MR in renal disease: Importance of cortical–medullary distinction

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Abstract
The diagnostic value of MR contrast between renal cortex and medulla (CMC) as an indicator of renal disease was retrospectively studied in 51 patients (9 patients with obstructive disease, 7 with inflammatory disease, 12 with various noninfectious parenchymal medical disease, 5 with vascular disease, 2 with diffuse neoplastic disease, 7 with hemosiderosis, and 10 with renal trauma [blunt trauma and 9 postlithotripsy]). Additionally, normal kidneys from 20 control subjects were studied. On T1-weighted spin-echo images (SE 500/30), CMC was visible in all the normal kidneys (19% contrast ± 2% SD). A decrease in or an absence of CMC on T1-weighted images (SE 500/28) was found to be a sensitive but nonspecific sign in most of the renal diseases studied. CMC was visibly preserved at normal levels in 7 of the 9 kidneys traumatized by lithotripsy and in all 4 kidneys with acute renal obstruction; CMC was above normal in kidneys with hemosiderosis. In conclusion, alteration in CMC is a sensitive but nonspecific indicator of renal disease. Furthermore, normal CMC can be seen in the presence of renal pathology. © 1987 Academic Press, Inc.