Renal Corticomedullary Differentiation Research Articles

One-stop assessment of renal function and renal artery in hypertensive patients with suspected renal dysfunction: non-enhanced MRI using spatial labeling with multiple inversion pulses.

To assess whether spatial labeling with multiple inversion pulses (SLEEK) sequence can be employed as a one-stop assessment method for evaluating renal function and displaying renal artery in hypertensive patients with suspected renal dysfunction. A total of 78 patients with suspected hypertensive renal damage were enrolled in this retrospective study. All patients underwent MRI examinations, and both SLEEK and DWI sequences were performed simultaneously. According to estimated glomerular filtration rate (eGFR), patients were divided into three groups (Group 1, eGFR> 90; Group 2, eGFR = 60-90; Group 3, eGFR< 60). Twenty-two of these patients also underwent CT angiography (CTA) examination. Comparison between CTA, DWI, and eGFR was performed to assess the value of SLEEK in evaluating renal function and displaying renal artery. The performance of SLEEK to display renal artery was highly consistent with the results of CTA (kappa = 0.713). The corticomedullary contrast ratio positively correlated with eGFR (p = 0.004, r = 0.322) and was significantly higher in SLEEK images than in DWI images in all three groups (p < 0.001). There was no significant difference in corticomedullary contrast ratio in SLEEK images between Group 1 and Group 2 (p = 0.285). However, the minimal renal cortical thickness, which significantly correlated with eGFR (p < 0.001, r = 0.866), was significantly different between Group 1 and Group 2 (p < 0.001). ROC analysis showed good diagnostic performance when differentiating patients with eGFR> 60 from those with eGFR< 60. The SLEEK sequence could evaluate simultaneously renal function through corticomedullary differentiation and renal arteries, enabling one-stop assessment in hypertensive patients with suspected renal dysfunction. • Spatial labeling with multiple inversion pulses (SLEEK) improves renal corticomedullary differentiation in hypertensive patients with renal dysfunction compared with DWI. • SLEEK clearly displays renal artery in hypertensive patients with renal dysfunction. • SLEEK could be utilized as a one-stop assessment method for evaluating renal function and renal artery in hypertensive patients.

Glomerulocystic kidney identified in older patients by magnetic resonance imaging: Relation to renal function and renal corticomedullary differentiation.

Glomerulocystic kidney (GCK) is often associated with genetic disorders and identified in children or adolescents. However, there are some case reports describing sporadic adult GCK identified by magnetic resonance imaging (MRI). The purpose of this study was to evaluate relationship of GCK identified by MRI in older patients to renal function and renal corticomedullary differentiation (CMD) assessed by MRI.GCK was identified in 16 older patients (mean age, 79.2 years) by T2-weighted imaging. The cysts of GCK were numerous, homogeneously small, and located in the renal cortex on T2-weighted images. Ten of the 16 patients with GCK had renal impairment (estimated glomerular filtration rate <60 ml/min/1.73 m2). Six patients who had GCK, chronic liver disease, and renal impairment showed moderate or good CMD.GCK identified by MRI may be related to renal impairment in some older patients, including those with preserved CMD as a result of chronic liver diseases.

Efficacy of Oclacitinib on Feline Atopic Syndrome Management

Background: The feline atopic syndrome (FAS) associated to environmental allergens is the third most common allergic dermatosis in domestic cats. In general, clinical signs are not pathognomonic and the exclusion of other pruritus causes is necessary to reach the diagnosis of FAS. The treatment is based on the use of drugs to control the pruritus, such as glucocorticoids, cyclosporine and, recently, oclacitinib, a Janus kinase inhibitor. This study aimed to report the efficacy of oclacitinib on the treatment of FAS associated to environmental allergens.Case: A 10-year-old female feline, crossbred, presented a history of pruritic dermatitis during ten months and diarrhea. The animal had been submitted to treatment for ectoparasites with pour-on selamectin and was fed with a commercial hypoallergenic diet in the last eight weeks or so. However, no improvement on the skin condition was observed. Physical examination revealed disseminated furfuraceous desquamation, excoriation and erythema on the right supraorbital region. Bilateral conjunctivitis was also observed. Complete blood cell count, biochemistry profile, urinalysis, immunochromathographic test for feline immunodeffiency virus (FIV) and feline leukemia virus (FeLV), fungic culture and abdominal ultrasonography were requested. The abnormalities observed were reduced urinary density and discrete loss of renal corticomedullary differentiation. Thus, based on physical examination and complementary exams, the animal was diagnosis with FAS, since the main other causes of pruritus (hypersensitivity to ectoparasites and alimentary allergens) were excluded. The animal was also diagnosed with stage 1 chronic kidney disease. Therapy based on oclacitinib was instituted with an induction dose of 1 mg/kg twice daily for 14 days, followed by a maintenance dose of 1 mg/kg once daily. After 30 days of treatment, a satisfactory therapeutic response was observed, with complete remission of pruritus. The animal was regularly evaluated, with clinical and laboratorial exams, to check the efficacy of treatment and to identify the possible adverse effects of the drug. After 300 days of treatment the animal presented a relapse of pruritic dermatitis, and the dose was changed to 1 mg/kg twice daily, with remission of clinical signs. No adverse reactions or changes in laboratorial exams were observed during the follow-up, and the chronic kidney disease remained on stage 1.Discussion: In spite of being the third most frequent allergic dermatopathy in cats, FAS is still considered as an uncommon disease. FAS is a diagnosis of exclusion, where hypersensivity to ectoparasites and alimentary allergens must be investigated before reaching the diagnosis of FAS. Clinical signs are not pathognomonic. Thus, pruritus, skin lesions on head and/or neck, miliaris dermatitis, symmetric alopecia and eosinophilic dermatitis can be observed. Other dermatologic and systemic manifestations, such as gastrointestinal, ophthalmic and respiratory signs, may be present. The reported animal presented dermatologic and systemic signs of FAS, since all the clinical alterations disappeared with the use of oclacitinib. Because some dogs demonstrated immunosuppression and developed diseases related to this, such as papilomatosis and demodicosis, while using this drug, we decided to rule out the presence of the infection by FIV and FeLV, before the beginning of the therapy. Other drugs can be used for treat cats with FAS, such as glucocorticoids and ciclosporin. However, these drugs are associated to side effects in a long-term therapy. In this case report, a cat treated with oclacitinib showed a long-term control of pruritus and clinical signs remission without adverse effects. Oclacitinib demonstrated to be a good therapeutic option on the treatment of FAS associated to environmental allergens.

Ultrasound Evaluation of Morphologic Changes of Transplanted Kidneys in Sudanese Patients

Background: Assessment of morphology of transplanted kidneys provides informative data on underlying pathological processes that involve the transplanted kidneys. Identification of these morphologic changes is useful to predict the rejection as early as possible. Objective: to evaluate the morphologic changes like corticomedullary differentiation, corticomedullary ratio, cortical thickness, size of transplanted kidneys with correlation with duration of the graft in Sudanese patients. Methodology: This retrospective study was conducted in Khartoum State from July 2015 to April 2017. A total of 115 cases of transplanted kidneys were analyzed. A designed data collection sheet was used to collect the sonographic findings, clinical and demographic data. The renal cortex, corticomedullary differentiation and ratio (CMD & CMR) and graft size were evaluated. Results: The incidence of renal transplantation was higher in males than females (89 vs. 26) and most common in the age of 20 to 49 years old. Sonographic evaluation of transplanted kidneys revealed that the CMD was disturbed in 20.9% (24 cases) lost in 6.96%(8 cases) and preserved in 72.2% (83 cases). The CMR was increased by 8 (6.98%) and decreased by 15.65% (21 cases). The cortical thickness was thin in 9.6%(11 cases), thick in 2.6%(3 cases) and normal in 87.8% (101 cases). The size of the graft was significantly decreased with duration of the transplantation (p-value =0.008). Conclusion: In Sudanese patients, considerable morphologic changes involving the renal graft in the duration ranged between 2 to 30 months. The incidence of morphologic changes increased as the age of transplantation increased. The graft size is the most significant morphologic change occurred as age of transplantation advanced. The ultrasound evaluation of renal grafts should be performed periodically to predict graft dysfunction. Key words: Sonographic, graft, morphologic changes, transplanted kidneys, cortico-medullary differentiation.

Kidney morphological parameters measured using noncontrast-enhanced steady-state free precession MRI with spatially selective inversion recovery pulse correlate with eGFR in patients with advanced CKD

BackgroundIt is well known that atrophic renal changes are associated with chronic kidney disease (CKD) progression, but conventional diagnostic imaging methods such as noncontrast-enhanced computed tomography and magnetic resonance imaging (MRI) have been insufficient for precisely assessing kidney function because they cannot clearly distinguish between the medulla and cortex. Hence, here we used noncontrast-enhanced steady-state free precession (SSFP) MRI with a spatially selective inversion recovery (IR) pulse to improve visibility for renal corticomedullary differentiation and evaluated the association between morphological parameters and kidney function in patients with CKD.MethodsKidney corticomedullary contrast ratio, cortical and medullary areas, and minimal cortical thickness of 107 patients with CKD G1–G5 were measured using SSFP MRI with a spatially selective IR pulse and the association between these morphological parameters and kidney function were evaluated.ResultsCorticomedullary contrast ratio was significantly improved on SSFP MRI compared with conventional in-phase T1-weighted gradient-echo MRI and positively correlated with estimated glomerular filtration ratio (eGFR), raw eGFR, and 24-h creatinine clearance. The medullary and cortical areas and minimal cortical thickness also positively correlated with those of kidney functional markers and the age. In patients with CKD and diabetes mellitus (DM), the correlation coefficients between raw eGFR and morphological parameters were higher than those in patients without DM, while minimal cortical thickness was larger in CKD patients with DM with a raw eGFR ≥ 45 mL/min.ConclusionKidney morphological parameters measured with SSFP MRI were clearly correlated with kidney function in patients with CKD, including those with advanced kidney dysfunction.

Investigation of renal corticomedullary differentiation with age-related change on non-contrast-enhanced MRI

To evaluate the relationship between renal corticomedullary differentiation, renal cortical thickness and age-related changes with non-contrast-enhanced steady-state free precession(SSFP) magnetic resonance imaging (MRI) and spatially selective inversion recovery(IR) pulse technology as well as its applied value . A total of 76 healthy volunteers had been recruited from August 2014 to June 2015 in First Hospital of China Medical University.All volunteers were divided into three groups: 2-40 years old, 41-60 years old, 61-80 years old. All 76 volunteers underwent non-contrast-enhanced steady-state free precession(SSFP) 3.0 T MRI scan using variable inversion times (TIs)(TI=1 000, 1 100, 1 200, 1 300, 1 400, 1 500, 1 600, 1 700 ms). The renal corticomedullary differentiation was observed and the signal intensity of renal cortex and medulla were measured respectively as well in order to calculate renal corticomedullary contrast ratio. Besides, renal cortical thickness and renal size were measured. All 76 volunteers were successfully performed all the sequences of MRI scan, including 152 useful imaging of kidney in total. The renal corticomedullary differentiation was clearly shown in all subjects. There was negative correlation between the optimal inversion time(TI) and age(r=-0.65, P<0.01). Similarly, negative correlation was observed between renal corticomedullary contrast ratio and age(r=-0.35, P<0.01). The mean renal cortical thickness of all subjects was (5.33±0.71)mm and there were statistically significant difference among those different groups, which was negative-related with age(r=-0.79, P<0.01). There was no statistically significant difference between sexuality and renal cortical thickness.Additionally, renal cortical thickness had no statistically significant difference in both sides of kidneys. The renal corticomedullary differentiation is depicted clearly by means of non-contrast-enhanced steady-state free precession MRI with spatially selective inversion recovery pulse technology. The optimal inversion time decreases along with the increase of age. In the meanwhile, the renal cortical thickness could be measured truthfully and accurately.

Measurement of renal cortical thickness using noncontrast‐enhanced steady‐state free precession MRI with spatially selective inversion recovery pulse: Association with renal function

To assess whether noncontrast-enhanced steady-state free precession (SSFP) magnetic resonance imaging (MRI) with a spatially selective inversion recovery (IR) pulse can improve the visibility of renal corticomedullary differentiation in patients showing renal dysfunction, and to investigate the correlation between renal cortical thickness and estimated glomerular filtration rate (eGFR). Sixty-five patients with and without chronic kidney diseases (CKD) were investigated. Based on eGFR, patients were divided into three groups (Group 1, eGFR < 60; Group 2, eGFR = 60-90; and Group 3, eGFR > 90). All patients underwent noncontrast-enhanced SSFP MRI with spatially selective IR pulses and minimal renal cortical thickness was measured. The mean corticomedullary contrast ratio was significantly higher in SSFP images with optimal TI than in in-phase images in all three groups (P = 0.001). Positive correlation was seen between the corticomedullary contrast ratio in SSFP images with optimal TI and eGFR (P = 0.011, r = 0.314). A significantly positive correlation was observed between minimal renal cortical thickness and eGFR (P < 0.01, r = 0.495). Noncontrast-enhanced SSFP MRI with a spatially selective IR pulse using optimal TI can improve the visibility of renal corticomedullary differentiation even in patients with renal insufficiency. The decrease in renal cortical thickness measured using this technique correlated significantly with eGFR.

Age‐related change in renal corticomedullary differentiation: Evaluation with noncontrast‐enhanced steady‐state free precession (SSFP) MRI with spatially selective inversion pulse using variable inversion time

To evaluate age-related change in renal corticomedullary differentiation and renal cortical thickness by means of noncontrast-enhanced steady-state free precession (SSFP) magnetic resonance imaging (MRI) with spatially selective inversion recovery (IR) pulse. The Institutional Review Board of our hospital approved this retrospective study and patient informed consent was waived. This study included 48 patients without renal diseases who underwent noncontrast-enhanced SSFP MRI with spatially selective IR pulse using variable inversion times (TIs) (700-1500 msec). The signal intensity of renal cortex and medulla were measured to calculate renal corticomedullary contrast ratio. Additionally, renal cortical thickness was measured. The renal corticomedullary junction was clearly depicted in all patients. The mean cortical thickness was 3.9 ± 0.83 mm. The mean corticomedullary contrast ratio was 4.7 ± 1.4. There was a negative correlation between optimal TI for the best visualization of renal corticomedullary differentiation and age (r = -0.378; P = 0.001). However, there was no significant correlation between renal corticomedullary contrast ratio and age (r = 0.187; P = 0.20). Similarly, no significant correlation was observed between renal cortical thickness and age (r = 0.054; P = 0.712). In the normal kidney, noncontrast-enhanced SSFP MRI with spatially selective IR pulse can be used to assess renal corticomedullary differentiation and cortical thickness without the influence of aging, although optimal TI values for the best visualization of renal corticomedullary junction were shortened with aging.

Corticomedullary differentiation of the kidney: Evaluation with noncontrast‐enhanced steady‐state free precession (SSFP) MRI with time‐spatial labeling inversion pulse (time‐SLIP)

To assess whether noncontrast-enhanced steady-state free precession (SSFP) magnetic resonance imaging (MRI) with time-spatial labeling inversion pulse (Time-SLIP) can improve the visibility of corticomedullary differentiation of the normal kidney. A series of noncontrast-enhanced SSFP MRI with Time-SLIP were performed in 20 patients by using various inversion times (TIs); 500-1800 msec in increments of 100 msec. In-phase (IP) and opposed-phase (OP) MR images were also obtained. The signal intensity (SI) of the renal cortex and medulla was measured to calculate corticomedullary contrast ratio (SI of cortex/medulla). Additionally, the visibility of corticomedullary differentiation was visually categorized using a four-point scale. In SSFP with Time-SLIP, corticomedullary contrast ratio was highest with TI of 1200 msec in eight subjects (40%), followed by 1100 msec in seven (35%) and 1000 msec in three (15%). The corticomedullary contrast ratio in SSFP with optimal Time-SLIP (4.93 ± 1.25) was significantly higher (P < 0.001) than those of IP (1.46 ± 0.12) and OP (1.43 ± 0.14). The visibility of corticomedullary differentiation was significantly better (P < 0.001) in SSFP images with Time-SLIP (averaged grade = 4.0) than in IP images (averaged grade = 2.63) and OP images (averaged grade = 2.05). SSFP MRI with Time-SLIP can improve the visibility of renal corticomedullary differentiation without using contrast agents.

Can Infant US Predict Clinical Function in Sickle Cell Anemia?

Research Article| November 01 2011 Can Infant US Predict Clinical Function in Sickle Cell Anemia? AAP Grand Rounds (2011) 26 (5): 57. https://doi.org/10.1542/gr.26-5-57 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Can Infant US Predict Clinical Function in Sickle Cell Anemia?. AAP Grand Rounds November 2011; 26 (5): 57. https://doi.org/10.1542/gr.26-5-57 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: sickle cell anemia, spleen, kidney, gallbladder Source: McCarville MB, Luo Z, Huang X, et al. Abdominal ultrasound with scintigraphic and clinical correlates in infants with sickle cell anemia: baseline data from the BABY HUG trial. AJR. 2011; 196(6): 1399– 1404; doi: https://doi.org/10.2214/AJR.10.4664Google Scholar Investigators from multiple United States centers sought to determine if ultrasound (US) findings in/of the spleen, kidneys, and gallbladder/biliary tree among infants with sickle cell anemia (SCA) correlate with clinical, nuclear medicine (NM), and/or laboratory findings. Infants in this study were participating in the multi-institutional BABY HUG study, a randomized placebo-controlled phase 3 trial of hydroxyurea among infants with SCA. (See AAP Grand Rounds, August 2011;26:16.) US studies of 203 infants (116 females) between ages 7.5 and 18 months (mean 12.9 months) from 14 institutions were reviewed by one experienced pediatric radiologist. The following were considered abnormal: indistinct renal corticomedullary differentiation; gallbladder thickness greater than 3 mm after 6 hours NPO; and common bile duct greater than 2 mm. Splenic function was assessed by Technetium 99m sulfur colloid liver spleen scans, pitted RBC count, and flow cytometry for Howell-Jolly bodies. Spleen scans were reported as radiotracer uptake equal to the liver, less than that of the liver, or no splenic uptake. Renal glomerular filtration rates (GFR) were evaluated by DTPA (Technetium 99m diethylenetriaminepentaacetic acid). Liver function was assessed by serum alanine aminotransferase (ALT) levels. SCA patients had greater spleen volumes than hematologically normal children. However, spleen volume did not predict NM function. Lesser uptake was associated with some increase in spleen volume, perhaps due to increased congestion causing decreased function prior to inevitable splenic autoinfarction. There was no correlation between volumes and percentages of pitted RBCs or Howell-Jolly bodies. As expected, sonographic spleen volumes correlated with spleen palpation. Two hundred and one patients had adequate renal US images; 4% had renal abnormalities. Three percent had increased renal echogenicity or absent corticomedullary differentiation. Both kidneys were significantly larger in the studied cohort compared with charts for normal children. Kidney sizes correlated positively with GFR, and the cohorts’ GFRs were statistically greater than published values for normal children. Two hundred patients had adequate biliary tree imaging. Abnormalities included multiple gallstones (1 child), sludge (6), thickened gallbladder wall (1), and dilated common duct (2). Only two patients had abnormal ALT levels: a child with a dilated duct and a child with sludge. There was no overall correlation between serum chemistries (ALT or bilirubin) and gallbladder findings, although the patient with gallstones had a markedly elevated total bilirubin. The authors conclude that among infants with SCA, sonographic spleen volume does not reflect function, although increased kidney volume correlates with increased GFR, consistent with hyperfiltration. They also note that clinically silent gallbladder disease in SCA begins in infancy. Dr Cohen has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device. Transcranial Doppler US1 has been used... You do not currently have access to this content.

The 64-MSCT study of relationship between renal corticomedullary differentiation, contrast between renal cortex and medulla, renal cortex and medulla CT peak value with the single renal function in hydronephrotic kidney

Objective To study 64-MSCT perfusion imaging features about renal corticomedullary differentiation, contrast between renal cortex and medulla(CMC), renal cortex and medulla CT peak value in normal and hydronephrotic kidneys, and to explore the relationship between them and the unilateral renal function. Methods Thirty-six patients with obstructive nephrohydrosis underwent 64-MSCT perfusion scanning. The split renal glomerular filtration rates (GFR) of their kidneys were measured by SPECT renal dynamic imaging. The 72 kidneys were divided into groups of normal renal function group, mild and severe renal impairment groups according to GFR. Renal corticomedullary differentiation on CT images was graded as clear, obscure, part clear. The CT intensity of cortex and medulla was measured in order to calculate contrast between renal cortex and medulla (CMC). Using Pearson correlation test, the correlation between them and renal GFR were examined. Resets (1) In the 24 kidneys of normal group, all kidneys showed clear CMD. In the 21 kidneys of mild renal impairment group, 14 kidneys showed clear CMD,2 showed obscure CMD and 5 showed part clear of CMD. In the 27 kidneys of severe renal impairment group, 7 kidneys showed clear CMD, 5 showed obscure CMD and 15 showed part clear of CMD. (2)The CMC of normal group was 0. 62±0. 20, while it was 0. 52±0. 14 and 0. 37±0. 11 for mild renal impairment group and severe renal impairment group CMC respectively. The CMC had positive linear correlation with GFR (r=0.536,P <0.05). (3)The renal cortex and medulla CT peak value of normal group were (133 ± 22) and (104 ± 16) HU; The renal cortex and medulla CT peak value of mild renal impairment group were (91 ± 29) and (76 ± 25) HU ; The renal cortex and medulla CT peak value of severe renal impairment group were (68 ± 24) and (57 ± 21) HU (F = 42. 76 and 32. 68, P < 0. 05). The renal cortex and medulla CT peak value had positive linear correlation with GFR (r = 0. 672 and 0. 623, P < 0. 05). Conclusions The CMC and the renal cortex and medulla CT peak value all degrade when kidney function decreases in patients with obstructive nephrohydrosis. The CMC and the renal cortex CT peak value of obstructive nephrohydrosis had positive linear correlation with GFR. So they are valuable in evaluating the unilateral renal function of hydronephresis. Key words: Kidney calculi; Tomography; X-ray computed; Kidney cortex; Kidney medulla

Acute renal failure: common occurrence of preservation of corticomedullary differentiation on MR images

The purpose of this study was to evaluate the relationship between renal corticomedullary differentiation (CMD) on MR imaging and serum creatinine (sCr) level in patients with acute renal failure (ARF). Twenty-one patients with ARF were retrospectively investigated. In all 21 patients, sCr levels were obtained on the same date as the MR study, and within 8 days before and after the MR study. CMD was assessed on non-contrast T1-weighted images and immediate post-gadolinium spoiled gradient echo (Gd-SGE) images. Presence of CMD was graded into 3 groups as ‘preserved’, ‘intermediate’, or ‘loss’. On non-contrast T1-weighted images, 12/21 (57%) showed loss of CMD and 9/21 (43%) showed preserved CMD. On immediate Gd-SGE images, 5/21 (24%) showed loss of CMD, 12/21 (57%) preserved CMD, and 4/21 (19%) intermediate CMD. The sCr levels of 9 patients with preserved CMD on non-contrast T1-weighted images ranged from 1.4 to 10.5 mg/dl (mean 4.6 mg/dl), while those of 12 patients with loss of CMD ranged from 1.6 to 7.6 mg/dl (mean 4.8 mg/dl), which was not statistically significant (p > 0.2). Renal CMD can remain preserved on non-contrast T1-weighted or immediate Gd-SGE images in patients with acute presentation of ARF, independent of sCr level.

Renal corticomedullary differentiation: observation in patients with differing serum creatinine levels.

To evaluate renal corticomedullary differentiation (CMD) in patients with differing serum creatinine (sCr) levels. Ten patients with normal sCr levels (0.9-1.3 mg/dL [80-115 mumol/L]), 14 with mildly elevated levels (1.5-2.9 mg/dL [133-256 mumol/L]), and 15 with elevated levels (> 3.0 mg/dL [265 mumol/L]) were examined with unenhanced T1-weighted fat-suppressed spin-echo (T1FS) and immediate gadolinium-enhanced gradient-echo (Gd-GRE) imaging. Patients with normal sCr levels had CMD on T1FS and Gd-GRE images. Among patients with mildly elevated levels, seven did and seven did not have CMD on T1FS images; all had CMD on Gd-GRE images. Patients with elevated levels had no CMD on T1FS images; 13 had CMD on Gd-GRE images. Two patients with levels above 10.0 mg/dL (884 mumol/L) had no CMD on Gd-GRE images. Independent of the cause of elevated sCr level, levels above 3.0 mg/dL result in loss of CMD on T1FS images, while levels above 10.0 mg/dL result in loss of CMD on Gd-GRE images.