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AJNR Awards, New Junior Editors, and more. Read the latest AJNR updates

Research ArticleBRAIN

Brain MR Imaging Abnormalities in Kidney Transplant Recipients

Nada Besenski, Zoran Rumboldt, Osemwegie Emovon, Joyce Nicholas, Sunil Kini, Jovan Milutinovic and Milos N. Budisavljevic
American Journal of Neuroradiology October 2005, 26 (9) 2282-2289;
Nada Besenski
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Zoran Rumboldt
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Osemwegie Emovon
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Joyce Nicholas
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Sunil Kini
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Jovan Milutinovic
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Milos N. Budisavljevic
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  • Fig 1.
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    Fig 1.

    A 52-year-old-man (group 3) with multiple acute embolic infarctions.

    A, Axial DWI shows small bilateral hyperintense lesions indicative of embolic infarcts.

    B, Axial ADC map reveals low signal intensity within the lesions, consistent with restricted diffusion of water molecules, confirming acute nature of embolic infarcts.

    C, FLAIR image at approximately the same level as A and B demonstrates faint hyperintensity of the lesions.

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    Fig 2.

    A 48-year-old man (group 3) with cerebral fungal abscess.

    A, Axial T2-weighted image shows a relatively isointense intra-axial lesion with surrounding hyperintense vasogenic edema in the right frontoparietal region.

    B, Corresponding axial ADC map shows lower signal intensity of the lesion compared with the normal-appearing brain parenchyma, consistent with relatively decreased diffusion, as typically seen within brain abscesses. The lesion is surrounded by increased diffusion of vasogenic edema.

    C, Postcontrast axial T1-weighted image corresponding to A and B demonstrates irregular, predominantly peripheral enhancement of the mass.

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    Fig 3.

    A 45-year-old woman (group 2) with PRES.

    A, Axial T2-weighted image shows bilateral abnormal hyperintense signal intensity in the occipital subcortical white matter and in the posterior limb of the internal capsule.

    B, Corresponding axial FLAIR image shows the hyperintense abnormalities more clearly.

    C, On axial ADC map corresponding to A and B increased signal intensity of the abnormalities is seen, consistent with increased diffusion, which is indicative of vasogenic edema.

  • Fig 4.
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    Fig 4.

    A 39-year-old woman (group 3) with cerebellar lymphoma.

    A, Axial T2-weighted image shows an isointense left cerebellar mass surrounded by hyperintense area of vasogenic edema.

    B, Axial ADC map corresponding to A reveals relatively decreased diffusion within the mass with surrounding increased diffusion of the vasogenic edema. Relatively low diffusion rate is indicative of high cellularity of the mass.

    C, Postcontrast fat-suppressed axial T1-weighted corresponding to A and B images demonstrates attenuated homogenous enhancement of the mass.

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    Fig 5.

    A 31-year-old woman (group 1) with heterogenous calvarial thickening.

    A, Midsagittal T1-weighted image demonstrates increased thickness of the calvaria with widening of the diploic space and abnormal heterogeneous signal intensity. This finding is presumably related to a long-standing chronic renal failure and associated chronic anemia and osteodistrophy before kidney transplantation.

    B, Axial T2-weighted image shows thickened and heterogenous diploic space of the calvaria.

    C, Axial postcontrast T1-weighted image corresponding to B reveals heterogenous enhancement of the calvaria.

Tables

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    TABLE 1:

    Most common clinical presentations in kidney transplant recipients

    Group 0(n = 24)Group 1(n = 19)Group 2(n = 22)Group 3(n = 36)
    Altered mental status(13)11 (58)9 (41)9 (25)
    Headache4 (17)2 (11)4 (18)15 (42)
    Seizures4 (17)6 (32)1 (5)2 (6)
    Infection1 (4)2 (11)6 (27)4 (11)
    Vision disturbance001 (5)4 (11)
    Hemiparesis1 (4)003 (8)
    Weakness2 (8)2 (11)01 (3)
    Dizziness001 (5)3 (8)
    Ataxia1 (4)02 (9)1 (3)
    Aphasia01 (5)1 (5)2 (6)
    Syncope0002 (6)
    • Note.—Number of patients is followed by percentage in parentheses.

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    TABLE 2:

    Location of lesions in 26 pre- and post-transplant MR imaging examinations

    NormalWhite MatterGray MatterBrain Stem
    FrontalParietalOccipitalTemporalDPVCerebellumBasal GangliaThalamusCortex
    Pretransplant8 (31)9 (35)1 (4)1 (4)1 (4)8 (31)01 (4)04 (15)1 (4)
    Post-transplant23 (23)13 (13)3 (3)4 (4)1 (1)38 (39)4 (4)15 (15)7 (7)9 (9)5 (5)
    • Note.—Number of patients with lesions is followed by percentage in parentheses. DPV indicates deep periventricular area.

    • View popup
    TABLE 3:

    Lesion type on MR image in patients before (group 0) and after kidney transplant (groups 1–3)

    Group(s)*NormalAcute ChangesChronic Changes
    AIIPRESLIMATDuraC
    08 (33)2 (8)01 (4)3 (13)10 (42)000
    14 (21)3 (16)2 (11)1 (5)4 (21)6 (32)01 (5)1 (5)
    27 (32)2 (9)01 (5)7 (32)10 (45)01 (5)2 (9)
    312 (33)4 (11)3 (8)2 (6)6 (17)13 (33)1 (3)2 (6)3 (8)
    1–323 (30)9 (12)5 (6)4 (5)17 (22)29 (38)1 (1)4 (5)6 (8)
    • Note.—Number of patients is followed by percentage in parentheses. AI indicates acute and subacute infarct; I, infection; PRES, posterior reversible encephalopathy syndrome; LI, chronic lacunar infarct; MA, microangiopathy; T, tumor; Dura, dural thickening; C, thickened calvaria.

    • * Group 0 (no. patients/no. MR imaging examinations), 24/26; group 1, 19/21; group 2, 22/26; group 3, 36/51.

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American Journal of Neuroradiology: 26 (9)
American Journal of Neuroradiology
Vol. 26, Issue 9
1 Oct 2005
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Cite this article
Nada Besenski, Zoran Rumboldt, Osemwegie Emovon, Joyce Nicholas, Sunil Kini, Jovan Milutinovic, Milos N. Budisavljevic
Brain MR Imaging Abnormalities in Kidney Transplant Recipients
American Journal of Neuroradiology Oct 2005, 26 (9) 2282-2289;

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Brain MR Imaging Abnormalities in Kidney Transplant Recipients
Nada Besenski, Zoran Rumboldt, Osemwegie Emovon, Joyce Nicholas, Sunil Kini, Jovan Milutinovic, Milos N. Budisavljevic
American Journal of Neuroradiology Oct 2005, 26 (9) 2282-2289;
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