Renal Corticomedullary Junction

Abstract

Inability to demonstrate the renal corticomedullary junction (CMJ) on magnetic resonance (MR) images has been reported in connection with several medical renal diseases. T1-weighted spin echo pulse sequences have been advocated to demonstrate a signal intensity difference between cortex and medulla. This study was undertaken to determine which of several T1-weighted spin echo (SE) and gradient echo (GE) sequences are better for delineation of the CMJ. The MR studies were performed at 0.5 Tesla on 27 normal volunteers. Multi-slice axial images of both kidneys were obtained in all subjects at each of the following five pulse sequences: SE 250/20, SE 500/30, SE 900/30, and GE 300/15 with 80 degrees and 64 degrees flip angles. Contrast/noise ratios were calculated for the signal intensity differences between cortex and medulla; the average standardized contrast/noise ratios ranked as follows: GE 300/15/80 degrees = 3.01 +/- 0.74, GE 300/15/64 degrees = 2.72 +/- 0.74, SE 250/20 = 2.02 +/- 0.33, SE 500/30 = 1.96 +/- 0.51, and SE 900/30 = 1.71 +/- 0.39. In addition, the five sequences for each patient were randomized and the images were independently ranked for delineation of CMJ by three MR radiologists. The cumulative subjective ranking for all observers from best to worst is as follows: SE 500/30, GE 300/15/80 degrees, GE 300/15/64 degrees, SE 900/30, SE 250/20. Although better contrast/noise ratios are achieved with the GE sequences and the more T1-weighted SE sequences, as a practical matter this does not seem to be the only significant factor when compared with the visual image evaluation by independent observers.(ABSTRACT TRUNCATED AT 250 WORDS)