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Striated nephrogram is a descriptive term indicating the appearance of alternating linear bands of high and low attenuation in a radial pattern extending through the corticomedullary layers of the kidney on iodine-based intravenous contrast-enhanced imaging.
It is important to know that a similar striated appearance on gadolinium-enhanced pediatric MR imaging may not be pathologic 6,7.
Striations result from stasis and concentration of contrast material in edematous or necrosed tubules. It demonstrates increasing attenuation over time 3.
The pattern is non-specific and may be seen in a number of conditions:
Unilateral striated nephrogram
acute ureteric obstruction
acute renal vein thrombosis
acutely following renal contusion
acute radiation therapy to the kidney
Bilateral striated nephrograms
acute tubular obstruction
idiopathic asymptomatic in some children 8,9
History and etymology
The term "nephrogram" was originally used in the evaluation of plain film excretory urography 3. The use of intravenous contrast for imaging evaluation of the kidney was pioneered by American physician Moses Swick (1900-1985) in 1929 5. He worked with German urologist Alexander von Lichtenberg and chemist Arthur Binz to develop the first excretory contrast agent, known as Uroselectan.
In modern radiology, the nephrogram patterns are more commonly observed on CT urography and on plain film radiography following intravenous injection of an iodinated contrast agent.
more segmental or subsegmental areas of corticomedullary hypoattenuation
secondary to multiple small-vessel infarctions
seen in intrarenal vasculitis (classic), embolic disease
see also: cortical rim sign
enhancing cortex, and absent medullary enhancement
seen days to weeks following global renal infarction, due to collateral circulation
main renal artery occlusion
main renal vein occlusion/thrombosis (more commonly associated with an enlarged kidney)
see also: cortical rim sign
reverse rim nephrogram
absent cortical enhancement, and normal medullary enhancement
indicative of acute cortical necrosis
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- 7. Strocka S, Sorge I, Ritter L, Hirsch FW. Striated Nephrogram as an Incidental Finding in MRI Examination of Children. (2016) RoFo : Fortschritte auf dem Gebiete der Rontgenstrahlen und der Nuklearmedizin. 188 (1): 69-72. doi:10.1055/s-0041-106539 - Pubmed
- 8. S. Strocka, I. Sorge, L. Ritter, F. W. Hirsch. Striated Nephrogram as an Incidental Finding in MRI Examination of Children. (2016) RöFo - Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebenden Verfahren. 188 (01): 69. doi:10.1055/s-0041-106539 - Pubmed
- 9. Andrew T. Trout, Bin Zhang, Marguerite M. Care, Alexander J. Towbin. The striated MR nephrogram, not a reflection of pathology. (2015) Pediatric Radiology. 45 (11): 1644. doi:10.1007/s00247-015-3388-7 - Pubmed