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MR Renography with Low-Dose Gadopentetate Dimeglumine: Feasibility¹

¹ From the Department of Radiology-MRI, New York University, 530 First Ave, HCC Basement, New York, NY 10016. From the 1999 RSNA scientific assembly. Received December 14, 2000; revision requested February 4, 2001; revision received February 21; accepted March 19. Supported in part by a 1998 RSNA Research and Education Fund Seed Grant, National Institutes of Health grant K23-DK02814, and a Society of Computed Body Tomography/Magnetic Resonance Lauterbur Award. Address correspondence to V.S.L. (e-mail: lee@mri.med.nyu.edu).

PURPOSE: To develop a low-dose magnetic resonance (MR) renographic method performed with and without an angiotensin converting enzyme (ACE) inhibitor and in conjunction with gadolinium-enhanced MR angiography in patients with suspected renovascular disease.

MATERIALS AND METHODS: Thirty-two patients underwent MR renography (turbo fast low-angle shot sequence: repetition time, 5 msec; echo time, 2.3 msec; flip angle, 15°; one coronal image acquired every 2 seconds for 4 minutes) following intravenous injection of 2 mL of gadopentetate dimeglumine, which was repeated following intravenous injection of an ACE inhibitor. Contrast material–enhanced MR angiography was also performed. On the basis of renographic findings, renal cortex and renal medulla enhancement curves and normalized enhancement ratios were analyzed.

RESULTS: The cortex and medulla showed an early transient period of enhancement within 20 seconds (vascular phase). During 1–2 minutes, a second, gradual increase in medullary enhancement, reflecting transit of filtered contrast material, was observed that was significantly greater in patients with a serum creatinine level less than 2 mg/dL (177 µmol/L) than in those with a level of 2 mg/dL or greater (P < .01). After injection of the ACE inhibitor, patients with elevated creatinine levels showed low renal medullary enhancement regardless of the presence of renal artery stenosis (RAS). However, in patients with creatinine less than 2 mg/dL, medullary enhancement ratios after injection of the ACE inhibitor were consistently lower in patients with RAS of 50% or greater than in those without stenosis (P = .02 to .08).

CONCLUSION: Low-dose MR renography can be performed in the clinical setting before and after injection of an ACE inhibitor, and its potential use for evaluating decreased renal function as a consequence of RAS is promising.

Index terms: Kidney, function, 81.12143, 81.12144 • Magnetic resonance (MR), vascular studies, 961.12942, 961.12943 • Renal arteries, stenosis or obstruction, 961.72

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