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GENITOURINARY IMAGING Table of Contents   
Year : 2004  |  Volume : 14  |  Issue : 4  |  Page : 361-363
3D contrast enhanced Mr Angiography in paod with Mr Findings in horse-shoe kidney-a case report


Department Of Radiology And Imaging G.B Pant Superspeciality Hospital, New Delhi-2, India

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Keywords: 3D contrast- enhanced MR angiography, atherosclerosis, and horse-shoe kidney

How to cite this article:
Sharma A, Baweja S, Chibber S, Puri S. 3D contrast enhanced Mr Angiography in paod with Mr Findings in horse-shoe kidney-a case report. Indian J Radiol Imaging 2004;14:361-3

How to cite this URL:
Sharma A, Baweja S, Chibber S, Puri S. 3D contrast enhanced Mr Angiography in paod with Mr Findings in horse-shoe kidney-a case report. Indian J Radiol Imaging [serial online] 2004 [cited 2019 Sep 15];14:361-3. Available from: http://www.ijri.org/text.asp?2004/14/4/361/28673

   Introduction Top


High resolution total body 3D MRA has recently become available revealing additional clinically relevant disease in patients with peripheral arterial occlusive disease (PAOD).It permits a quick, risk free and comprehensive evaluation of the arterial system in patients with atherosclerosis and does indeed have an impact on patient management in POAD as well as in asymptomatic patients.


   Case report Top


A 60 year man presented with intermittent claudication and pain in the lower limbs. Serum biochemistry revealed evidence of hypercholesteremia.Patient was subjected

to color Doppler which showed an evidence of atherosclerotic disease with? Block at common iliac vessels on both sides. Catheter angiography could not be performed because of atherosclerotic disease.3D MR angiography was performed with 20 ml contrast using technique as follow

1 Plain survey MST

2 Synergy reference scan

3 BTFE arch sagittal, axial, coronal.

4 3D Hi Resolution Bolus track

These sequences were obtained on Phillips 1.5T system.

MIP sequences were obtained in sagittal, coronal, and axial orientation which showed an evidence of horse-shoe kidney [Figure - 1],[Figure - 2] with bilateral blocks at common iliac vessels [Figure - 3],[Figure - 4].There was an evidence of collateral vessels feeding the lower abdominal aorta. Lower limb vessels showed an evidence of beading of vessel wall consistent with atherosclerotic changes [Figure - 5]. This case report is presented because of the incidental finding of horse-shoe kidney while doing 3D MR angiography for atherosclerotic disease and its significance and utility in such entity. Patient is conservative treatment.


   Discussion Top


Contrast enhanced 3D MRA represents a milestone for non-invasive vascular imaging.

While its clinical entity is already established in many vascular territories, the continuous development of hard - and software, as well as of new contrast agents, will likely result in a further widening in the spectrum of indications. The future for contrast enhanced 3D MRA looks very bright indeed.

Using bolus- tracking techniques, the peripheral arterial tree can be imaged to good Advantage.Multistation protocols generally require the use of 0 .3 mmol/kg of gadolinium chelate.Timing of contrast needs to be individualized to coincide with the collection of the centre of the K-space of the first station. With these techniques the peripheral arterial tree can be depicted from the aortic bifurcation to the distal trifurcation of vessels.

In the present case we have evaluated the role of 3D contrast enhanced angiography in atherosclerotic disease. It showed an evidence of block at both common iliac vessels. Collaterals were seen filling the lower abdominal aorta.Popliteal artery, anterior tibial and posterior tibial showed an evidence of beading suggestive Arteriosclerosis.Incidently we came across horse-shoe kidney very nicely demonstrated on coronal 3D reconstruction images. It showed the horse shoe kidney with its collecting System and blood supply. Isthmus is nicely demonstrated .Similar findings has been demonstrated by Mohammad R etal.in 1997.He advocated the advantage of using MRU and MRA in primary evaluation of renal obstruction. The technique offers superior imaging when compared to all other modalities. Both anatomy (kidney, collecting system, ureters, and blood supply) and renal function (using Gd-DTPA) are assessed in one procedure. Thus, this comprehensive procedure obviates the need for multiple examinations to establish a diagnosis, and also offers significant savings in cost.

In present case 3D contrast MR Angio was performed because of the failure of catheter angiography. Although the spatial resolution remains limited compared to conventional digital subtraction angiography, clinically relevant vascular pathologies are well displayed. The lack of nephrotoxicity inherent to paramagnetic contrast agents makes contrast enhanced 3D MRA the modality of choice for assessing complex arterial anatomy and especially in those cases where in atherosclerotic vessels catherisation becomes difficult.[6]

 
   References Top

1.Hany TF, Debatain JF, Leung DA et al: Evaluation of the aortoiliac and renal arteries: Comparison of breath-hold, contrast-enhanced, Three-dimensional MR angiography with conventional catheter angiography. Radiology 1997; 204:357-362.  Back to cited text no. 1    
2.Ho KY, Leiner T, de Haan MW etal.Peripheral vascular tree stenosis: Evaluation with moving bed infusion-tracking MR angiography. Radiology 1998; 206:683-692.  Back to cited text no. 2    
3.Ruehm SG, Hany TF etal: Pelvic and lower extremity arterial Imaging: Diagnostic performance of 3D contrast-enhanced MRA.AJR 2000; 174:1127-1135.  Back to cited text no. 3    
4.Goyen M, Quick HH etal. Whole-body three dimensional MR angiography with rolling table platform:intial clinical experience. Radiology 2002:224(1):270-277.  Back to cited text no. 4    
5.Goyen M, Herborn CU etal: Detection of atherosclerosis: systemic imaging for systemic disease with whole-body three dimensional MR angiography-initial experience. Radiology 2003; 227(1) :277-282.  Back to cited text no. 5    
6.Mohammad R.Mostafavi etal: Magnetic resonance urography and angiography in the evaluation of a horse-shoe kidney with uretero-pelvic junction obstruction. images in clinical urology 1998,Elsevier Science Inc. 486-487.  Back to cited text no. 6    

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Correspondence Address:
A Sharma
C10 Kendriya Vihar Sector 51 Noida 201307
India
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Source of Support: None, Conflict of Interest: None


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    Figures

[Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4], [Figure - 5]



 

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    Introduction
    Case report
    Discussion
    References
    Article Figures

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