Genitourinary MR: Kidneys and adrenal glands

Krestin, Gabriël P.

doi:10.1007/s003300050914

Cited by 27 publications

(14 citation statements)

References 14 publications

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“…Animal and patient studies have shown that the sole injection of gadolinium without a diuretic cannot safely provide a sufficient urographic effect [16,17]. The normal kidney function is able to concentrate the excreted amount of gadolinium inside the tubular system by a factor of 50±100 [18]. The particular value of low-dose furosemi-23 Fig.…”

Section: Discussionmentioning

confidence: 99%

Diuretic-enhanced gadolinium excretory MR urography: comparison of conventional gradient-echo sequences and echo-planar imaging

et al. 2001

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The aim of this study was to investigate the utility of different gadolinium-enhanced T1-weighted gradient-echo techniques in excretory MR urography. In 74 urologic patients, excretory MR urography was performed using various T1-weighted gradient-echo (GRE) sequences after injection of gadolinium-DTPA and low-dose furosemide. The examinations included conventional GRE sequences and echo-planar imaging (GRE EPI), both obtained with 3D data sets and 2D projection images. Breath-hold acquisition was used primarily. In 20 of 74 examinations, we compared breath-hold imaging with respiratory gating. Breath-hold imaging was significantly superior to respiratory gating for the visualization of pelvicaliceal systems, but not for the ureters. Complete MR urograms were obtained within 14-20 s using 3D GRE EPI sequences and in 20-30 s with conventional 3D GRE sequences. Ghost artefacts caused by ureteral peristalsis often occurred with conventional 3D GRE imaging and were almost completely suppressed in EPI sequences (p < 0.0001). Susceptibility effects were more pronounced on GRE EPI MR urograms and calculi measured 0.8-21.7% greater in diameter compared with conventional GRE sequences. Increased spatial resolution degraded the image quality only in GRE-EPI urograms. In projection MR urography, the entire pelvicaliceal system was imaged by acquisition of a fast single-slice sequence and the conventional 2D GRE technique provided superior morphological accuracy than 2D GRE EPI projection images (p < 0.0003). Fast 3D GRE EPI sequences improve the clinical practicability of excretory MR urography especially in old or critically ill patients unable to suspend breathing for more than 20 s. Conventional GRE sequences are superior to EPI in high-resolution detail MR urograms and in projection imaging.

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Section: Discussionmentioning

confidence: 99%

Diuretic-enhanced gadolinium excretory MR urography: comparison of conventional gradient-echo sequences and echo-planar imaging

et al. 2001

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“…Furthermore, sensitivity 2 and specificity, 3 as well as increases of sensitivity and specificity from precontrast MRI to the combined precontrast and postcontrast MRI, were determined. No threshold for statistical significance was prospectively defined for the sensitivity and specificity datasets.…”

Section: Discussionmentioning

confidence: 99%

“…The use of gadopentetate dimeglumine (0.5 M Gd-DTPA, Magnevist®, Bayer Schering Pharma) in combination with fat-saturation (FS) techniques has been shown to be superior to unenhanced MR imaging for detection and characterization of renal [2]. Furthermore, 0.5 M gadopentate dimeglumine may also provide the detection of functional kidney derangement [3,4] and allow for selective direct imaging of the entire urinary tract [5].…”

Section: Introductionmentioning

confidence: 99%

Comparison of 1.0 M gadobutrol and 0.5 M gadopentate dimeglumine-enhanced MRI in 471 patients with known or suspected renal lesions: results of a multicenter, single-blind, interindividual, randomized clinical phase III trial

et al. 2008

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The purpose of this phase III clinical trial was to compare two different extracellular contrast agents, 1.0 M gadobutrol and 0.5 M gadopentate dimeglumine, for magnetic resonance imaging (MRI) in patients with known or suspected focal renal lesions. Using a multicenter, single-blind, interindividual, randomized study design, both contrast agents were compared in a total of 471 patients regarding their diagnostic accuracy, sensitivity, and specificity to correctly classify focal lesions of the kidney. To test for noninferiority the diagnostic accuracy rates for both contrast agents were compared with CT results based on a blinded reading. The average diagnostic accuracy across the three blinded readers ('average reader') was 83.7% for gadobutrol and 87.3% for gadopentate dimeglumine. The increase in accuracy from precontrast to combined precontrast and postcontrast MRI was 8.0% for gadobutrol and 6.9% for gadopentate dimeglumine. Sensitivity of the average reader was 85.2% for gadobutrol and 88.7% for gadopentate dimeglumine. Specificity of the average reader was 82.1% for gadobutrol and 86.1% for gadopentate dimeglumine. In conclusion, this study documents evidence for the noninferiority of a single i.v. bolus injection of 1.0 M gadobutrol compared with 0.5 M gadopentate dimeglumine in the diagnostic assessment of renal lesions with CE-MRI.

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“…Hormonally inactive adrenal adenomas are seen in ≈ 1% of the adult population. Moreover, those associated with thrombus in the IVC are even more rare [2].…”

Section: Discussionmentioning

confidence: 99%

Surgical management of large adrenal tumours: the University of Miami experience using liver transplantation techniques

et al. 2008

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OBJECTIVE To report our experience in the surgical management of patients with large adrenal masses and describe the key steps in performing radical resections, which are especially demanding where thrombi extend into the inferior vena cava (IVC). PATIENTS AND METHODS From 2003 to 2007, 14 patients presented with large adrenal mass, and underwent surgical extirpation. In five patients thrombi extended into the IVC, causing Budd–Chiari syndrome in one. RESULTS The median (range) patient age was 48 (40–58) years. The excision was radical with negative tumour margins in all cases. Cardiopulmonary bypass (CPB) was required in one case with adherent intra‐atrial thrombus. The mean blood loss was 500 (250–1500) mL except in the patient who required CPB. Morbidity included pleural effusion (three patients) and postoperative pneumonia (two), which responded to conservative management. All patients were alive and free of disease at a median follow‐up of 12 (5–42) months. CONCLUSIONS Surgical extirpation of large adrenal masses requires technical experience to optimize outcome. Total tumour excision is the only therapeutic option in such cases and provides acceptable results in survival and quality of life.

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Genitourinary MR: Kidneys and adrenal glands

Cited by 27 publications

References 14 publications

Diuretic-enhanced gadolinium excretory MR urography: comparison of conventional gradient-echo sequences and echo-planar imaging

Diuretic-enhanced gadolinium excretory MR urography: comparison of conventional gradient-echo sequences and echo-planar imaging

Comparison of 1.0 M gadobutrol and 0.5 M gadopentate dimeglumine-enhanced MRI in 471 patients with known or suspected renal lesions: results of a multicenter, single-blind, interindividual, randomized clinical phase III trial

Surgical management of large adrenal tumours: the University of Miami experience using liver transplantation techniques

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