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Contrast-enhanced Three-dimensional Fast Spoiled Gradient-Echo Renal MR Imaging: Evaluation of Vascular and Nonvascular Disease¹

¹ From the Department of Radiology, Stanford University Medical Center, 300 Pasteur Dr, Rm H-1307, Stanford, CA 94305-5105. Presented as a scientific exhibit at the 1998 RSNA scientific assembly. Received September 9, 1999; revision requested November 5 and received December 2; accepted December 13. Address correspondence to F.G.S. (e-mail: gsommer@leland.stanford.edu).

View larger version (115K): [in a new window]   Figure 1a.   Normal renal transplant vasculature in a healthy renal transplant donor. (a, b) Oblique sliding thin-slab maximum intensity projection images from contrast-enhanced 3D FSPGR imaging depict each renal artery. (c) Curved-planar reformatted image in a later phase shows normal renal veins. (d) Volume-rendered image shows the renal arteries.

View larger version (123K): [in a new window]   Figure 1b.   Normal renal transplant vasculature in a healthy renal transplant donor. (a, b) Oblique sliding thin-slab maximum intensity projection images from contrast-enhanced 3D FSPGR imaging depict each renal artery. (c) Curved-planar reformatted image in a later phase shows normal renal veins. (d) Volume-rendered image shows the renal arteries.

View larger version (105K): [in a new window]   Figure 1c.   Normal renal transplant vasculature in a healthy renal transplant donor. (a, b) Oblique sliding thin-slab maximum intensity projection images from contrast-enhanced 3D FSPGR imaging depict each renal artery. (c) Curved-planar reformatted image in a later phase shows normal renal veins. (d) Volume-rendered image shows the renal arteries.

View larger version (95K): [in a new window]   Figure 1d.   Normal renal transplant vasculature in a healthy renal transplant donor. (a, b) Oblique sliding thin-slab maximum intensity projection images from contrast-enhanced 3D FSPGR imaging depict each renal artery. (c) Curved-planar reformatted image in a later phase shows normal renal veins. (d) Volume-rendered image shows the renal arteries.

View larger version (90K): [in a new window]   Figure 2a.   Renal transplant vasculature in a 1-year-old renal transplant recipient. Full-thickness (a) and oblique sliding thin-slab (3-cm section thickness) (b) maximum intensity projection images from contrast-enhanced 3D FSPGR imaging show the renal artery.

View larger version (117K): [in a new window]   Figure 2b.   Renal transplant vasculature in a 1-year-old renal transplant recipient. Full-thickness (a) and oblique sliding thin-slab (3-cm section thickness) (b) maximum intensity projection images from contrast-enhanced 3D FSPGR imaging show the renal artery.

View larger version (159K): [in a new window]   Figure 3a.   Normal renal enhancement patterns in a patient with normal function and kidneys: Precontrast (a) and postcontrast corticomedullary phase (b) and tubular nephrographic phase (c) images from dynamic contrast-enhanced 3D FSPGR show normal renal enhancement.

View larger version (153K): [in a new window]   Figure 3b.   Normal renal enhancement patterns in a patient with normal function and kidneys: Precontrast (a) and postcontrast corticomedullary phase (b) and tubular nephrographic phase (c) images from dynamic contrast-enhanced 3D FSPGR show normal renal enhancement.

View larger version (157K): [in a new window]   Figure 3c.   Normal renal enhancement patterns in a patient with normal function and kidneys: Precontrast (a) and postcontrast corticomedullary phase (b) and tubular nephrographic phase (c) images from dynamic contrast-enhanced 3D FSPGR show normal renal enhancement.

View larger version (122K): [in a new window]   Figure 4a.   Atherosclerotic renal arterial stenosis (50% diameter) is seen on the coronal contrast-enhanced 3D FSPGR source MR image (a), oblique sliding thin-slab maximum intensity projection image (b), and selective digital subtraction angiogram obtained prior to angioplasty (c).

View larger version (115K): [in a new window]   Figure 4b.   Atherosclerotic renal arterial stenosis (50% diameter) is seen on the coronal contrast-enhanced 3D FSPGR source MR image (a), oblique sliding thin-slab maximum intensity projection image (b), and selective digital subtraction angiogram obtained prior to angioplasty (c).

View larger version (112K): [in a new window]   Figure 4c.   Atherosclerotic renal arterial stenosis (50% diameter) is seen on the coronal contrast-enhanced 3D FSPGR source MR image (a), oblique sliding thin-slab maximum intensity projection image (b), and selective digital subtraction angiogram obtained prior to angioplasty (c).

View larger version (121K): [in a new window]   Figure 5a.   Renal arterial venous malformation. Oblique sliding thin-slab maximum intensity projection (a) and arterial phase curved-planar (b) reformatted images from contrast-enhanced 3D FSPGR imaging depict tortuous arterial branches and prominent early enhancement of the right renal vein.

View larger version (128K): [in a new window]   Figure 5b.   Renal arterial venous malformation. Oblique sliding thin-slab maximum intensity projection (a) and arterial phase curved-planar (b) reformatted images from contrast-enhanced 3D FSPGR imaging depict tortuous arterial branches and prominent early enhancement of the right renal vein.

View larger version (152K): [in a new window]   Figure 6.   Aortic dissection affecting renal arteries. Delayed contrast-enhanced 3D FSPGR MR image depicts aortic dissection extending into the left renal artery. A large portion of the left kidney (arrow) is not enhanced, consistent with infarction.

View larger version (150K): [in a new window]   Figure 7a.   Renal transplant venous thrombosis. Contrast-enhanced 3D FSPGR images clearly show the main transplant artery (a) and several branches (b) in the left iliac fossa. (c) On delayed phase image, the transplant kidney is not enhanced, consistent with infarction.

View larger version (151K): [in a new window]   Figure 7b.   Renal transplant venous thrombosis. Contrast-enhanced 3D FSPGR images clearly show the main transplant artery (a) and several branches (b) in the left iliac fossa. (c) On delayed phase image, the transplant kidney is not enhanced, consistent with infarction.

View larger version (179K): [in a new window]   Figure 7c.   Renal transplant venous thrombosis. Contrast-enhanced 3D FSPGR images clearly show the main transplant artery (a) and several branches (b) in the left iliac fossa. (c) On delayed phase image, the transplant kidney is not enhanced, consistent with infarction.

View larger version (144K): [in a new window]   Figure 8a.   Acute pyelonephritis depicted with contrast-enhanced 3D FSPGR imaging. (a) Precontrast MR image. (b) On early corticomedullary phase MR image, striated enhancement of the right kidney is prominent. (c) On 5-minute delayed image, the enhancement pattern is still abnormal, which helps confirm bilateral excretion of gadopentetate dimeglumine. The nonenhancing fluid (arrow) medial to the lower pole of the right kidney, which is evident in b and c, may represent a perinephric abscess, but a sterile urinoma could have an identical appearance.

View larger version (153K): [in a new window]   Figure 8b.   Acute pyelonephritis depicted with contrast-enhanced 3D FSPGR imaging. (a) Precontrast MR image. (b) On early corticomedullary phase MR image, striated enhancement of the right kidney is prominent. (c) On 5-minute delayed image, the enhancement pattern is still abnormal, which helps confirm bilateral excretion of gadopentetate dimeglumine. The nonenhancing fluid (arrow) medial to the lower pole of the right kidney, which is evident in b and c, may represent a perinephric abscess, but a sterile urinoma could have an identical appearance.

View larger version (147K): [in a new window]   Figure 8c.   Acute pyelonephritis depicted with contrast-enhanced 3D FSPGR imaging. (a) Precontrast MR image. (b) On early corticomedullary phase MR image, striated enhancement of the right kidney is prominent. (c) On 5-minute delayed image, the enhancement pattern is still abnormal, which helps confirm bilateral excretion of gadopentetate dimeglumine. The nonenhancing fluid (arrow) medial to the lower pole of the right kidney, which is evident in b and c, may represent a perinephric abscess, but a sterile urinoma could have an identical appearance.

View larger version (106K): [in a new window]   Figure 9a.   Psoas abscess. (a) Axial T2-weighted MR image depicts renal and perinephric inflammation, which extends to the left psoas muscle, as an ill-defined area of increased signal intensity. (b) Contrast-enhanced 3D FSPGR MR image demonstrates enhancement of corresponding regions of infection in the left kidney and left psoas muscle. A simple cyst is present in the upper pole of the right kidney.

View larger version (114K): [in a new window]   Figure 9b.   Psoas abscess. (a) Axial T2-weighted MR image depicts renal and perinephric inflammation, which extends to the left psoas muscle, as an ill-defined area of increased signal intensity. (b) Contrast-enhanced 3D FSPGR MR image demonstrates enhancement of corresponding regions of infection in the left kidney and left psoas muscle. A simple cyst is present in the upper pole of the right kidney.

View larger version (115K): [in a new window]   Figure 10a.   Reflux nephropathy depicted with contrast-enhanced 3D FSPGR imaging. (a) Corticomedullary phase image depicts a small left kidney with a striated enhancement pattern. (b) On the tubular nephrographic phase image, the areas of scarring and cortical thinning are depicted clearly.

View larger version (122K): [in a new window]   Figure 10b.   Reflux nephropathy depicted with contrast-enhanced 3D FSPGR imaging. (a) Corticomedullary phase image depicts a small left kidney with a striated enhancement pattern. (b) On the tubular nephrographic phase image, the areas of scarring and cortical thinning are depicted clearly.

View larger version (140K): [in a new window]   Figure 11a.   Multilocular cystic nephroma depicted with contrast-enhanced 3D FSPGR imaging. (a) Corticomedullary phase image reveals a septated cystic mass in the left kidney. (b) Delayed image reveals that the left renal cystic lesion involves the renal sinus and displaces the renal pelvis, in a manner characteristic of multilocular cystic nephroma, with some enhancement in the septations (arrow).

View larger version (136K): [in a new window]   Figure 11b.   Multilocular cystic nephroma depicted with contrast-enhanced 3D FSPGR imaging. (a) Corticomedullary phase image reveals a septated cystic mass in the left kidney. (b) Delayed image reveals that the left renal cystic lesion involves the renal sinus and displaces the renal pelvis, in a manner characteristic of multilocular cystic nephroma, with some enhancement in the septations (arrow).

View larger version (172K): [in a new window]   Figure 12a.   Autosomal dominant polycystic kidney disease. (a) Contrast-enhanced 3D FSPGR MR image depicts several cysts with internal hemorrhage as hyperintense. (b) Fat-saturated fast spin-echo T2-weighted MR image depicts the cysts as iso- or hypointense. In a, the high spatial resolution, contrast sensitivity, and breath-hold technique allow evaluation of the intervening solid renal parenchyma and clearly define the nonenhancing cysts.

View larger version (132K): [in a new window]   Figure 12b.   Autosomal dominant polycystic kidney disease. (a) Contrast-enhanced 3D FSPGR MR image depicts several cysts with internal hemorrhage as hyperintense. (b) Fat-saturated fast spin-echo T2-weighted MR image depicts the cysts as iso- or hypointense. In a, the high spatial resolution, contrast sensitivity, and breath-hold technique allow evaluation of the intervening solid renal parenchyma and clearly define the nonenhancing cysts.

View larger version (112K): [in a new window]   Figure 13a.   Renal cell carcinoma. Fat-saturated fast spin-echo T2-weighted (a) and contrast-enhanced 3D FSPGR (b) MR images reveal a solid left renal mass. In b, the mass, arteries, and veins can be simultaneously evaluated. (c) Curved-planar image reformatted from b shows that the mass (arrow) involves the renal vein at only the renal hilum.

View larger version (120K): [in a new window]   Figure 13b.   Renal cell carcinoma. Fat-saturated fast spin-echo T2-weighted (a) and contrast-enhanced 3D FSPGR (b) MR images reveal a solid left renal mass. In b, the mass, arteries, and veins can be simultaneously evaluated. (c) Curved-planar image reformatted from b shows that the mass (arrow) involves the renal vein at only the renal hilum.

View larger version (127K): [in a new window]   Figure 13c.   Renal cell carcinoma. Fat-saturated fast spin-echo T2-weighted (a) and contrast-enhanced 3D FSPGR (b) MR images reveal a solid left renal mass. In b, the mass, arteries, and veins can be simultaneously evaluated. (c) Curved-planar image reformatted from b shows that the mass (arrow) involves the renal vein at only the renal hilum.

View larger version (126K): [in a new window]   Figure 14a.   Renal cell carcinoma with renal vein and inferior vena caval invasion. Fat-saturated fast spin-echo T2-weighted (a), T1-weighted spin-echo (b), and contrast-enhanced 3D FSPGR (c, d) MR images reveal a solid right renal mass. In c and d, tumor extension (arrows in d) into the inferior vena cava enhances progressively, which can help differentiate between bland thrombus and tumor thrombus.

View larger version (131K): [in a new window]   Figure 14b.   Renal cell carcinoma with renal vein and inferior vena caval invasion. Fat-saturated fast spin-echo T2-weighted (a), T1-weighted spin-echo (b), and contrast-enhanced 3D FSPGR (c, d) MR images reveal a solid right renal mass. In c and d, tumor extension (arrows in d) into the inferior vena cava enhances progressively, which can help differentiate between bland thrombus and tumor thrombus.

View larger version (137K): [in a new window]   Figure 14c.   Renal cell carcinoma with renal vein and inferior vena caval invasion. Fat-saturated fast spin-echo T2-weighted (a), T1-weighted spin-echo (b), and contrast-enhanced 3D FSPGR (c, d) MR images reveal a solid right renal mass. In c and d, tumor extension (arrows in d) into the inferior vena cava enhances progressively, which can help differentiate between bland thrombus and tumor thrombus.

View larger version (139K): [in a new window]   Figure 14d.   Renal cell carcinoma with renal vein and inferior vena caval invasion. Fat-saturated fast spin-echo T2-weighted (a), T1-weighted spin-echo (b), and contrast-enhanced 3D FSPGR (c, d) MR images reveal a solid right renal mass. In c and d, tumor extension (arrows in d) into the inferior vena cava enhances progressively, which can help differentiate between bland thrombus and tumor thrombus.

View larger version (135K): [in a new window]   Figure 15a.   Angiomyolipoma. Fat-saturated fast spin-echo T2-weighted (a), T1-weighted spin-echo (b), and arterial (c) and delayed phase (d) contrast-enhanced 3D FSPGR MR images reveal a solid left renal mass. In a and b, the mass is isointense to fat, but a hemorrhagic cyst could have a similar appearance. In c and d, the mass (arrow) is seen to enhance.

View larger version (142K): [in a new window]   Figure 15b.   Angiomyolipoma. Fat-saturated fast spin-echo T2-weighted (a), T1-weighted spin-echo (b), and arterial (c) and delayed phase (d) contrast-enhanced 3D FSPGR MR images reveal a solid left renal mass. In a and b, the mass is isointense to fat, but a hemorrhagic cyst could have a similar appearance. In c and d, the mass (arrow) is seen to enhance.

View larger version (115K): [in a new window]   Figure 15c.   Angiomyolipoma. Fat-saturated fast spin-echo T2-weighted (a), T1-weighted spin-echo (b), and arterial (c) and delayed phase (d) contrast-enhanced 3D FSPGR MR images reveal a solid left renal mass. In a and b, the mass is isointense to fat, but a hemorrhagic cyst could have a similar appearance. In c and d, the mass (arrow) is seen to enhance.

View larger version (122K): [in a new window]   Figure 15d.   Angiomyolipoma. Fat-saturated fast spin-echo T2-weighted (a), T1-weighted spin-echo (b), and arterial (c) and delayed phase (d) contrast-enhanced 3D FSPGR MR images reveal a solid left renal mass. In a and b, the mass is isointense to fat, but a hemorrhagic cyst could have a similar appearance. In c and d, the mass (arrow) is seen to enhance.

View larger version (141K): [in a new window]   Figure 16a.   Renal laceration from blunt trauma. (a) Axial fat-saturated fast spin-echo T2-weighted MR image reveals a hypointense right renal laceration. (b) Contrast-enhanced 3D FSPGR MR image reveals that enhancement in the right kidney is less than that in the left kidney. The region of hematoma is the nonenhanced focus (arrow) at the lateral lower pole. A small amount of fluid is also seen around the left kidney.

View larger version (175K): [in a new window]   Figure 16b.   Renal laceration from blunt trauma. (a) Axial fat-saturated fast spin-echo T2-weighted MR image reveals a hypointense right renal laceration. (b) Contrast-enhanced 3D FSPGR MR image reveals that enhancement in the right kidney is less than that in the left kidney. The region of hematoma is the nonenhanced focus (arrow) at the lateral lower pole. A small amount of fluid is also seen around the left kidney.