Böbrek yetmezlikli hastalarda FLAIR imajlarda subaraknoid aralık hiperintensitesi: Tanısal bir tuzak

Yıl 2015, Cilt: 25 Sayı: 1, 30 - 32, 01.03.2015

Havva Kalkan Demet Kıreşi Suat Keskin

Öz

Subaraknoid aralık SAA hiperintensitesi, manyetik rezonans görüntülemenin MRG FLAIR sekansında ayırıcı tanısı dikkatlice yapılması gereken önemli bir bulgudur. FLAIR sekansında SAA hiperintensitesinin subaraknoid kanama SAK , leptomeningeal karsinomatozis, menenjit gibi ciddi tedavi gerektiren birçok nedeni vardır. Kontrast madde, vasküler pulsasyonlar, beyin omurilik sıvısı BOS pulsasyonları ve hareket artefaktları sadece tuzak görüntülerdir, bu nedenle de tedavi gerektirmezler. Böbrek yetmezlikli hastalar için birçok komorbidite sebebi bulunmaktadır. Bunlardan bir tanesi serebrovasküler olaylardır. Nörolojik semptomlara sahip hastalarda MRG tanı için en iyi tercihtir. Fakat hastaya beyin MR tetkiki öncesinde kontrastlı başka bir MRG incelemesi uygulan- mışsa gadolinyumun SAA’da gecikmiş klirensi ve persistansı ortaya çıkar. Sonuçta bu durum ciddi patolojileri taklit edebilir. Bu olgu sunumunda daha önce kontrastlı boyun MRG uygulanan böbrek yetmezlikli olgunun SAA hiperintensitesine ait ilginç görüntülerini sunmayı amaçladık

Anahtar Kelimeler

Böbrek yetmezliği, gadolinyum, manyetik rezonans görüntüleme, subaraknoid aralık

Hyperintensity in the subarachnoid space on FLAIR MRI in patients with renal insufficiency: A diagnostic pitfall

Öz

Subarachnoid space SAS hyperintensity in fluid attenuated inversion recovery FLAIR magnetic resonance imaging MRI is an important finding that differantial diagnosis must be done carefully. FLAIR hyperintensity has lots of reasons: subarachnoid hemor- rhage SAH , leptomemingeal carcinomatosis, meningitis, etc. which are required serious treatment. Some of the reasons such as contrast media, vascular–cerebrospinal fluid CSF pulsation, motion artifact are only pitfall, so no treatment is necessary for them. Patients with renal failure have comorbidities. One of them is cerebrovascular events and if patient has neurologic symptoms, MRI is the best choice for diagnosis. But if patient was applied gadolinium enhanced MRI previously, it will be confusing. Because delayed clearance and persistance of gadolinium on SAS may mimick the serious pathologies mentioned above. This case report highlights the interesting appearance of SAS in a patient with renal insufficiency who underwent previous contrast-enhanced neck MRI

Anahtar Kelimeler

Gadolinium, magnetic resonans imaging, renal insufficiency, subarachnoid space

Kaynakça

• Joffe P, Thomsen HS, Meusel M. Pharmacokinetics of gadodiamide injection in patients with severe renal insufficiency and patients undergoing hemodialysis or continuous ambulatory peritoneal di- alysis. Acad Radiol 1998;5:491–502.
• Shellock FG, Kanal E. Safety of magnetic resonance imaging cont- rast agents. J Magn Reson Imaging 1999;10:477–84.
• Adams JG, Melhem ER. Clinical usefulness of T2-weighted fluid attenuated inversion recovery MR imaging of the CNS. AJR Am J Roentgenol 1999;172:529–36.
• Noguchi K, Ogawa T, Inugami A, et al. Acute subarachnoid he- morrhage: diagnosis with fluid-attenuated inversion-recovery MR imaging. Radiology 1995;196:773–7.
• Singer MB, Atlas SW, Drayer BP. Subarachnoid space disease: di- agnosis with fluid–attenuated inversion-recovery MR imaging and comparisons with gadolinium-enhanced spinecho MR imaging: blinded reader study. Radiology 1998;208:417–22.
• Mathews VP, Caldemeyer KS, Lowe MJ, et al. Brain: gadolini- um-enhanced fast fluid-attenuated inversion-recovery MR ima- ging. Radiology 2000;215:922–4.
• Tsuchiya K, Katase S, Yoshino A, et al. FLAIR MR imaging for di- agnosing intracranial meningeal carcinomatosis. AJR Am J Roent- genol 2001;176:1585–98.
• Singh SK, Leeds NE, Ginsberg LE.MR imaging of leptomeningeal metastases:comparison of three sequences. AJNR Am J Neuroradi- ol 2002;23:817–21.
• Stuckey SL, Goh TD, Heffernan T, Rowan D. Hyperintensity in the subarachnoid space on FLAIR MRI. AJR Am J Roentgenol 2007;189:913–21.
• Lakadamyalı H, Ergün T. MRI for acute neurologic complications in endstage renal disease patients on hemodialysis: Pictorial Essay, Diagn Interv Radiol 2011;17:112–7.
• Kanamalla US, Boyko OB. Gadolinium diffusion into orbital vitreous and aqueous humor, perivascular space, and ventric- les in patients with chronic renal disease. AJR Am J Roentgenol 2002;179:1350–2.
• Yıldız AE, Atlı E, Oğuz KK. Gadolinium leakage into subarachnoid space and cystic metastases. Diagn Interv Radiol 2013;19:187–90.
• Felix P. Brunner, Antony J. Wing, Sheila R. Dykes, et al. Internatio- nal review of replacement therapy: strategies and results. In: Maher JF, ed. Replacement of renal function by dialysis. 3rd ed. Norwell: Kluwer Academic Publishers, 1989;697–719.
• Nakatani T, Naganuma T, Uchida J, et al. Silent cerebral infarction in hemodialysis patients. Am J Nephrol 2003;23:86–90.
• Bozzao A, Floris R, Fasoli F, et al. Cerebrospinal fluid changes after intravenous injection of gadolinium chelate: assessment by FLAIR MR imaging. Eur Radiol 2003;13:592–7.