MR peritoneography in complications of continuous ambulatory peritoneal dialysis

Abstract

Background: We evaluated the usefulness of magnetic resonance (MR) peritoneography for the examination of complications from continuous ambulatory peritoneal dialysis (CAPD).

Methods: MR peritoneography was performed in 20 patients who had suspected CAPD-related complications. Patients who had active peritonitis were not included in the study. Before MR imaging, a mixture of 2000 mL of peritoneal dialysis solution and 20 mL of gadopentetate dimeglumine was instilled into the peritoneal cavity. MR imaging was performed on a 1.0-Tesla system using a body coil. Axial, coronal, and sagittal fat-saturated fast spoiled gradient echo (repetition/echo times, 100/6.3 ms; flip angle, 90 degrees), axial fat-saturated T2-weighted fast spin echo (repetition/echo times, 6000/107 ms), and coronal fat-saturated T2-weighted fast spin echo (repetition/echo times, 3000/96.2 ms) images of the abdomen and the pelvis were obtained. After drain-age, triplanar fat-saturated fast spoiled gradient echo images were repeated with the same parameters.

Results: Homogeneous distribution of the dialysate in the peritoneal cavity was detected in 18 patients (90%). In 12 patients (60%), fluid leaks were discovered peripheral to the exit site, tunnel, and site of peritoneal entrance of the catheter. Fluid leaks through the abdominal wall in five patients (25%), retroperitoneum in one patient (5%), and a previous operation site in one patient (5%) were demonstrated. No abnormal finding was detected in three patients (15%) who had clinically suspected complications, whereas a dialysate leak was found in two patients (10%) who had no significant finding at physical examination.

Conclusions: MR peritoneography provides detailed information about the anatomic distribution of dialysate leaks in patients treated with CAPD and poses no risks associated with ionizing radiation and nephrotoxic contrast medium.