Magnetic Resonance Imaging of the Peritoneal Cavity among Peritoneal Dialysis Patients, Using the Dialysate as “Contrast Medium”

Abstract

ABSTRACT. The objectives of this study were to evaluate whether adequate observation of abdominal pathologic features related to peritoneal dialysis (PD) was possible with magnetic resonance imaging (MRI) under routine conditions, i.e., against the background of the dialysate and without contrast medium. For 16 male and seven female patients (mean age, 51.8 ± 15.0 yr; mean duration of PD, 324 ± 542 d), 25 peritoneal MRI studies were performed with the intraperitoneal dialysate as usual. Indications were symptoms or combinations of symptoms, such as leakage or abdominal wall edema (n = 3), bloody dialysate (n = 4), suspected herniation (n = 1), suspected ultrafiltration failure (n = 2), and abdominal pain (n = 5), or routine assessment after initiation of PD (n = 12). The MRI protocol, which was performed with a 1.0-T scanner, consisted of breath-hold, coronal and transverse, T2-weighted, half-Fourier single-shot turbo spin-echo sequences, using a standard body-array coil. MRI studies were well tolerated and successfully completed for all except two patients. Results indicated a leak along the catheter (n = 1), a leak in an umbilical hernia (n = 1), suspected leakage (n = 1), hernias (n = 5, in three patients), intraperitoneal adhesions (n = 5, in four patients), a ruptured ovarian cyst (n = 1), and pleural effusions (n = 4). Pathologic findings unrelated to PD or located extra-abdominally were observed in 19 of the 25 studies. The catheter tip position was easily identified for all patients. In conclusion, this first report on peritoneal MRI using only dialysate as the “contrast medium” indicates that MRI permits detailed observation of all relevant, PD-related, abdominal pathologic features against the dialysate background, thus avoiding system contamination (and thus the risk of peritonitis).

Peritoneo-Vaginal Leaks in Peritoneal Dialysis: A Report of 3 Cases

“…There are several clinical manifestations that can be diagnosed by loss of UF, weight gain, or clinically by the appearance of a hydrocele, uni or bilateral. In the case of bursal swelling, transillumination (a light source behind the scrotum) can be used to distinguish whether the swelling is liquid or solid, thus confirming the diagnosis of hydrocele [15].…”

Complications of Peritoneal Dialysis Part I

“…Dialysate on T2-weighted images will appear white, thus confirming the diagnosis of leaks and the location of the defect without the use of gadolinum. 5 In patients with retroperitoneal leaks without clinical edema, imaging may be required for the diagnosis.…”