Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
Allied Health Professionals’ Corner
Author Reply
Book Review
Brief Communication
Case Report
Case Series
Clinical Case Report
Clinicopathological Conference
Commentary
Commentary : Patient’s Voice
Corrigendum
Editorial
Editorial – World Kidney Day 2016
Editorial Commentary
Erratum
Foreward
Guideline
Guidelines
Image in Nephrology
Images in Nephrology
In-depth Review
Letter to Editor
Letter to the Editor
Letter to the Editor – Authors’ reply
Letters to Editor
Literature Review
Nephrology in India
Notice of Retraction
Obituary
Original Article
Perspective
Research Letter
Retraction Notice
Review
Review Article
Short Review
Special Article
Special Feature
Special Feature - World Kidney Day
Systematic Review
Technical Note
Varia
Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
Allied Health Professionals’ Corner
Author Reply
Book Review
Brief Communication
Case Report
Case Series
Clinical Case Report
Clinicopathological Conference
Commentary
Commentary : Patient’s Voice
Corrigendum
Editorial
Editorial – World Kidney Day 2016
Editorial Commentary
Erratum
Foreward
Guideline
Guidelines
Image in Nephrology
Images in Nephrology
In-depth Review
Letter to Editor
Letter to the Editor
Letter to the Editor – Authors’ reply
Letters to Editor
Literature Review
Nephrology in India
Notice of Retraction
Obituary
Original Article
Perspective
Research Letter
Retraction Notice
Review
Review Article
Short Review
Special Article
Special Feature
Special Feature - World Kidney Day
Systematic Review
Technical Note
Varia
View/Download PDF

Translate this page into:

Letters to Editor
25 (
1
); 60-61
doi:
10.4103/0971-4065.143301

Use of diffusion-weighted magnetic resonance imaging in the management of infected renal cyst in polycystic kidney disease

Department of Radiology, SVIMS, Tirupati, Andhra Pradesh, India
Department of Nephrology, SVIMS, Tirupati, Andhra Pradesh, India

Address for correspondence: Dr. Pavankumar G. Kale, Department of Radiology, SVIMS, Allipiri Road, Tirupati, Andhra Pradesh, India. E-mail: pavankale.doc@gmail.com

Licence

This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Disclaimer:
This article was originally published by Medknow Publications & Media Pvt Ltd and was migrated to Scientific Scholar after the change of Publisher.

Sir,

Renal cyst infection is a potentially serious complication of polycystic kidney disease (PKD). To aid the early diagnosis and management of such infection various imaging modalities such as computed tomography (CT), ultrasonography, positron emission tomography (PET) have been used to locate the infected cyst of the multiple cysts, especially when initial antibiotic therapy has failed.[1] We used diffusion-weighted magnetic resonance imaging (DW-MRI), T1- and T2-weighted imaging (T1/T2-WI) sequences to localize the exact infected cyst.

A 66-year-old woman with PKD presented with high fever and left flank pain. Serum creatinine was 4.1 mg/dl. C-reactive protein and leukocyte counts were elevated. Blood and urine cultures were negative. An abdominal ultrasound scan revealed multiple anechoic cysts and a few cysts with echogenic contents within in the left kidney suggesting hemorrhage and/or infection. Extrapolating the data available about the use of DW-MRI in brain abscess[2] we tried localizing the exact infected cyst in our patient by using DW-MRI, T1-WI and T2-WI sequences. DW-MRI with b-factor = 1000 s/mm2 was used for evaluation. The MRI appearance of cysts on DW-MRI, T1-WI, and T2-WI [Figure 1] were examined. The left mid-pole cyst in our patient showed low signal on both T1-WI and T2-WI with wall thickening, it showed exclusively high-signal intensity on DW-MRI, and was suspected as to be the infected cyst. Purulent material up to 5 ml was aspirated on CT guided drainage of the mid pole anterior cyst. Culture grew Escherichia coli. The patient's symptoms and fever resolved after the administration of appropriate antibiotics.

DW - MRI showing left renal cyst with remarkably high signal intensity, indicating that the contents of cyst show restricted diffusion (straight arrow). T1 - WI showing the low - signal in corresponding cyst (step arrow) and Fat - saturated T2WI showing the low - signal cyst (curved arrow)
Figure 1
DW - MRI showing left renal cyst with remarkably high signal intensity, indicating that the contents of cyst show restricted diffusion (straight arrow). T1 - WI showing the low - signal in corresponding cyst (step arrow) and Fat - saturated T2WI showing the low - signal cyst (curved arrow)

Diffusion-weighted-MRI provides a non-invasive imaging technique to assess the random diffusion of water molecules.[3] This takes only a few minutes in addition to a routine MRI protocol and no use of harmful radiation involved or contrast agents, when compared to PET scan, which involves the use of radiopharmaceuticals. Compared to PET, MRI is cheaper and easily available. In DW-MRI highly viscous fluids characteristically appear as high-signal intensity, which in appropriate clinical scenario can imply the presence of pus and thus help to locate the infected cyst. From these observations, we suggest that when there are hyperdense cysts in CT the possibilities are presence of blood or pus in the cysts, in this situation from the above findings MRI can help us to differentiate between blood and pus. To conclude, DW-MRI can be used as an effective tool in cases of suspected infected cyst.

References

  1. , , , , , , . Cyst infections in patients with autosomal dominant polycystic kidney disease. Clin J Am Soc Nephrol. 2009;4:1183-9.
    [Google Scholar]
  2. , , , , . Diffusion-weighted MR imaging in the preoperative assessment of brain abscesses. Surg Neurol. 2002;58:395-402.
    [Google Scholar]
  3. , , , , , , . Understanding diffusion MR imaging techniques: From scalar diffusion-weighted imaging to diffusion tensor imaging and beyond. Radiographics. 2006;26(Suppl 1):S205-23.
    [Google Scholar]

    Fulltext Views
    284

    PDF downloads
    490
    View/Download PDF
    Download Citations
    BibTeX
    RIS
    Show Sections