Highlights
- •Nutcracker syndrome (NCS) is a type of extrinsic venous compression.
- •NCS may present with symptoms such as flank pain, hematuria, proteinuria, pelvic congestion or left-sided varicocele.
- •Noncontrast MR imaging particularly using TRUFI sequence may have an incremental value in accurate diagnosis and follow-up.
Abstract
Objective
Nutcracker Syndrome (NCS) is the extrinsic compression of the left renal vein by neighboring
arterial, ligamentous, muscular, or osseous structures. Diagnosis is made by Doppler
ultrasonography (US), multidetector computerized tomography (MDCT), magnetic resonance
imaging (MRI), phlebography. The aim of the current study is to assess the value of
MRI and compare the efficiency of different sequences in diagnosis and follow up of
children with NCS.
Material and methods
A total of 40 children (female/male ratio 3:1) with NCS were included in this prospective
study. A standardized abdominal MRI protocol was used and T2-TRUFI (True Fast Imaging
with Steady-State Free Precession), T2-HASTE (Half Fourier Acquisition with Single
Shot Turbo Spin Echo), T1-VIBE (Volumetric Interpolated Breath Hold Examination),
and out-of-phase (opposed-phase) T1 sequences were obtained. The sequences were compared
according to anatomical depiction, measurability, and pulsation artifact.
Results
A four point-scale was used to assess subjective image quality and the results were
listed as: 1 = poor, 2 = fair, 3 = good, and 4 = excellent. Both in total and for
each individual criterion, the highest scores were obtained with T2-TRUFI (total mean
3.74 ± 0.45, anatomical depiction 3.9 ± 0.3, measurability 3.8 ± 0.4, aortic pulsation
artifact 3.52 ± 0.55).
Conclusion
Although Doppler US is the gold standard technique in the diagnosis of NCS, MR imaging
may be used as an additional modality, as it is superior to Doppler US in terms of
anatomic depiction and a lower rate of imaging artifacts. Non-contrast MR imaging,
particularly TRUFI sequence, may have an incremental value in the accurate diagnosis
and follow-up of these patients.
Keywords
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Article info
Publication history
Published online: February 19, 2019
Accepted:
February 5,
2019
Received in revised form:
January 31,
2019
Received:
May 22,
2018
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
