Magnetic Resonance Imaging in Renal Infarction and Ischemia

Ishikawa, Isao; Masuzaki, Shigeki; Saito, Tadashi; Yuri, Takehisa; Shinoda, Akira; Tsujigiwa, Masaya

doi:10.1159/000185251

Cited by 21 publications

(11 citation statements)

References 9 publications

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“…Magnetic resonance imaging of renal infarction revealed an area of non-corticomedullary differentiation with a low SI, and renal ischemia was visualized as an ill-defined focus of low SI in the renal cortex. 18 The high SI of the infarcted area may be related to a hemorrhagic component of the infarct or interstitial edema due to a penumbra effect at the margin of the infarct. 19 Computed tomography and MRI are accurate in assessing the viability of renal fragments.…”

Section: Discussionmentioning

confidence: 99%

Is there a role for magnetic resonance imaging in renal trauma?

Jeon

Kim

et al. 2001

Int J of Urology

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Background: Computed tomography (CT) has been the most informative imaging method in renal trauma. Despite the good sensitivity of magnetic resonance imaging (MRI) to the presence of hematoma, edema and ischemia, MRI has not been widely studied in patients with renal trauma. The present study was initiated to evaluate the role of MRI in patients with renal trauma. Methods: Between June 1998 and September 1999, CT and MRI were prospectively performed on 12 patients who suffered from renal trauma and the results reviewed. Results:The presence and size of perirenal hematoma could be detected by both CT and MRI. Magnetic resonance imaging could differentiate intrarenal hematoma from perirenal hematoma more accurately, and provided additional information about the hematoma as T1-and T2-weighted MRI were able to determine recent bleeding in the hematoma by regional differences in signal intensity. Magnetic resonance imaging clearly revealed renal fracture with non-viable fragment and detected focal renal laceration that was not detected on CT due to perirenal hematoma associated with renal infarction. However, although MRI had many advantages over CT, it had also major drawbacks, which were that it required longer imaging time and increased the cost. Conclusions: Magnetic resonance imaging may be useful in renal trauma. However, it is suggested that MRI should be limited to carefully selected patients, such as those with severe renal injury or equivocal findings on CT.

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Section: Discussionmentioning

confidence: 99%

Is there a role for magnetic resonance imaging in renal trauma?

Jeon

Kim

et al. 2001

Int J of Urology

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“…ARF with severe loin pain and evidence of patchy renal vasoconstriction such as wedge-shaped contrast enhancement on the renal CT occurs in young and previ ously healthy persons and has been known by the 7 cases reported by Ishikawa et al [4][5][6][7], Of the 7 cases, 4 had histories of both analgesics and exercise, such as track race, swimming, skiing and weight lifting, 2 had taken Urine myoglobin ------BUN = Blood urea nitrogen; HPF= high-power field; ND = not done. Diffusely enhanced = Diffuse enhancement without focal lesion in the kidney; patchy low density = patchy areas of less enhancement; patchy wedge = patchy wedge-shaped areas of radiocontrast enhancement; disappeared = disappearance of wedge-shaped areas of radiocontrast enhancement; ND = not done.…”

Section: Discussionmentioning

confidence: 99%

“…Exercise is considered to be the most possible initiating etiologic factor [5][6][7], but 2 cases of Ishikawa et al were not associated with exercise and 4 cases had histories of both exercise and analgesics. In our patients, 5 were associated with both exercise and analgesics and 1 with exercise only.…”

Section: Discussionmentioning

confidence: 99%

“…Since the first report by Ishikawa et al [4] of ARF with severe back pain and patchy enhancement on postcontrast renal computed tomography (CT) after the intake of analgesics without obvious evidence of myoglobinuria, there have been 6 additional cases of ARF with severe loin pain after exer cise or analgesics and characteristic findings of patchy wedge-shaped contrast enhancement of the kidney on the CT [5][6][7], These cases of ARF have been regarded as an entity of ARF due to patchy renal vasoconstriction, and the typical patchy wedge-shaped contrast enhancement of the kidney is to be one of the essential diagnostic features.…”

Section: Introductionmentioning

confidence: 99%

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Bone Scintigraphy in Acute Renal Failure with Severe Loin Pain and Patchy Renal Vasoconstriction

Han

Kim²,

Kim³

et al. 1991

Nephron

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To evaluate the patterns of renal images and the diagnostic value as a screening test of the whole-body bone and renal scintigraphy with technetium-99m-methylene diphosphonate (^99mTc-MDP) or -pyrophosphate (^99mTc-PYP), we performed bone scintigraphy in 6 patients with acute renal failure (ARF) with severe loin pain and patchy renal vasoconstriction on postcontrast renal computed tomography (CT). All 6 patients were young and previously healthy but experienced severe loin pain after track events. Five took analgesics. Postcontrast renal CT showed patchy low-density areas or diffuse enhancement immediately after radiocontrast injection and then patchy wedge-shaped enhancement 24 or 48 h later, which subsequently disappeared 72 h later. On the whole-body bone scintigrams with ^99mTc-MDP or ^99mTc-PYP before obtaining renal CT, there was no increased uptake of isotope in the soft tissue, and multiple patchy increased accumulations of the isotope in the kidney were observed in 5 patients. In 2 patients, renal scintigraphies with technetium-99m-dimercaptosuccinate showed photon-deficient areas in the same areas of patchy isotope accumulation in the whole-body bone scintigraphies. Whole-body image and renal scintigraphy with bone-seeking agents may be useful as a screening test and in the search for the theoretical evidence of ARF with severe loin pain and patchy renal vasoconstriction.

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“…Improvements in CT imaging have resulted in a marked improvement in the diagnosis of SDVI and of related vascular occlusion. 6 Such a diagnosis in patients with ischemic stroke may have an adjunctive role to clarify stroke mechanisms when an embolic mechanism is suspected. In the context of brain infarction, the presence of an SDVI mainly suggests a cardiac source of embolism or multiple arterial dissections 7 or a thrombotic disease (eg, disseminated intravascular coagulation or thrombocytopenia), but no series have quantified the frequency of SDVI in patients with stroke.…”

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confidence: 99%

Prevalence and Determinants of Subdiaphragmatic Visceral Infarction in Patients With Fatal Stroke

Abboud

Labreuche

Gongora-Riverra

et al. 2007

Stroke

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Background and Purpose-Arterial thromboembolism is a common cause of both visceral and brain infarctions. Because the cause of brain infarction is unknown in up to 39% of patients, the discovery of subdiaphragmatic visceral infarction (SDVI) in this context is important, but its frequency is unknown. We therefore investigated the prevalence of SDVI in subjects who died from stroke. We also evaluated the yield of SDVI diagnosis for stroke subtyping. Methods-We performed a case-control study using a series of 815 consecutive autopsies of patients who had died from a neurological disease, including 350 with stroke (260 infarcts and 90 hemorrhages). We systematically assessed the presence of renal, splenic, and mesenteric infarction (no case of spinal cord was recorded) and analyzed their determinants in patients with stroke. Patients with other neurological diseases served as the control group. Results-Renal infarction was the most frequent SDVI (10.2%), whereas mesenteric infarction was rare (1.1%). At least one SDVI was found in 16.9% of patients with stroke (38.7% of patients with a cardioembolic stroke) and in 5.1% of patients with other neurological diseases (adjusted ORϭ2.12; 95% CIϭ1.08 to 4.16). Among patients with stroke, a significant heterogeneity in the prevalence of SDVI was found across etiological stroke subgroups with only three patients (3.3%) with hemorrhagic stroke having an SDVI (2 mesenteric and one renal infarction) compared with 56 patients (21.5%) with ischemic stroke (PϽ0.0001). Among patients with brain infarction and a SDVI, 76.8% had a definite cardiac source of embolism. Conclusions-In patients with fatal brain infarction, the prevalence of SDVI is higher than previously thought, especially in those with stroke attributed to cardiac emboli. Seeking SDVI may assist in the etiologic diagnosis of brain infarction

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Magnetic Resonance Imaging in Renal Infarction and Ischemia

Cited by 21 publications

References 9 publications

Is there a role for magnetic resonance imaging in renal trauma?

Is there a role for magnetic resonance imaging in renal trauma?

Bone Scintigraphy in Acute Renal Failure with Severe Loin Pain and Patchy Renal Vasoconstriction

Prevalence and Determinants of Subdiaphragmatic Visceral Infarction in Patients With Fatal Stroke

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