Okayama Satoshi, Matsui Masaru, Somekawa Satoshi, Iwano Masayuki, Saito Yoshihiko
First Department of Internal Medicine, Nara Medical University, Kashihara, Nara, Japan.
Ren Fail. 2009;31(2):153-8. doi: 10.1080/08860220802595914.
Gadolinium-containing magnetic resonance imaging (MRI) contrast agents have been reported to induce nephrogenic systemic fibrosis in patients with renal dysfunction, and therefore their use has been restricted. However, even without contrast agents, MRI can provide much valuable information on the pathophysiology of renal diseases. This report describes the case of a 90-year-old man with a hydronephrotic and dysfunctioning right kidney induced by testicular cancer evaluated by non-contrast MRI. He was referred to our hospital complaining of lower abdominal distention and appetite loss. Physical examination revealed a painless enlargement of the right scrotum and inguinal lymph node. Laboratory analysis revealed renal dysfunction, after which a non-contrast MRI was performed. T1-, T2-, and diffusion-weighted images (T1WI, T2WI, and DWI, respectively) revealed carcinoma of the right testicle with extensive multiple lymphadenopathy. Moreover, a retroperitoneal metastatic tumor was detected adjacent to the right kidney, which appeared to constrict the right urinary duct. An enlarged right kidney with loss of corticomedullary differentiation was observed on T1WI. The right kidney and enlarged renal pelvis were observed as large signal intensity areas on T2WI. DWI showed an increased signal intensity of the right kidney and a decreased apparent diffusion coefficient. These findings clarified that the retroperitoneal metastasis from the right testicular cancer led to hydronephrosis and dysfunctioning of the right kidney. The present case indicates that non-contrast MRI is useful for the evaluation of renal diseases even in elderly patients with renal dysfunction.
据报道，含钆磁共振成像（MRI）造影剂可在肾功能不全患者中诱发肾源性系统性纤维化，因此其使用受到限制。然而，即使不使用造影剂，MRI也能提供有关肾脏疾病病理生理学的许多有价值信息。本报告描述了一例90岁男性患者，其因睾丸癌导致右肾积水且功能不全，通过非增强MRI进行评估。他因下腹胀和食欲减退被转诊至我院。体格检查发现右侧阴囊无痛性肿大及腹股沟淋巴结肿大。实验室分析显示肾功能不全，之后进行了非增强MRI检查。T1加权像、T2加权像和扩散加权像（分别为T1WI、T2WI和DWI）显示右侧睾丸癌伴广泛多发淋巴结病。此外，在右肾旁检测到一个腹膜后转移瘤，似乎压迫了右侧输尿管。T1WI上观察到右肾增大，皮髓质分界消失。T2WI上右肾及增大的肾盂表现为高信号强度区。DWI显示右肾信号强度增加，表观扩散系数降低。这些发现明确了右侧睾丸癌的腹膜后转移导致了右肾积水和功能不全。本病例表明，即使在肾功能不全的老年患者中，非增强MRI对肾脏疾病的评估也很有用。
