Alterations in renal morphology and function after ESWL therapy: evaluation with dynamic contrast-enhanced MRI |
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Authors: | G P Krestin R Fischbach R Vorreuther G K von Schulthess |
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Institution: | (1) Department of Medical Radiology, University Hospital Zurich, Rämistrasse 100, CH-8091 Zurich, Switzerland;(2) Department of Radiology, University of Cologne, Joseph-Stelzmann-Strasse 9, W-5000 Cologne 41, Germany;(3) Department of Urology, University of Cologne, Josepht-Stelzmann-Strasse 9, W-5000 Cologne 41, Germany |
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Abstract: | Contrast-enhanced gradient-echo MRI was used to evaluate morphological and functional alternations in the kidneys after extracorporeal shock wave lithotripsy (ESWL). Dynamic MRI with a temporal resolution of 10 s per image was performed by repeated imaging in the coronal plane after administration of gadolinium-DTPA (0.1 mmol/kg) before and after ESWL for renal calculi in 25 patients. Before ESWL 22 patients had normally functioning kidneys, characterised by a marked decrease in signal intensity in the renal medulla 30–40 s after the onset of cortical perfusion. After ESWL 8 patients had functional abnormalities: in 2 cases the medullary signal decrease was disturbed throughout the whole organ, while 6 kidneys demonstrated regional loss of concentrating ability in the medulla. Morphological alterations (oedema with blurred contours and loss of corticomedullary differentiation; parenchymal haemorrhage and haemorrhage in a cortical cyst; subcapsular, perirenal and pararenal haematoma) were detected in 9 cases. Haemorrhage was encountered more often after administration of more than 2500 shock waves; however, no such correlation was seen in the kidneys with functional disturbances following ESWL therapy. MRI proved to be a sensitive method for the assessment of morphological and functional alterations after ESWL, but longer follow-up studies are required to identify the clinical impact of these early changes. |
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Keywords: | Kidney ESWL Kidney function Kidney MRI |
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