Radiology, Vol 179, 61-65, Copyright © 1991 by Radiological Society of North America
Renal transplants: can acute rejection and acute tubular necrosis be differentiated with MR imaging?
JT Liou, JK Lee, JP Heiken, WG Totty, PL Molina and WM Flye
Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO 63110.
Magnetic resonance (MR) imaging was used in 40 renal transplant recipients
to determine whether this modality can enable distinction of acute tubular
necrosis (ATN) and acute rejection by means of corticomedullary
differentiation (CMD). Each patient underwent initial MR imaging after
allograft renal transplantation. Twenty-nine of these 40 patients (72%)
also underwent subsequent follow-up MR imaging. Seventeen studies were
obtained during episodes of ATN; 12 of these studies (71%) showed poor CMD.
Eleven studies were obtained during episodes of acute rejection; eight of
these studies (73%) showed poor CMD. In addition, six of seven studies
(86%) showing various combinations of renal disease (ATN, acute rejection,
chronic rejection, and cyclosporine toxicity) also showed poor CMD. Loss of
CMD is reversible after improvement of ATN and acute rejection. Because
loss of CMD is a nonspecific though sensitive sign reflecting renal
transplant dysfunction, MR imaging is of limited value in the
differentiation of ATN from acute rejection.
