Fumi Yamada MD, Presenter: Nothing to Disclose

Yasuo Amano MD, Abstract Co-Author: Nothing to Disclose

Fumitaka Hidaka MD, Abstract Co-Author: Nothing to Disclose

Yoshimitsu Fukushima, Abstract Co-Author: Nothing to Disclose

Shinichiro Kumita MD, Abstract Co-Author: Nothing to Disclose

Corticomedullary differentiation (CMD) of the kidney on T1-weighted magnetic resonance imaging(MRI) increases in cirrhotic patients with normal renal function, compared with normal controls. If the pathological conditon also occurs in cirrhotic patients with chronic kidney disease (CKD), the severity of renal insufficiency can be underestimated by T1-weighted MRI. The aim of this study was to determine whether CMD in cirrhotic patients with CKD increased to a "pseudonormal" appearance on the T1-weighted images.

Abdominal T1-weighted MRI was performed in 32 cirrhotic patients with CKD and 32 age-matched CKD patients without liver cirrhosis. Estimated glomerular filtration rate  (eGFR) did not differ between them (P= 0.43). Visual CMD was assessed using a 3-point scale (i.e. good, moderate, poor). Quantitative CMD was calculated by (signal intensity of the cortex / signal intensity of the medulla) for patients with visually good and moderate CMD. Differences in the proportions of the visual CMD scores were assessed between the patients with and without liver cirrhosis. We evaluated the differences in eGFR between the good, moderate, and poor scores of the patients with or without liver cirrhosis. We also assessed correlations between the quantitative CMD and eGFR in the patients with and without cirrhosis.

For visual CMD, the proportions of patients in each of the three scores were different between patients with and without liver cirrhosis: more good and fewer poor CMD in the cirrhotic patients (P= 0.048). In cirrhotic patients, eGFR differed between poor CMD and good or moderate CMD (P< 0.01), but not between good and moderate CMD. There were significant differences in eGFR between the three visual scores in CKD patients without cirrhosis (P< 0.05). No significant correlation was observed between quantitative CMD and eGFR in the cirrhotic patients (P= 0.22), in contrast to the CKD patients without cirrhosis (P< 0.05, r= 0.62).

Cirrhotic patients with CKD had pseudonormal CMD of the kidney on the T1-weighted MRI. We should interpret CMD carefully in the patients with both liver cirrhosis and CKD.

T1-weighted MRI is useful for identifying chronic kidney diseases in daily practice, but not necessarily in cirrhotic patients because of pseudonormal corticomedullary differentiation of the kidney.

Yamada, F, Amano, Y, Hidaka, F, Fukushima, Y, Kumita, S, Pseudonormal Corticomedullary Differentiation of the Kidney Assessed by T1-weighted MRI in Cirrhotic Patients with Chronic Kidney Disease.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14005073.html