Clinical & Pediatric Nephrology

Biography

Biography: Ahmed Abdel Samie Mahmoud

Abstract

Objective: To observe MRI features about renal corticomedullary differentiation in the assessment of renal allograft complications during the post transplantation period. Materials & Methods: 30 patients with post transplantation complications underwent MR T_1 weighted fat saturation (T_1 FS) and contrast enhanced gradient echo scan. The signal intensity of the cortex and medulla were measured on the coronal scans and the cortio-medullary contrast (CMC) was calculated. Results: All the patients with acute rejection showed loss of the corticomedullary differentiation with a negative CMC% with a sensitivity of 75%, a specificity of 31% and a positive predictive value of 11% and a negative predictive value of 92%. One of the 2 cases with ATN showed a decreased CMD with a CMC% of 6% and the other one showed a negative CMC% of -3%, having a sensitivity of 100%, a specificity of 36%, a positive predictive value of 15% and a negative predictive value of 100%. The cases with cyclosporine nephrotoxicity showed a wide variability in their CMD, where 40% showed normal CMC% of >9%, 17% showed a decreased CMD ranging between 0-9% and 43% showed loss of CMD. The MR assessment by this modality showed a sensitivity of 63%, a specificity of 28% and a positive predictive value of 18% and a negative predictive value of 75% in detection of this type of medical complication. On the other hand, all patients with CAN showed decreased CMD ranging from 0-9% with a sensitivity of 100%, a specificity of 32%, a positive predictive value of 7% and a negative predictive value of 100%. There was a statistically significant decrease in the CMD seen in patients with chronic allograft rejection and those of the controls (p=0.02). Conclusion: In conclusion, alteration in CMC is a sensitive but nonspecific indicator of renal disease.