Abou El-Ghar M E, Shokeir A A, Refaie H F, El-Diasty T A
Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
Br J Radiol. 2008 Aug;81(968):624-9. doi: 10.1259/bjr/30109090.
The aim of this study was to assess the role of MRI as a single modality for anatomical and functional evaluation of obstructed kidneys in patients with compromised renal function. The study included 96 adults with unilateral or bilateral chronic obstructive hydronephrosis and compromised renal function (serum creatinine >or=1.8 mg dl(-1)). Patients were subjected to gadolinium-enhanced MRI (Gd-MRI), which determined the anatomy of both renoureteral units, as well as their function, through selective calculation of the glomerular filtration rate (GFR) of each kidney. All patients underwent a technetium-99m diethylenetriamine-pentaacetic acid renal scan. Moreover, a correlation was made between the GFR determined by Gd-MRI and the isotope GFR. The study comprised 59 males and 37 females. A comprehensive MRI study detected the cause of obstruction in all kidneys with non-calcular obstruction (sensitivity of 100%) and in 21 kidneys with calcular obstruction (sensitivity of 70%). The overall sensitivity of MRI combined with plain X-ray of the abdomen and ultrasound in the detection of various causes of obstruction was 97%. A comparison between the isotope GFR of the obstructed kidneys and the corresponding magnetic resonance urography (MRU) GFR showed perfect correlation. In conclusion, combined static and dynamic MRU is a promising technique that allows anatomical and functional evaluation of obstructed kidneys in patients with impaired renal function but, owing to the possible risk of nephrogenic systemic fibrosis in patients with a GFR <30 ml min(-1), the lowest possible dose of the most stable Gd-macrocyclic chelates should be used if a functional MRI study is required.
本研究的目的是评估磁共振成像（MRI）作为单一模式对肾功能受损患者梗阻性肾脏进行解剖和功能评估的作用。该研究纳入了96例患有单侧或双侧慢性梗阻性肾盂积水且肾功能受损（血清肌酐≥1.8mg/dl）的成年人。患者接受了钆增强MRI（Gd-MRI）检查，通过选择性计算每个肾脏的肾小球滤过率（GFR）来确定双肾输尿管单位的解剖结构及其功能。所有患者均接受了99m锝二乙三胺五乙酸肾扫描。此外，还对Gd-MRI测定的GFR与同位素GFR进行了相关性分析。该研究包括59名男性和37名女性。一项全面的MRI研究在所有非结石性梗阻的肾脏中检测到了梗阻原因（敏感性为100%），在21例结石性梗阻的肾脏中检测到了梗阻原因（敏感性为70%）。MRI联合腹部平片和超声检测各种梗阻原因的总体敏感性为97%。梗阻性肾脏的同位素GFR与相应的磁共振尿路造影（MRU）GFR之间的比较显示出完美的相关性。总之，静态和动态MRU相结合是一种有前景的技术，可对肾功能受损患者的梗阻性肾脏进行解剖和功能评估，但由于GFR<30ml/min的患者可能存在发生肾源性系统性纤维化的风险，因此如果需要进行功能性MRI研究，应使用最稳定的钆大环螯合物的最低可能剂量。
