Korean J Radiol.  2005 Sep;6(3):179-184. 10.3348/kjr.2005.6.3.179.

Imaging Features of Gray-Scale and Contrast-Enhanced Color Doppler US for the Differentiation of Transient Renal Arterial Ischemia and Arterial Infarction

• Park BK
• Kim SH
• Moon MH
• Jung SI

• KMID: 1102715
• DOI: http://doi.org/10.3348/kjr.2005.6.3.179

Abstract

OBJECTIVE
To characterize the imaging features on gray-scale and contrast-enhanced color Doppler US images which differentiate renal ischemia from renal infarction. MATERIALS AND METHODS: The segmental renal arteries of eight healthy rabbits were surgically ligated. In four of these rabbits, the ligated renal artery was released 60 minutes after arterial occlusion to cause transient ischemia. In the remaining four rabbits, the arterial ligation was retained to cause a permanent infarction. The gray-scale and contrast-enhanced color Doppler US imaging features of the involved renal parenchyma of both ischemia and infarction groups were compared with respect to the presence or absence of parenchymal swelling, echogenicity changes, tissue loss and perfusion defects. RESULTS: Parenchyma swelling, echogenic changes, tissue loss and perfusion defects were found to be more extensive in the infarction than the ischemia group. The hyperechoic areas reperfused with blood flow recovered normal echogenicity and perfusion, whereas the hyperechoic areas without reperfusion became renal infarcts. CONCLUSION: Gray-scale and contrast-enhanced color Doppler US showed that the hyperechoic areas with reperfusion may reverse to normal parenchyma and allow the differentiation of renal ischemia from renal infarction.

Keyword

Renal ischemia; Renal infarction; Ultrasonography; Contrast media

MeSH Terms

Ultrasonography, Doppler/*methods
Renal Artery
Rabbits
Male
Kidney/*blood supply
Ischemia/*ultrasonography
Infarction/*ultrasonography
Image Enhancement
Diagnosis, Differential
Contrast Media
Animals

Figure

• 

  Fig. 1 Comparison of the parenchyma swelling between renal ischemia and infarction on postoperative day one. A. Longitudinal image of gray-scale US shows no or only mild parenchymal swelling (arrows), without echogenicity change, as a result of transient renal ischemia. B. Longitudinal image of contrast-enhanced color Doppler US shows moderate or severe swelling (arrows) of the hypoechoic parenchyma as a result of renal infarction. (Figure B has been permitted by the Journal of Korean Society of Ultrasound in Medicine 2004;23:137-145)

• 

  Fig. 2 Gray-scale and contrast-enhanced color Doppler US images of renal ischemia on postoperative day 28. A. Transverse image of gray-scale US shows a wedge-shaped hyperechoic area (arrows) in the lower pole of the left kidney. B. Transverse image of contrast-enhanced color Doppler US shows reperfusion (arrows) of blood flow in the hyperechoic area. C. Transverse section of a pathologic specimen (×1, haematoxylin and eosin staining) shows a normal parenchyma (single arrow), with reperfusion between the infarction areas (double arrows) without reperfusion.

• 

  Fig. 3 Contrast-enhanced color Doppler US images of renal infarction on postoperative day 28. A. Longitudinal image of contrast-enhanced color Doppler US shows a complete perfusion defect (arrows) in the hyperechoic lower polar parenchyma of the left kidney, which is severely atrophic. B. Longitudinal section of a pathologic specimen shows atrophic parenchyma (arrows), with infarction, which correlated well with the US findings. (Figure B has been permitted by the Journal of Korean Society of Ultrasound in Medicine 2004;23:137-145)

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