HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Abstract Full Text Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Dong, Q. Articles by Prince, M. R. Search for Related Content PubMed PubMed Citation Articles by Dong, Q. Articles by Prince, M. R. Related Collections Magnetic Resonance Imaging Vascular and/or Interventional Radiology Genitourinary Radiology

Diagnosis of Renal Vascular Disease with MR Angiography¹

¹ From the Department of Radiology, Weill Medical College, Cornell University, 1300 York Ave, New York, NY 10021 (Q.D., M.R.P.); and the Department of Radiology, University of Michigan, Ann Arbor (Q.D., S.O.S., R.C.C., M.N., K.J.C., D.M.W., S.N.K.). Recipient of a Certificate of Merit award for a scientific exhibit at the 1998 RSNA scientific assembly. Received April 2, 1999; revision requested May 7 and received June 15; accepted June 21. Supported in part by the Whitaker Foundation, the Deutsche Forschungsgemeinschaft, and the Verein zur Foerderung der Krebserkennung und Krebsvorsorge. Address reprint requests to Q.D.

View larger version (166K): [in a new window]   Figure 1a.   Sagittal T1-weighted spin-echo (a) and single-shot fast spin-echo (b) MR images obtained for localization show the abdominal aorta and the origins of the celiac artery (open arrow) and superior mesenteric artery (solid arrow). The position of the 3D volume for gadolinium-enhanced MR angiography is represented by the rectangular black outline in a, which includes the abdominal aorta and most of the kidneys (curved black outlines). The tracker for automatic triggering is placed on the aorta at the level of the superior mesenteric artery.

View larger version (167K): [in a new window]   Figure 1b.   Sagittal T1-weighted spin-echo (a) and single-shot fast spin-echo (b) MR images obtained for localization show the abdominal aorta and the origins of the celiac artery (open arrow) and superior mesenteric artery (solid arrow). The position of the 3D volume for gadolinium-enhanced MR angiography is represented by the rectangular black outline in a, which includes the abdominal aorta and most of the kidneys (curved black outlines). The tracker for automatic triggering is placed on the aorta at the level of the superior mesenteric artery.

View larger version (146K): [in a new window]   Figure 2a.   Coronal images obtained with multiphase 3D gadolinium-enhanced MR angiography (repetition time msec/echo time msec = 3.2/1.1, field of view = 27 x 36 cm, slab thickness = 8 cm, number of reconstructed sections = 44, acquisition time per phase = 6.3 seconds) show the evolution of renal enhancement. (a) Early arterial-phase image shows that the renal arteries are completely enhanced. There is a proximal high-grade stenosis of the left renal artery (arrow) and a normal right renal artery. No parenchymal enhancement is present. (b) Late arterial-phase image shows the stenosis (solid arrow) and delayed enhancement of the shrunken left kidney (open arrows). (c) Early venous-phase image shows that the enhancement of the left kidney (arrows) is equal to that of the right kidney. (Reprinted, with permission, from reference 53.)

View larger version (175K): [in a new window]   Figure 2b.   Coronal images obtained with multiphase 3D gadolinium-enhanced MR angiography (repetition time msec/echo time msec = 3.2/1.1, field of view = 27 x 36 cm, slab thickness = 8 cm, number of reconstructed sections = 44, acquisition time per phase = 6.3 seconds) show the evolution of renal enhancement. (a) Early arterial-phase image shows that the renal arteries are completely enhanced. There is a proximal high-grade stenosis of the left renal artery (arrow) and a normal right renal artery. No parenchymal enhancement is present. (b) Late arterial-phase image shows the stenosis (solid arrow) and delayed enhancement of the shrunken left kidney (open arrows). (c) Early venous-phase image shows that the enhancement of the left kidney (arrows) is equal to that of the right kidney. (Reprinted, with permission, from reference 53.)

View larger version (169K): [in a new window]   Figure 2c.   Coronal images obtained with multiphase 3D gadolinium-enhanced MR angiography (repetition time msec/echo time msec = 3.2/1.1, field of view = 27 x 36 cm, slab thickness = 8 cm, number of reconstructed sections = 44, acquisition time per phase = 6.3 seconds) show the evolution of renal enhancement. (a) Early arterial-phase image shows that the renal arteries are completely enhanced. There is a proximal high-grade stenosis of the left renal artery (arrow) and a normal right renal artery. No parenchymal enhancement is present. (b) Late arterial-phase image shows the stenosis (solid arrow) and delayed enhancement of the shrunken left kidney (open arrows). (c) Early venous-phase image shows that the enhancement of the left kidney (arrows) is equal to that of the right kidney. (Reprinted, with permission, from reference 53.)

View larger version (24K): [in a new window]   Figure 3.   Diagram shows renal blood flow measurements obtained with cine PC MR imaging (repetition time/echo time = 26/6) performed bilaterally perpendicular to the vessel axis. The right renal artery has a normal flow profile with an early systolic peak. The mean flow rate is 310 mL/min. The left renal artery has a flattened flow profile with loss of the systolic velocity components. The mean flow rate is only 93 mL/min. The diagnosis of a hemodynamically and functionally significant stenosis of the left renal artery was made. (Reprinted, with permission, from reference 53.)

View larger version (159K): [in a new window]   Figure 4a.   (a) Sagittal T1-weighted spin-echo MR image shows a right kidney of normal length and parenchymal thickness. (b, c) Oblique reformation images from arterial-phase 3D gadolinium-enhanced MR angiography also show measurement of kidney length.

View larger version (155K): [in a new window]   Figure 4b.   (a) Sagittal T1-weighted spin-echo MR image shows a right kidney of normal length and parenchymal thickness. (b, c) Oblique reformation images from arterial-phase 3D gadolinium-enhanced MR angiography also show measurement of kidney length.

View larger version (128K): [in a new window]   Figure 4c.   (a) Sagittal T1-weighted spin-echo MR image shows a right kidney of normal length and parenchymal thickness. (b, c) Oblique reformation images from arterial-phase 3D gadolinium-enhanced MR angiography also show measurement of kidney length.

View larger version (121K): [in a new window]   Figure 5a.   (a, b) Axial reformation images show the origins of the celiac artery (a) and superior mesenteric artery (SMA) (b). (c) Sagittal subvolume MIP image reconstructed from axial reformation images shows normal celiac, superior mesenteric (SMA), and inferior mesenteric (IMA) arteries.

View larger version (119K): [in a new window]   Figure 5b.   (a, b) Axial reformation images show the origins of the celiac artery (a) and superior mesenteric artery (SMA) (b). (c) Sagittal subvolume MIP image reconstructed from axial reformation images shows normal celiac, superior mesenteric (SMA), and inferior mesenteric (IMA) arteries.

View larger version (77K): [in a new window]   Figure 5c.   (a, b) Axial reformation images show the origins of the celiac artery (a) and superior mesenteric artery (SMA) (b). (c) Sagittal subvolume MIP image reconstructed from axial reformation images shows normal celiac, superior mesenteric (SMA), and inferior mesenteric (IMA) arteries.

View larger version (62K): [in a new window]   Figure 6a.   (a) Axial reformation image shows the renal arteries. (b) Coronal oblique subvolume MIP image reconstructed from axial reformation images shows the renal arteries. (c) Axial oblique subvolume MIP image reconstructed from a coronal oblique subvolume MIP shows the entire renal arteries.

View larger version (112K): [in a new window]   Figure 6b.   (a) Axial reformation image shows the renal arteries. (b) Coronal oblique subvolume MIP image reconstructed from axial reformation images shows the renal arteries. (c) Axial oblique subvolume MIP image reconstructed from a coronal oblique subvolume MIP shows the entire renal arteries.

View larger version (64K): [in a new window]   Figure 6c.   (a) Axial reformation image shows the renal arteries. (b) Coronal oblique subvolume MIP image reconstructed from axial reformation images shows the renal arteries. (c) Axial oblique subvolume MIP image reconstructed from a coronal oblique subvolume MIP shows the entire renal arteries.

View larger version (130K): [in a new window]   Figure 7a.   Coronal (top) and axial (middle) 3D gadolinium-enhanced MR angiograms and axial 3D PC MR images (bottom) show normal renal arteries (a), mild right renal artery stenosis (<50%) (b), and moderate left renal artery stenosis and severe right renal artery stenosis (c). The 3D PC image shows a normal artery when there is only mild stenosis (solid arrow) but shows spin dephasing in the region of the severe stenosis (arrowhead). Therefore, in mild stenosis, lesion severity is underestimated with 3D PC imaging and the artery appears normal. In severe stenosis, lesion severity is overestimated with 3D PC imaging, which shows focal occlusion. In moderate stenosis (open arrow), the 3D gadolinium-enhanced MR angiograms and 3D PC images have a similar appearance.

View larger version (122K): [in a new window]   Figure 7b.   Coronal (top) and axial (middle) 3D gadolinium-enhanced MR angiograms and axial 3D PC MR images (bottom) show normal renal arteries (a), mild right renal artery stenosis (<50%) (b), and moderate left renal artery stenosis and severe right renal artery stenosis (c). The 3D PC image shows a normal artery when there is only mild stenosis (solid arrow) but shows spin dephasing in the region of the severe stenosis (arrowhead). Therefore, in mild stenosis, lesion severity is underestimated with 3D PC imaging and the artery appears normal. In severe stenosis, lesion severity is overestimated with 3D PC imaging, which shows focal occlusion. In moderate stenosis (open arrow), the 3D gadolinium-enhanced MR angiograms and 3D PC images have a similar appearance.

View larger version (131K): [in a new window]   Figure 7c.   Coronal (top) and axial (middle) 3D gadolinium-enhanced MR angiograms and axial 3D PC MR images (bottom) show normal renal arteries (a), mild right renal artery stenosis (<50%) (b), and moderate left renal artery stenosis and severe right renal artery stenosis (c). The 3D PC image shows a normal artery when there is only mild stenosis (solid arrow) but shows spin dephasing in the region of the severe stenosis (arrowhead). Therefore, in mild stenosis, lesion severity is underestimated with 3D PC imaging and the artery appears normal. In severe stenosis, lesion severity is overestimated with 3D PC imaging, which shows focal occlusion. In moderate stenosis (open arrow), the 3D gadolinium-enhanced MR angiograms and 3D PC images have a similar appearance.

View larger version (124K): [in a new window]   Figure 8.   Coronal subvolume MIP image from 3D gadolinium-enhanced MR angiography shows normal renal arteries bilaterally with an accessory left renal artery (arrow) arising from the aorta.

View larger version (162K): [in a new window]   Figure 9a.   (a) Coronal subvolume MIP image from arterial-phase 3D gadolinium-enhanced MR angiography shows the main left and right renal arteries in their expected locations as well as bilateral accessory renal arteries (arrows). (b) Coronal subvolume MIP image from venous-phase 3D gadolinium-enhanced MR angiography shows both renal veins (arrows) and fusion of the lower renal poles (horseshoe kidney).

View larger version (171K): [in a new window]   Figure 9b.   (a) Coronal subvolume MIP image from arterial-phase 3D gadolinium-enhanced MR angiography shows the main left and right renal arteries in their expected locations as well as bilateral accessory renal arteries (arrows). (b) Coronal subvolume MIP image from venous-phase 3D gadolinium-enhanced MR angiography shows both renal veins (arrows) and fusion of the lower renal poles (horseshoe kidney).

View larger version (157K): [in a new window]   Figure 10.   Coronal subvolume MIP image from equilibrium-phase 3D gadolinium-enhanced MR angiography shows a retroaortic left renal vein (arrow) with its characteristic inferior insertion on the inferior vena cava.

View larger version (173K): [in a new window]   Figure 11a.   (a) Sagittal T1-weighted MR image shows that the left kidney is reduced in length with parenchymal thinning. (b) Sagittal T1-weighted MR image shows that the right kidney is of normal size. (c) Coronal subvolume MIP image from 3D gadolinium-enhanced MR angiography shows atherosclerotic changes in the abdominal aorta, stenosis of the right renal artery (solid arrow), and occlusion of the left renal artery (open arrow). (d) Axial MIP image from 3D PC imaging shows spin dephasing in the region of stenosis (solid arrowhead). The occluded left renal artery is not visible (open arrowhead). (e) Conventional arteriogram shows the same findings seen on the MR angiograms (c, d). There was a pressure gradient of 60 mm Hg across the right renal artery stenosis.

View larger version (167K): [in a new window]   Figure 11b.   (a) Sagittal T1-weighted MR image shows that the left kidney is reduced in length with parenchymal thinning. (b) Sagittal T1-weighted MR image shows that the right kidney is of normal size. (c) Coronal subvolume MIP image from 3D gadolinium-enhanced MR angiography shows atherosclerotic changes in the abdominal aorta, stenosis of the right renal artery (solid arrow), and occlusion of the left renal artery (open arrow). (d) Axial MIP image from 3D PC imaging shows spin dephasing in the region of stenosis (solid arrowhead). The occluded left renal artery is not visible (open arrowhead). (e) Conventional arteriogram shows the same findings seen on the MR angiograms (c, d). There was a pressure gradient of 60 mm Hg across the right renal artery stenosis.

View larger version (162K): [in a new window]   Figure 11c.   (a) Sagittal T1-weighted MR image shows that the left kidney is reduced in length with parenchymal thinning. (b) Sagittal T1-weighted MR image shows that the right kidney is of normal size. (c) Coronal subvolume MIP image from 3D gadolinium-enhanced MR angiography shows atherosclerotic changes in the abdominal aorta, stenosis of the right renal artery (solid arrow), and occlusion of the left renal artery (open arrow). (d) Axial MIP image from 3D PC imaging shows spin dephasing in the region of stenosis (solid arrowhead). The occluded left renal artery is not visible (open arrowhead). (e) Conventional arteriogram shows the same findings seen on the MR angiograms (c, d). There was a pressure gradient of 60 mm Hg across the right renal artery stenosis.

View larger version (84K): [in a new window]   Figure 11d.   (a) Sagittal T1-weighted MR image shows that the left kidney is reduced in length with parenchymal thinning. (b) Sagittal T1-weighted MR image shows that the right kidney is of normal size. (c) Coronal subvolume MIP image from 3D gadolinium-enhanced MR angiography shows atherosclerotic changes in the abdominal aorta, stenosis of the right renal artery (solid arrow), and occlusion of the left renal artery (open arrow). (d) Axial MIP image from 3D PC imaging shows spin dephasing in the region of stenosis (solid arrowhead). The occluded left renal artery is not visible (open arrowhead). (e) Conventional arteriogram shows the same findings seen on the MR angiograms (c, d). There was a pressure gradient of 60 mm Hg across the right renal artery stenosis.

View larger version (91K): [in a new window]   Figure 11e.   (a) Sagittal T1-weighted MR image shows that the left kidney is reduced in length with parenchymal thinning. (b) Sagittal T1-weighted MR image shows that the right kidney is of normal size. (c) Coronal subvolume MIP image from 3D gadolinium-enhanced MR angiography shows atherosclerotic changes in the abdominal aorta, stenosis of the right renal artery (solid arrow), and occlusion of the left renal artery (open arrow). (d) Axial MIP image from 3D PC imaging shows spin dephasing in the region of stenosis (solid arrowhead). The occluded left renal artery is not visible (open arrowhead). (e) Conventional arteriogram shows the same findings seen on the MR angiograms (c, d). There was a pressure gradient of 60 mm Hg across the right renal artery stenosis.

View larger version (132K): [in a new window]   Figure 12a.   (a) Coronal subvolume MIP image from 3D gadolinium-enhanced MR angiography optimized for the right renal artery shows severe stenosis (arrow). The stenosis was thought to be atherosclerotic on the basis of MR angiographic findings. (b) Digital subtraction angiogram shows fibromuscular dysplasia with much more extensive involvement of the artery (arrow).

View larger version (164K): [in a new window]   Figure 12b.   (a) Coronal subvolume MIP image from 3D gadolinium-enhanced MR angiography optimized for the right renal artery shows severe stenosis (arrow). The stenosis was thought to be atherosclerotic on the basis of MR angiographic findings. (b) Digital subtraction angiogram shows fibromuscular dysplasia with much more extensive involvement of the artery (arrow).

View larger version (132K): [in a new window]   Figure 13a.   Coronal (a) and axial (b) subvolume MIP images from 3D gadolinium-enhanced MR angiography show an aortic dissection that extends distally to the aortic bifurcation. The superior mesenteric artery and right renal artery arise from the true lumen (solid arrow); the left renal artery arises from the false lumen (open arrow).

View larger version (73K): [in a new window]   Figure 13b.   Coronal (a) and axial (b) subvolume MIP images from 3D gadolinium-enhanced MR angiography show an aortic dissection that extends distally to the aortic bifurcation. The superior mesenteric artery and right renal artery arise from the true lumen (solid arrow); the left renal artery arises from the false lumen (open arrow).

View larger version (134K): [in a new window]   Figure 14.   Coronal subvolume MIP image from 3D gadolinium-enhanced MR angiography shows a saccular aneurysm of the right renal artery (solid arrow) and a fusiform aneurysm of the left renal artery (open arrow).

View larger version (134K): [in a new window]   Figure 15.   Coronal subvolume MIP image from 3D gadolinium-enhanced MR angiography shows a stenosis of the left external iliac artery (solid arrow) and a normal transplanted renal artery (open arrow). The stenosis compromised flow to the transplanted kidney, resulting in hypertension and elevation of serum creatinine level, which improved after balloon angioplasty.

View larger version (139K): [in a new window]   Figure 16a.   Axial T2-weighted MR image (a), coronal subvolume MIP image from arterial-phase 3D gadolinium-enhanced MR angiography (b), and coronal reformation image from venous-phase 3D gadolinium-enhanced MR angiography (c) of a patient with a large renal cell carcinoma show a heterogeneously enhancing mass in the left kidney (solid arrows) with tumor extension into the left renal vein (open arrow). Two right renal veins are also seen (arrowheads).

View larger version (132K): [in a new window]   Figure 16b.   Axial T2-weighted MR image (a), coronal subvolume MIP image from arterial-phase 3D gadolinium-enhanced MR angiography (b), and coronal reformation image from venous-phase 3D gadolinium-enhanced MR angiography (c) of a patient with a large renal cell carcinoma show a heterogeneously enhancing mass in the left kidney (solid arrows) with tumor extension into the left renal vein (open arrow). Two right renal veins are also seen (arrowheads).

View larger version (164K): [in a new window]   Figure 16c.   Axial T2-weighted MR image (a), coronal subvolume MIP image from arterial-phase 3D gadolinium-enhanced MR angiography (b), and coronal reformation image from venous-phase 3D gadolinium-enhanced MR angiography (c) of a patient with a large renal cell carcinoma show a heterogeneously enhancing mass in the left kidney (solid arrows) with tumor extension into the left renal vein (open arrow). Two right renal veins are also seen (arrowheads).