Pseudonormal Corticomedullary Differentiation of the Kidney Assessed on T₁-weighted Imaging for Chronic Kidney Disease Patients with Cirrhosis

Abstract

Purpose: We investigated whether corticomedullary differentiation (CMD) increased to a pseudonormal appearance on T 1 -weighted magnetic resonance (MR) images in patients with chronic kidney disease (CKD) with cirrhosis compared with patients with CKD without chronic liver disease.Methods: We assessed CMD on T 1 -weighted MR images of 32 patients with CKD with liver cirrhosis and 32 age-matched patients with CKD without liver cirrhosis, grading CMD visualization as good, moderate, or poor. We calculated quantitative CMD by the ratio of the signal intensity of the cortex to that of the medulla.Results: The proportions of patients in each of the good, moderate, and poor groups differed significantly between those with and without liver cirrhosis (P = 0.048). In patients with CKD with liver cirrhosis, the estimated glomerular filtration rate (eGFR) differed between those with poor CMD and those with good or moderate CMD (P < 0.01) but not between those with good and those with moderate CMD. In patients with CKD without cirrhosis, the eGFR differed significantly among the good, moderate, and poor CMD groups (P < 0.05). We observed no significant correlation between CMD and eGFR in patients with and without cirrhosis (P < 0.05, r = 0.62).Conclusion: CMD of the kidney had a pseudonormal appearance on T 1 -weighted MR imaging in patients with CKD with cirrhosis.

Magnetic resonance imaging T1- and T2-mapping to assess renal structure and function: a systematic review and statement paper

“…These findings are also in line with some qualitative assessments in the 1990s [ 40 , 41 ], but not with all [ 42 ], due to the fact that renal T 1 values are modulated by many confounders, such as the degree of fibrosis [ 29 ], comorbidities (e.g. liver cirrhosis) [ 43 , 44 ], the acquisition protocol (e.g. breathing motion) and fastening and hydration level [ 14 ], which all together seem to be responsible for the accomplished correlations in the envisioned quantitative studies at 1.5 and 3T.…”

Multi-organ assessment of compensated cirrhosis patients using quantitative magnetic resonance imaging

“…The relevance of the strong relationship of renal cortex T 1 to both disease severity and clinical outcomes is novel. Two studies, in patients with cirrhosis, have suggested changes in T 1 occur within the cortex of the kidney, but until now these studies have been based on signal intensity changes of T 1 -weighted images, 29,30 with no quantitative measures of T 1 relaxation times having previously being reported. These previous studies suggest that the mechanism and physiology of reduced renal cortex T 1 is decreased water content in the renal cortex due to renal hypoperfusion.…”

Glomerulocystic kidney identified in older patients by magnetic resonance imaging

“…MRI is an ideal imaging method to identify GCK, because T2-weighted imaging is highly sensitive to cystic lesions and T1-weighted imaging reflects renal function. [3,5,9–11,13] Indeed, its diagnosis was made easily by 2 investigators, because T2-weighted MRI showed numerous, uniformly small cysts located in the renal cortex, which may reflect cystic dilatation of Bowman capsule. [1,3,5] In addition, the assessment of CMD by T1-weighted imaging was concordant between them in almost all kidneys.…”

“…Lee et al [14] have reported that CMD is increased in patients with LC and normal renal function. Yamada et al [13] have shown that in patients with LC, poor CMD reflects renal function, but good and moderate CMD do not. Therefore, in older patients with chronic liver diseases, the presence of GCK can indicate renal impairment even when good or moderate CMD is observed.…”

“…Third, CMD as observed on the T1-weighted images was defined as good, moderate, or poor, based on previous studies as follows: good, CMD was visualized clearly throughout the kidney; moderate, CMD was partially lost in the kidney; poor, CMD was diminished. [12,13] The CMD was compared with renal function in these older patients with GCK. A kappa analysis was used to evaluate the radiologists’ assessment of CMD.…”