Wen J G, Chen Y, Ringgaard S, Frøkiaer J, Jørgensen T M, Stødkilde-Jørgensen H, Djurhuus J C
Institute of Experimental Clinical Research, Aarhus University, Department of Urology K, Skejby University Hospital, Denmark.
J Urol. 2000 Apr;163(4):1264-70.
PURPOSE: Magnetic resonance imaging (MRI) is becoming established as a modality complementary to computerized tomography and ultrasound for evaluating kidney function. The evaluation of renal function during ureteral obstruction may be improved by contrast enhanced MRI. We evaluated dynamic changes in relative signal intensity in normal and hydronephrotic rat kidneys after intravenous injection of gadolinium (Gd) diethylenetetramine-pentaacetic acid (DTPA). MATERIALS AND METHODS: Using Gd-DTPA enhanced dynamic MRI we evaluated 35, 1-year-old rats, including 10 with partial and complete unilateral ureteral obstruction, respectively, and 15 with sham operated nonobstructed kidneys. Partial obstruction was created in 2-day-old rats by embedding the left ureter into the psoas muscle. Complete obstruction was created 10 days before MRI by placing a ligature around the upper third of the left ureter. MRI was performed before and 0.1 to 60 minutes after and intravenous injection of Gd-DTPA. We calculated relative signal intensity per time interval in the renal cortex, medulla and pelvis. RESULTS: Dynamic relative signal intensity patterns differed significantly among normal, and partially and completely obstructed kidneys. In normal kidneys signal intensity changes were divided into 3 phases after Gd-DTPA administration. During phase 1 rapid parenchymal uptake of Gd-DTPA within the initial minute after injection produced a rapid signal intensity decrease in the cortex, which achieved a minimum of 28% of pre-injection intensity. During phase 2 signal intensity decreased in the medulla and pelvis to a minimum of 18% and 22%, respectively, of pre-injection intensity within 5 minutes. During phase 3 significant relative signal intensity recovery began in the cortex at 7 minutes, and in the medulla and pelvis at 10 to 15 minutes, and lasted 30 to 60 minutes. In partially obstructed kidneys the 3 phases were significantly slower than in controls. In completely obstructed kidneys only phase 1 occurred within 60 minutes. CONCLUSIONS: Gd-DTPA enhanced dynamic MRI provides useful information for distinguishing obstructed from nonobstructed and partially from completely obstructed kidneys.
目的:磁共振成像(MRI)正逐渐成为一种与计算机断层扫描和超声互补的用于评估肾功能的检查方法。通过对比增强MRI可改善输尿管梗阻时肾功能的评估。我们评估了静脉注射钆(Gd)二乙烯三胺五乙酸(DTPA)后正常和肾积水大鼠肾脏相对信号强度的动态变化。 材料与方法:使用Gd-DTPA增强动态MRI评估35只1岁大鼠,其中10只分别有部分和完全性单侧输尿管梗阻,15只进行假手术的非梗阻肾脏大鼠。在2日龄大鼠中,通过将左输尿管埋入腰大肌造成部分梗阻。在MRI检查前10天,通过在左输尿管上三分之一处结扎造成完全梗阻。在静脉注射Gd-DTPA之前以及注射后0.1至60分钟进行MRI检查。我们计算了肾皮质、髓质和肾盂每个时间间隔的相对信号强度。 结果:正常、部分梗阻和完全梗阻的肾脏之间动态相对信号强度模式有显著差异。在正常肾脏中,注射Gd-DTPA后信号强度变化分为3个阶段。在第1阶段,注射后最初1分钟内Gd-DTPA快速实质摄取导致皮质信号强度快速下降,降至注射前强度的28%。在第2阶段,髓质和肾盂信号强度在5分钟内分别降至注射前强度的18%和22%。在第3阶段,7分钟时皮质开始有显著的相对信号强度恢复,10至15分钟时髓质和肾盂开始恢复,持续30至60分钟。在部分梗阻的肾脏中,这3个阶段明显比对照组慢。在完全梗阻的肾脏中,60分钟内仅出现第1阶段。 结论:Gd-DTPA增强动态MRI为区分梗阻与非梗阻肾脏以及部分梗阻与完全梗阻肾脏提供了有用信息。
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