing contrast material accumulation in right kidney consistent with ureteropelvic junction obstruction. Split renal function per unit volume was 47% for right kidney ({diamondsuit}, C) and 53% for left kidney ({blacksquare}, C). Volume-corrected split renal function was 39% for right kidney and 61% for left kidney. Reduced overall right renal function was due to reduction in right kidney bulk rather than to renal impairment.

 


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  		Fig. 1D. —66-year-old man with right ureteropelvic junction obstruction. Graph of whole-kidney renographic curve (C) generated from dynamic T1-weighted gradient-echo MR renographic image (21.9/4.2; flip angle, 60°) with whole-kidney ROI (D), including dilated renal pelvis, shows obstructive pattern with increasing contrast material accumulation in right kidney consistent with ureteropelvic junction obstruction. Split renal function per unit volume was 47% for right kidney ({diamondsuit}, C) and 53% for left kidney ({blacksquare}, C). Volume-corrected split renal function was 39% for right kidney and 61% for left kidney. Reduced overall right renal function was due to reduction in right kidney bulk rather than to renal impairment.

 


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  		Fig. 2A. —45-year-old woman with hematuria from urinary tract infection. Graph of MR renogram (A) reveals similar curve pattern to graph of radionuclide renogram (B). Graph of MR renogram (A) shows characteristic curve pattern consisting of three segments corresponding to vascular (arrowhead), parenchymal (thin arrow), and excretory (thick arrow) phases. Parenchymal phase is initiated by minimal signal drop at end of initial vascular peak (peak–trough pattern). Split renal function between the right ({diamondsuit}) and left ({blacksquare}, A; •, B) kidneys acquired with radionuclide renography (B) and MR renography (A) also shows good agreement; values of 56%, 44% and 55%, and 45%, respectively, were obtained.

 


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  		Fig. 2B. —45-year-old woman with hematuria from urinary tract infection. Graph of MR renogram (A) reveals similar curve pattern to graph of radionuclide renogram (B). Graph of MR renogram (A) shows characteristic curve pattern consisting of three segments corresponding to vascular (arrowhead), parenchymal (thin arrow), and excretory (thick arrow) phases. Parenchymal phase is initiated by minimal signal drop at end of initial vascular peak (peak–trough pattern). Split renal function between the right ({diamondsuit}) and left ({blacksquare}, A; •, B) kidneys acquired with radionuclide renography (B) and MR renography (A) also shows good agreement; values of 56%, 44% and 55%, and 45%, respectively, were obtained.

 


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  		Fig. 3. —Scatterplot shows comparison of single-kidney split renal function obtained with MR renography versus radionuclide renography. Note good correlation (r = 0.97, p < 0.001) between measurements obtained by the different techniques.

 


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  		Fig. 4A. —Selected serial MR renograms acquired from dynamic T1-weighted gradient-recalled echo sequence (TR/TE, 21.9/4.2; flip angle, 60°) in 45-year-old woman with urinary tract infection. Vascular phase of MR renogram shows enhancement beginning at outer rim of renal cortex.

 


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  		Fig. 4B. —Selected serial MR renograms acquired from dynamic T1-weighted gradient-recalled echo sequence (TR/TE, 21.9/4.2; flip angle, 60°) in 45-year-old woman with urinary tract infection. Parenchymal phase of MR renogram shows contrast material proceeding steadily through renal cortex and medulla resulting in homogeneously enhanced renal parenchyma.

 


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  		Fig. 4C. —Selected serial MR renograms acquired from dynamic T1-weighted gradient-recalled echo sequence (TR/TE, 21.9/4.2; flip angle, 60°) in 45-year-old woman with urinary tract infection. Excretory phase of MR renogram shows contrast material opacifying renal pelvicalices, ureters, and bladder. Note two small simple renal cysts in left kidney and incidental liver cyst.

 


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  		Fig. 5A. —38-year-old man with horseshoe kidney and ureteric implantation. Radionuclide renogram (A) and excretory urogram (B) obtained 15 min after administration of contrast agent show dilated left collecting system. Note poor depiction of horseshoe kidney.

 


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  		Fig. 5B. —38-year-old man with horseshoe kidney and ureteric implantation. Radionuclide renogram (A) and excretory urogram (B) obtained 15 min after administration of contrast agent show dilated left collecting system. Note poor depiction of horseshoe kidney.

 


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  		Fig. 5C. —38-year-old man with horseshoe kidney and ureteric implantation. Coronal MR renogram obtained with low-dose gadopentetate dimeglumine (0.025 mmol/kg of body weight) shows excellent delineation of horseshoe kidney. Difference in parenchymal thickness between left and right moieties is also better appreciated than on A and B.

 


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  		Fig. 6. —24-year-old woman with severe ureteropelvic junction obstruction. MR renogram shows whirlpool phenomenon. Contrast material swirls in circular motion as it is forced to return via path of least resistance back into renal pelvis. Forward thrust of urine jet is blocked as "gate" into ureter is closed. Whirlpool phenomenon may indicate presence of significant obstruction.

 


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  		Fig. 7. —34-year-old man with solitary right kidney and obstruction of ureteropelvic junction. Double-dose gadopentetate dimeglumine (0.2 mmol/kg of body weight) MR angiogram obtained after low-dose MR urogram (not shown) shows relationship between renal artery and collecting system. Note vessel (arrow) crossing ureteropelvic junction and double renal artery supplies.

 

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