Non-Contrast MRI for the Evaluation of Hydronephrotic and Dysfunctioning Kidney Secondary to Testicular Cancer
Non-Contrast MRI for the Evaluation of Hydronephrotic and Dysfunctioning Kidney Secondary to Testicular Cancer
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DOI：
10.1080/08860220802595914
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发表时间：
2009-01-01
期刊：
影响因子：
3
通讯作者：
Saito, Yoshihiko
中科院分区：
文献类型：
--
作者：
Okayama, Satoshi;Matsui, Masaru;Saito, Yoshihiko
据报道，含Gd的磁共振成像(MRI)造影剂可导致肾功能不全患者的肾源性全身性纤维化，因此其使用受到限制。然而，即使没有造影剂，MRI也可以提供关于肾脏疾病病理生理的许多有价值的信息。本报告描述一位90岁男性患者，因睾丸癌导致右肾积水及功能障碍，经MRI平扫评估。他被转到我们医院，主诉下腹胀和食欲不振。体格检查显示右侧阴囊和腹股沟淋巴结无痛性肿大。实验室分析显示肾功能受损，之后进行了非增强MRI检查。T1、T2和弥散加权像(分别为T1WI、T2WI和DWI)显示右侧睾丸癌伴广泛的多发性淋巴结病变。此外，在右肾附近发现了一个腹膜后转移瘤，似乎压迫了右尿管。在T1WI上可见右肾增大，皮质髓质分化消失。T2WI上可见右肾及增大的肾盆呈高信号区。DWI显示右肾信号增强，表观弥散系数降低。这些发现表明，右侧睾丸癌腹膜后转移导致右肾积水和功能障碍。本病例表明，即使在老年肾功能不全的患者中，非增强MRI对肾脏疾病的评估也是有用的。
Gadolinium-containing magnetic resonance imaging (MRI) contrast agents have been reported to induce nephrogenic systemic fibrosis in patients with renal dysfunction, and therefore their use has been restricted. However, even without contrast agents, MRI can provide much valuable information on the pathophysiology of renal diseases. This report describes the case of a 90-year-old man with a hydronephrotic and dysfunctioning right kidney induced by testicular cancer evaluated by non-contrast MRI. He was referred to our hospital complaining of lower abdominal distention and appetite loss. Physical examination revealed a painless enlargement of the right scrotum and inguinal lymph node. Laboratory analysis revealed renal dysfunction, after which a non-contrast MRI was performed. T1-, T2-, and diffusion-weighted images (T1WI, T2WI, and DWI, respectively) revealed carcinoma of the right testicle with extensive multiple lymphadenopathy. Moreover, a retroperitoneal metastatic tumor was detected adjacent to the right kidney, which appeared to constrict the right urinary duct. An enlarged right kidney with loss of corticomedullary differentiation was observed on T1WI. The right kidney and enlarged renal pelvis were observed as large signal intensity areas on T2WI. DWI showed an increased signal intensity of the right kidney and a decreased apparent diffusion coefficient. These findings clarified that the retroperitoneal metastasis from the right testicular cancer led to hydronephrosis and dysfunctioning of the right kidney. The present case indicates that non-contrast MRI is useful for the evaluation of renal diseases even in elderly patients with renal dysfunction.