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Wang X, Li S, Lin X, Lu Y, Mao C, Ye Z, Li X, Koh TS, Liu J, Liu J, Ma X, Cheng J, Ning G, Yan Z, Hou Z. Evaluation of tracer kinetic parameters in cervical cancer using dynamic contrast-enhanced MRI as biomarkers in terms of biological relevance, diagnostic performance and inter-center variability. Front Oncol 2022; 12:958219. [PMID: 36324571 PMCID: PMC9620719 DOI: 10.3389/fonc.2022.958219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 08/04/2022] [Indexed: 11/18/2022] Open
Abstract
Objectives This study assessed the clinical value of parameters derived from dynamic contrast-enhanced (DCE) MRI with respect to correlation with angiogenesis and proliferation of cervical cancer, performance of diagnosis and reproducibility of DCE-MRI parameters across MRI scanners. Materials and Methods A total of 113 patients with cervical carcinoma from two centers were included in this retrospective study. The DCE data were centralized and processed using five tracer kinetic models (TKMs) (Tofts, Ex-Tofts, ATH, SC, and DP), yielding the following parameters: volume transfer constant (Ktrans), extravascular extracellular volume (Ve), fractional volume of vascular space (Vp), blood flow (Fp), and permeability surface area product (PS). CD34 counts and Ki-67 PI (proliferation index) of cervical cancer and normal cervix tissue were obtained using immunohistochemical staining in Center 1. Results CD34 count and Ki-67 PI in cervical cancer were significantly higher than in normal cervix tissue (p<0.05). Parameter Ve from each TKM was significantly smaller in cervical cancer tissue than in normal cervix tissue (p<0.05), indicating the higher proliferation of cervical cancer cells. Ve of each TKM attained the largest AUC to diagnose cervical cancer. The distributions of DCE parameters for both cervical cancer and normal cervix tissue were not significantly different between two centers (P>0.05). Conclusion Parameter Ve was similar to the expression of Ki-67 in revealing the proliferation of tissue cells, attained good performance in diagnosis of cervical cancer, and demonstrated consistent findings on measured values across centers.
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Affiliation(s)
- Xue Wang
- Department of Radiology, The Second Affiliated Hospital and Yuying Children′s Hospital of Wenzhou Medical University, Wenzhou, China
| | - Shujian Li
- Department of Magnetic Resonance Imaging (MRI), The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xianhui Lin
- Department of Pathology, The Second Affiliated Hospital and Yuying Children′s Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yi Lu
- Department of Radiology, The Second Affiliated Hospital and Yuying Children′s Hospital of Wenzhou Medical University, Wenzhou, China
| | - Chuanwan Mao
- Department of Radiology, The Second Affiliated Hospital and Yuying Children′s Hospital of Wenzhou Medical University, Wenzhou, China
| | - Zhijun Ye
- Department of Radiology, The Second Affiliated Hospital of Sichuan University, Chengdu, China
| | - Xuesheng Li
- Department of Radiology, The Second Affiliated Hospital of Sichuan University, Chengdu, China
| | - Tong-San Koh
- Department of Oncologic Imaging, National Cancer Center, Singapore, Singapore
- The department of Jiangsu Key Laboratory of Medical Optics, Duke-National University of Singapore (NUS) Graduate Medical School, Singapore, Singapore
| | - Jie Liu
- Department of Magnetic Resonance Imaging (MRI), The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jingjing Liu
- Department of Magnetic Resonance Imaging (MRI), The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiaoyue Ma
- Department of Magnetic Resonance Imaging (MRI), The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jingliang Cheng
- Department of Magnetic Resonance Imaging (MRI), The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Gang Ning
- Department of Radiology, The Second Affiliated Hospital of Sichuan University, Chengdu, China
| | - Zhihan Yan
- Department of Radiology, The Second Affiliated Hospital and Yuying Children′s Hospital of Wenzhou Medical University, Wenzhou, China
| | - Zujun Hou
- Department of Radiology, The Second Affiliated Hospital and Yuying Children′s Hospital of Wenzhou Medical University, Wenzhou, China
- Jiangsu Key Laboratory of Medical Optics, Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, China
- *Correspondence: Zujun Hou,
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Kidney Perfusion in Contrast-Enhanced Ultrasound (CEUS) Correlates with Renal Function in Living Kidney Donors. J Clin Med 2022; 11:jcm11030791. [PMID: 35160243 PMCID: PMC8836871 DOI: 10.3390/jcm11030791] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 01/28/2022] [Accepted: 01/30/2022] [Indexed: 01/22/2023] Open
Abstract
Contrast-enhanced ultrasound (CEUS) is a widely used diagnostic tool for analyzing perfusion and characterizing lesions in several organs. However, to date, it has not been sufficiently investigated whether there is an association between CEUS findings and kidney function. This study aimed at identifying the potential relationship between kidney function and the renal perfusion status determined by CEUS in living kidney donors. A total of 30 living kidney donors examined between April 2018 and March 2020 were included in the study. All patients underwent various diagnostic procedures for evaluation of renal function. CEUS was performed in all 30 donors one day before nephrectomy. Kidney perfusion was quantified using a postprocessing tool (VueBox, Bracco Imaging). Various perfusion parameters were subsequently analyzed and compared with the results of the other methods used to evaluate kidney function. Of all parameters, mean signal intensity (MeanLin) had the strongest correlation, showing significant correlations with eGFR (CG) (r = −0.345; p = 0.007) and total kidney volume (r = −0.409; p = 0.001). While there was no significant correlation between any perfusion parameter and diethylenetriaminepentaacetic acid (DTPA), we detected a significant correlation between MeanLin and DTPA (r = −0.502; p = 0.005) in the subgroup of normal-weight donors. The results indicate that signal intensity in CEUS is associated with kidney function in normal-weight individuals. Body mass index (BMI) may be a potential confounder of signal intensity in CEUS. Thus, more research is needed to confirm these results in larger study populations.
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Clinical Comparison of the Glomerular Filtration Rate Calculated from Different Renal Depths and Formulae. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12020698] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
A camera-based method using Technetium-99m diethylenetriaminepentaacetic acid (Tc-99m DTPA) is commonly used to calculate glomerular filtration rate (GFR), especially, as it can easily calculate split renal function. Renal depth is the main factor affecting the measurement of GFR accuracy. This study aimed to compare the difference of renal depths between three formulae and a CT scan, and, additionally, to calculate the GFRs by four methods. We retrospectively reviewed the medical records of patients receiving a renal dynamic scan. All patients underwent a laboratory test within one month, and a computed tomography (CT) scan within two months, before or after the renal dynamic scan. The GFRs were calculated by employing a renal dynamic scan using renal depth measured in three formulae (Tonnesen’s, Itoh K’s, and Taylor’s), and a CT scan. The renal depths measured by the above four methods were compared, and the GFRs were compared to the modified estimated GFR (eGFR). Fifty-one patients were enrolled in the study. The mean modified eGFR was 60.5 ± 42.7 mL/min. The mean GFRs calculated by three formulae and CT were 45.3 ± 23.3, 54.7 ± 27.5, 56.5 ± 26.3, and 63.7 ± 30.0, respectively. All of them correlated well with the modified eGFR (r = 0.87, 0.87, 0.87, and 0.84, respectively). The Bland–Altman plot revealed good consistency between the calculated GFR by Tonnesen’s and the modified eGFR. The renal depths measured using the three formulae were smaller than those measured using the CT scan, and the right renal depth was always larger than the left. In patients with modified eGFR > 60 mL/min, the GFR calculated by CT was the closest to the modified eGFR. The Renal depth measured by CT scan is deeper than that using formula, and it influences the GFR calculated by Gate’s method. The GFR calculated by CT is more closely related to modified eGFR when modified eGFR > 60 mL/min.
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Xue R, Chen M, Cai J, Deng Z, Pan D, Liu X, Li Y, Rong X, Li H, Xu Y, Shen Q, Tang Y. Blood-Brain Barrier Repair of Bevacizumab and Corticosteroid as Prediction of Clinical Improvement and Relapse Risk in Radiation-Induced Brain Necrosis: A Retrospective Observational Study. Front Oncol 2021; 11:720417. [PMID: 34692494 PMCID: PMC8526720 DOI: 10.3389/fonc.2021.720417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 09/09/2021] [Indexed: 11/13/2022] Open
Abstract
Background Blood-brain barrier (BBB) disruption after endothelial damage is a crucial part of radiation-induced brain necrosis (RN), but little is known of BBB disruption quantification and its role in the evaluation of therapeutic effect and prognosis for drug treatment. In this retrospective study, BBB repair by bevacizumab and corticosteroid and the correlation between BBB permeability and treatment response and relapse were evaluated by dynamic contrast-enhanced MRI (DCE-MRI). Methods Forty-one patients with RN after radiotherapy for nasopharyngeal carcinoma (NPC) (28 treated with bevacizumab and 13 with corticosteroid), 12 patients with no RN after NPC radiotherapy, and 12 patients with no radiotherapy history were included as RN, non-RN, and normal groups, respectively. DCE-MRI assessed BBB permeability in white matter of bilateral temporal lobe. DCE parameters were compared at baseline among the three groups. DCE parameters after treatment were compared and correlated with RN volume decrease, neurological improvement, and relapse. Results The extent of BBB leakage at baseline increased from the normal group and non-RN group and to RN necrosis lesions, especially K trans (Kruskal-Wallis test, P < 0.001). In the RN group, bevacizumab-induced K trans and v e decrease in radiation necrosis lesions (both P < 0.001), while corticosteroid showed no obvious effect on BBB. The treatment response rate of bevacizumab was significantly higher than that of corticosteroid [30/34 (88.2%) vs. 10/22 (45.4%), P < 0.001]. Spearman analysis showed baseline K trans, K ep, and v p positively correlated with RN volume decrease and improvement of cognition and quality of life in bevacizumab treatment. After a 6-month follow-up for treatment response cases, the relapse rate of bevacizumab and corticosteroid was 10/30 (33.3%) and 2/9 (22.2%), respectively, with no statistical difference. Post-bevacizumab K trans level predicted relapse in 6 months with AUC 0.745 (P < 0.05, 95% CI 0.546-0.943, sensitivity = 0.800, specificity = 0.631). Conclusions Bevacizumab improved BBB leakage in RN necrosis. DCE parameters may be useful to predict therapeutic effect and relapse after bevacizumab.
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Affiliation(s)
- Ruiqi Xue
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Meiwei Chen
- Department of Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jinhua Cai
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhenhong Deng
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Dong Pan
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiaohuan Liu
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yi Li
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiaoming Rong
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Honghong Li
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yongteng Xu
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Qingyu Shen
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yamei Tang
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Province Key Laboratory of Brain Function and Disease, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China
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Bo S, Sedaghat F, Pavuluri K, Rowe SP, Cohen A, Kates M, McMahon MT. Dynamic Contrast Enhanced-MR CEST Urography: An Emerging Tool in the Diagnosis and Management of Upper Urinary Tract Obstruction. Tomography 2021; 7:80-94. [PMID: 33801533 PMCID: PMC8103243 DOI: 10.3390/tomography7010008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 02/16/2021] [Indexed: 02/04/2023] Open
Abstract
Upper urinary tract obstructions (UTOs) are blockages that inhibit the flow of urine through its normal course, leading to impaired kidney function. Imaging plays a significant role in the initial diagnosis of UTO, with anatomic imaging (primarily ultrasound (US) and non-contrast computed tomography (CT)) serving as screening tools for the detection of the dilation of the urinary collecting systems (i.e., hydronephrosis). Whether hydronephrosis represents UTO or a non-obstructive process is determined by functional imaging (typically nuclear medicine renal scintigraphy). If these exams reveal evidence of UTO but no discernable source, multiphase contrast enhanced CT urography and/or dynamic contrast enhanced MR urography (DCE-MRU) may be performed to delineate a cause. These are often performed in conjunction with direct ureteroscopic evaluation. While contrast-enhanced CT currently predominates, it can induce renal injury due to contrast induced nephropathy (CIN), subject patients to ionizing radiation and is limited in quantifying renal function (traditionally assessed by renal scintigraphy) and establishing the extent to which hydronephrosis is due to functional obstruction. Traditional MRI is similarly limited in its ability to quantify function. DCE-MRU presents concerns regarding nephrogenic systemic fibrosis (NSF), although decreased with newer gadolinium-based contrast agents, and regarding cumulative gadolinium deposition in the basal ganglia. DCE-MR CEST urography is a promising alternative, employing new MRI contrast agents and imaging schemes and allowing for concurrent assessment of renal anatomy and functional parameters. In this review we highlight clinical challenges in the diagnosis and management of UTO, identify key advances in imaging agents and techniques for DCE-MR CEST urography and provide perspective on how this technique may evolve in clinical importance.
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Affiliation(s)
- Shaowei Bo
- The Russell H. Morgan Department of Radiology and Radiological Science, School of Medicine, The Johns Hopkins University, Baltimore, MD 21205, USA; (S.B.); (F.S.); (K.P.); (S.P.R.)
| | - Farzad Sedaghat
- The Russell H. Morgan Department of Radiology and Radiological Science, School of Medicine, The Johns Hopkins University, Baltimore, MD 21205, USA; (S.B.); (F.S.); (K.P.); (S.P.R.)
| | - KowsalyaDevi Pavuluri
- The Russell H. Morgan Department of Radiology and Radiological Science, School of Medicine, The Johns Hopkins University, Baltimore, MD 21205, USA; (S.B.); (F.S.); (K.P.); (S.P.R.)
| | - Steven P. Rowe
- The Russell H. Morgan Department of Radiology and Radiological Science, School of Medicine, The Johns Hopkins University, Baltimore, MD 21205, USA; (S.B.); (F.S.); (K.P.); (S.P.R.)
- The James Buchanan Brady Urological Institute, Department of Urology, School of Medicine, Johns Hopkins University, Baltimore, MD 21205, USA; (A.C.); (M.K.)
| | - Andrew Cohen
- The James Buchanan Brady Urological Institute, Department of Urology, School of Medicine, Johns Hopkins University, Baltimore, MD 21205, USA; (A.C.); (M.K.)
| | - Max Kates
- The James Buchanan Brady Urological Institute, Department of Urology, School of Medicine, Johns Hopkins University, Baltimore, MD 21205, USA; (A.C.); (M.K.)
| | - Michael T. McMahon
- The Russell H. Morgan Department of Radiology and Radiological Science, School of Medicine, The Johns Hopkins University, Baltimore, MD 21205, USA; (S.B.); (F.S.); (K.P.); (S.P.R.)
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD 21205, USA
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Zöllner FG, Dastrù W, Irrera P, Longo DL, Bennett KM, Beeman SC, Bretthorst GL, Garbow JR. Analysis Protocol for Dynamic Contrast Enhanced (DCE) MRI of Renal Perfusion and Filtration. Methods Mol Biol 2021; 2216:637-653. [PMID: 33476028 PMCID: PMC9703217 DOI: 10.1007/978-1-0716-0978-1_38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Here we present an analysis protocol for dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) data of the kidneys. It covers comprehensive steps to facilitate signal to contrast agent concentration mapping via T1 mapping and the calculation of renal perfusion and filtration parametric maps using model-free approaches, model free analysis using deconvolution, the Toft's model and a Bayesian approach.This chapter is based upon work from the COST Action PARENCHIMA, a community-driven network funded by the European Cooperation in Science and Technology (COST) program of the European Union, which aims to improve the reproducibility and standardization of renal MRI biomarkers. This analysis protocol chapter is complemented by two separate chapters describing the basic concept and experimental procedure.
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Affiliation(s)
- Frank G Zöllner
- Computer Assisted Clinical Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Walter Dastrù
- Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy
| | - Pietro Irrera
- University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Dario Livio Longo
- Institute of Biostructures and Bioimaging (IBB), Italian National Research Council (CNR), Torino, Italy.
| | - Kevin M Bennett
- Washington University School of Medicine, St. Louis, MO, USA
| | - Scott C Beeman
- Washington University School of Medicine, St. Louis, MO, USA
| | | | - Joel R Garbow
- Washington University School of Medicine, St. Louis, MO, USA
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Irrera P, Consolino L, Cutrin JC, Zöllner FG, Longo DL. Dual assessment of kidney perfusion and pH by exploiting a dynamic CEST-MRI approach in an acute kidney ischemia-reperfusion injury murine model. NMR IN BIOMEDICINE 2020; 33:e4287. [PMID: 32153058 DOI: 10.1002/nbm.4287] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 02/03/2020] [Accepted: 02/18/2020] [Indexed: 06/10/2023]
Abstract
Several factors can lead to acute kidney injury, but damage following ischemia and reperfusion injuries is the main risk factor and usually develops into chronic disease. MRI has often been proposed as a method with which to assess renal function. It does so by measuring the renal perfusion of an injected Gd-based contrast agent. The use of pH-responsive agents as part of the CEST (chemical exchange saturation transfer)-MRI technique has recently shown that pH homeostasis is also an important indicator of kidney functionality. However, there is still a need for methods that can provide more than one type of information following the injection of a single contrast agent for the characterization of renal function. Herein we propose, for the first time, dynamic CEST acquisition following iopamidol injection to quantify renal function by assessing both perfusion and pH homeostasis. The aim of this study is to assess renal functionality in a murine unilateral ischemia-reperfusion injury model at two time points (3 and 7 days) after acute kidney injury. The renal-perfusion estimates measured with iopamidol were compared with those obtained with a gadolinium-based agent, via a dynamic contrast enhanced (DCE)-MRI approach, to validate the proposed method. Compared with the contralateral kidneys, the clamped ones showed a significant decrease in renal perfusion, as measured using the DCE-MRI approach, which is consistent with reduced filtration capability. Dynamic CEST-MRI findings provided similar results, indicating that the clamped kidneys displayed significantly reduced renal filtration that persisted up to 7 days after the damage. In addition, CEST-MRI pH imaging showed that the clamped kidneys displayed significantly increased pH values, reflecting the disturbance to pH homeostasis. Our results demonstrate that a single CEST-MRI contrast agent can provide multiple types of information related to renal function and can discern healthy kidneys from pathological ones by combining perfusion measurements with renal pH mapping.
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Affiliation(s)
- Pietro Irrera
- Università degli Studi della Campania "Luigi Vanvitelli", Napoli, Italy
- Istituto di Biostrutture e Bioimmagini (IBB), Consiglio Nazionale delle Ricerche (CNR), Torino, Italy
| | - Lorena Consolino
- Centro di Imaging Molecolare, Dipartimento di Biotecnologie Molecolari e Scienze per la Salute, Università degli Studi di Torino, Torino, Italy
| | - Juan Carlos Cutrin
- Centro di Imaging Molecolare, Dipartimento di Biotecnologie Molecolari e Scienze per la Salute, Università degli Studi di Torino, Torino, Italy
| | - Frank G Zöllner
- Computer Assisted Clinical Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Dario Livio Longo
- Istituto di Biostrutture e Bioimmagini (IBB), Consiglio Nazionale delle Ricerche (CNR), Torino, Italy
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Prospective pediatric study comparing glomerular filtration rate estimates based on motion-robust dynamic contrast-enhanced magnetic resonance imaging and serum creatinine (eGFR) to 99mTc DTPA. Pediatr Radiol 2020; 50:698-705. [PMID: 31984436 PMCID: PMC7153988 DOI: 10.1007/s00247-020-04617-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 12/12/2019] [Accepted: 01/10/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND Current methods to estimate glomerular filtration rate (GFR) have shortcomings. Estimates based on serum creatinine are known to be inaccurate in the chronically ill and during acute changes in renal function. Gold standard methods such as inulin and 99mTc diethylenetriamine pentaacetic acid (DTPA) require blood or urine sampling and thus can be difficult to perform in children. Motion-robust radial volumetric interpolated breath-hold examination (VIBE) dynamic contrast-enhanced MRI represents a novel tool for estimating GFR that has not been validated in children. OBJECTIVE The purpose of our study was to determine the feasibility and accuracy of GFR measured by motion-robust radial VIBE dynamic contrast-enhanced MRI compared to estimates by serum creatinine (eGFR) and 99mTc DTPA in children. MATERIALS AND METHODS We enrolled children, 0-18 years of age, who were undergoing both a contrast-enhanced MRI and nuclear medicine 99mTc DTPA glomerular filtration rate (NM-GFR) within 2 weeks of each other. Enrolled children consented to an additional 6-min dynamic contrast-enhanced MRI scan using the motion-robust high spatiotemporal resolution prototype dynamic radial VIBE sequence (Siemens, Erlangen, Germany) at 3 tesla (T). The images were reconstructed offline with high temporal resolution (~3 s/volume) using compressed sensing image reconstruction including regularization in temporal dimension to improve image quality and reduce streaking artifacts. Images were then automatically post-processed using in-house-developed software. Post-processing steps included automatic segmentation of kidney parenchyma and aorta using convolutional neural network techniques and tracer kinetic model fitting using the Sourbron two-compartment model to calculate the MR-based GFR (MR-GFR). The NM-GFR was compared to MR-GFR and estimated GFR based on serum creatinine (eGFR) using Pearson correlation coefficient and Bland-Altman analysis. RESULTS Twenty-one children (7 female, 14 male) were enrolled between February 2017 and May 2018. Data from six of these children were not further analyzed because of deviations from the MRI protocol. Fifteen patients were analyzed (5 female, 10 male; average age 5.9 years); the method was technically feasible in all children. The results showed that the MR-GFR correlated with NM-GFR with a Pearson correlation coefficient (r-value) of 0.98. Bland-Altman analysis (i.e. difference of MR-GFR and NM-GFR versus mean of NM-GFR and MR-GFR) showed a mean difference of -0.32 and reproducibility coefficient of 18 with 95% confidence interval, and the coefficient of variation of 6.7% with values between -19 (-1.96 standard deviation) and 18 (+1.96 standard deviation). In contrast, serum creatinine compared with NM-GFR yielded an r-value of 0.73. Bland-Altman analysis (i.e. difference of eGFR and NM-GFR versus mean of NM-GFR and eGFR) showed a mean difference of 2.9 and reproducibility coefficient of 70 with 95% confidence interval, and the coefficient of variation of 25% with values between -67 (-1.96 standard deviation) and 73 (+1.96 standard deviation). CONCLUSION MR-GFR is a technically feasible and reliable method of measuring GFR when compared to the reference standard, NM-GFR by serum 99mTc DTPA, and MR-GFR is more reliable than estimates based on serum creatinine.
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Feasibility of gamma camera-based GFR measurement using renal depth evaluated by lateral scan of 99mTc-DTPA renography. Ann Nucl Med 2020; 34:349-357. [PMID: 32166712 DOI: 10.1007/s12149-020-01455-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Accepted: 02/28/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Gamma camera-based measurement of glomerular filtration rate (GFR) with 99mTc-diethylenetriaminepentaacetic acid (DTPA) is an established non-invasive measurement of split renal function; however, it is not as accurate as the plasma sample method. Therefore, study into improving the accuracy of such method is clinically relevant. The aim of this study was to elucidate the feasibility of gamma camera-based GFR measurement using renal depth evaluated by lateral scan of 99mTc-DTPA renography and comparing the results with those of GFR using renal depth measured by CT, and three representative formulas. METHODS The study population comprised 38 patients (median, 69 years; male 28, female 10; median estimated GFR, 67.4 ml/min) with renourinary disorders. Scintigraphy was performed after intravenous injection of 370 MBq 99mTc-DTPA by dynamic data acquisition for 20 min, followed by a bilateral static scan of the abdomen for 3 min. All patients underwent computed tomography (CT) within 2 months from renography. GFR was calculated by renography using renal depth determined in five ways; lateral scan of 99mTc-DTPA, CT, and three formulas previously created with using weight, height and age. GFRs were compared with estimated GFR (eGFR). The depth of both kidneys measured as described above was compared and evaluated the laterality of the renal depth. RESULTS The median values of GFR calculated with renal depth determined by 99mTc-DTPA renography, CT, and the three formulas were 87.3, 83.9, 67.8, 68.3, and 71.5 ml/min, respectively. All of them correlated significantly with eGFR (r = 0.734, r = 0.687, r = 0.728, r = 0.726, and r = 0.686, respectively), however, no significant difference was observed among five correlation coefficients. Bland-Altman plot revealed that eGFR had error and fixed bias when compared with GFRs calculated using renal depth determined by renography, CT, and Taylor's formula. The depth of both kidneys measured by 99mTc-DTPA renography was equivalent to that measured by CT, however, those measured by the three formulas were significantly smaller than that measured by 99mTc-DTPA renography. The depth of the right kidney was larger than that of the left kidney using all three formulas in all patients. However, CT detected only 66% of patients to have a deeper right kidney than left kidney. CONCLUSION Lateral scanning is a feasible procedure to measure renal depth for accurate and reasonable split GFR measurements using 99mTc-DTPA renography.
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A Comparative Study of Two-Compartment Exchange Models for Dynamic Contrast-Enhanced MRI in Characterizing Uterine Cervical Carcinoma. CONTRAST MEDIA & MOLECULAR IMAGING 2019; 2019:3168416. [PMID: 31897081 PMCID: PMC6925719 DOI: 10.1155/2019/3168416] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 10/14/2019] [Indexed: 12/13/2022]
Abstract
A variety of tracer kinetic methods have been employed to assess tumor angiogenesis. The Standard two-Compartment model (SC) used in cervix carcinoma was less frequent, and Adiabatic Approximation to the Tissue Homogeneity (AATH) and Distributed Parameter (DP) model are lacking. This study compares two-compartment exchange models (2CXM) (AATH, SC, and DP) for determining dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) parameters in cervical cancer, with the aim of investigating the potential of various parameters derived from 2CXM for tumor diagnosis and exploring the possible relationship between these parameters in patients with cervix cancer. Parameters (tissue blood flow, Fp; tissue blood volume, Vp; interstitial volume, Ve; and vascular permeability, PS) for regions of interest (ROI) of cervix lesions and normal cervix tissue were estimated by AATH, SC, and DP models in 36 patients with cervix cancer and 17 healthy subjects. All parameters showed significant differences between lesions and normal tissue with a P value less than 0.05, except for PS from the AATH model, Fp from the SC model, and Vp from the DP model. Parameter Ve from the AATH model had the largest AUC (r = 0.85). Parameters Fp and Vp from SC and DP models and Ve and PS from AATH and DP models were highly correlated, respectively, (r > 0.8) in cervix lesions. Cervix cancer was found to have a very unusual microcirculation pattern, with over-growth of cancer cells but without evident development of angiogenesis. Ve has the best performance in identifying cervix cancer. Most physiological parameters derived from AATH, SC, and DP models are linearly correlated in cervix cancer.
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Free-Breathing Dynamic Contrast-Enhanced Imaging of the Upper Abdomen Using a Cartesian Compressed-Sensing Sequence With Hard-Gated and Motion-State-Resolved Reconstruction. Invest Radiol 2019; 54:728-736. [DOI: 10.1097/rli.0000000000000607] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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12
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Quantitative renal function assessment of atheroembolic renal disease using view-shared compressed sensing based dynamic-contrast enhanced MR imaging: An in vivo study. Magn Reson Imaging 2019; 65:67-74. [PMID: 31654738 DOI: 10.1016/j.mri.2019.10.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 10/09/2019] [Accepted: 10/14/2019] [Indexed: 11/21/2022]
Abstract
Atheroembolic renal disease (AERD) is the major cause of renal insufficiency in the elderly, and particularly, the diagnose of AERD is often delayed and even missed due to its nonspecific presentation and the sudden occurrence of an embolic event. To investigate the feasibility of the view-shared compressed sensing (VCS) based dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) in the assessment of AERD in animal models. The reproducibility of VCS DCE-MRI based glomerular filtration rate (GFR) estimation was first evaluated using the three healthy rabbits. Animal models of unilateral AERD were then conducted. All the rabbits underwent VCS DCE-MRI and the GFR maps were estimated by a commonly used cortical-compartment model. The whole kidney and suspicious lesion region GFR values of embolized kidneys were then compared with the corresponding values of normal kidneys. Finally, the suspicious lesion regions were confirmed by the corresponding renal specimens and histological findings. The reproducibility of GFR measurements was analyzed using the coefficient of variation and Bland-Altman analysis. The GFR values of normal and embolized kidneys were compared using the Student t-test. Contrast-enhanced images with sufficient diagnostic quality and reduced motion artifacts are obtained at a temporal resolution of 2.5 s. The Bland-Altman plot indicated close agreement between the GFR values estimated from between-day scans in healthy rabbits. Besides, there existed significant differences between the pixel-wise GFR values of normal and AERD kidneys in region-based comparison(P < 0.0001). The suspicious lesions are consistent well with the renal specimen and histological findings. The preliminary animal study verified the feasibility of VCS DCE-MRI for renal function evaluation, and the strategy could potentially provide a valuable tool to identify AERD.
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Jiang K, Tang H, Mishra PK, Macura SI, Lerman LO. Measurement of murine kidney functional biomarkers using DCE-MRI: A multi-slice TRICKS technique and semi-automated image processing algorithm. Magn Reson Imaging 2019; 63:226-234. [PMID: 31442558 DOI: 10.1016/j.mri.2019.08.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 08/16/2019] [Accepted: 08/18/2019] [Indexed: 11/24/2022]
Abstract
PURPOSE To propose a rapid multi-slice T1 measurement method using time-resolved imaging of contrast kinetics (TRICKS) and a semi-automated image processing algorithm for comprehensive assessment murine kidney function using dynamic contrast-enhanced MRI (DCE-MRI). METHODS A multi-slice TRICKS sampling scheme was implemented in an established rapid T1 measurement method. A semi-automated image-processing scheme employing basic image processing techniques and machine learning was developed to facilitate image analysis. Reliability of the multi-slice technique in measuring renal perfusion and glomerular filtration rate (GFR) was tested in normal mice (n = 7 for both techniques) by comparing to the validated single-slice technique. Utility of this method was demonstrated on mice after either sham surgery (n = 7) or induction of unilateral renal artery stenosis (RAS, n = 8). Renal functional parameters were extracted using a validated bi-compartment model. RESULTS The TRICKS sampling scheme achieved an acceleration factor of 2.7, allowing imaging of eight axial slices at 1.23 s/scan. With the aid of the semi-automated scheme, image analysis required under 15-min for both kidneys per mouse. The multi-slice technique yielded renal perfusion and GFR values comparable to the single-slice technique. Model-fitted renal parameters successfully differentiated control and stenotic mouse kidneys, including renal perfusion (706.5 ± 164.0 vs. 375.9 ± 277.9 mL/100 g/min, P = 0.002), blood flow (1.6 ± 0.4 vs. 0.7 ± 0.7 mL/min, P < 0.001), and GFR (142.9 ± 17.9 vs. 58.0 ± 42.8 μL/min, P < 0.001). CONCLUSION The multi-slice TRICKS-based DCE-MRI technique, with a semi-automated image processing scheme, allows rapid and comprehensive measurement of murine kidney function.
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Affiliation(s)
- Kai Jiang
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | - Hui Tang
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | - Prasanna K Mishra
- Division of Biochemistry and Molecular Biology, Mayo Clinic, Rochester, MN, USA
| | - Slobodan I Macura
- Division of Biochemistry and Molecular Biology, Mayo Clinic, Rochester, MN, USA
| | - Lilach O Lerman
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA.
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Taton B, De La Faille R, Asselineau J, Perez P, Merville P, Colin T, Combe C, Sourbron S, Grenier N. A prospective comparison of dynamic contrast-enhanced MRI and 51Cr-EDTA clearance for glomerular filtration rate measurement in 42 kidney transplant recipients. Eur J Radiol 2019; 117:209-215. [DOI: 10.1016/j.ejrad.2019.02.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 01/28/2019] [Accepted: 02/01/2019] [Indexed: 11/25/2022]
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The Accuracy of Renal Function Measurements in Obstructive Hydronephrosis Using Dynamic Contrast-Enhanced MR Renography. AJR Am J Roentgenol 2019; 213:859-866. [PMID: 31237781 DOI: 10.2214/ajr.19.21224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE. The objective of our study was to assess the accuracy of glomerular filtration rate (GFR) evaluation in patients with obstructive hydronephrosis using dynamic contrast-enhanced MR renography (DCE-MRR). MATERIALS AND METHODS. A group of 28 adult volunteers were enrolled in this study: 13 without hydronephrosis, eight with low-grade hydronephrosis, and seven with high-grade hydronephrosis. The GFR obtained from DCE-MRR (GFRMRR) and the GFR obtained from renal scintigraphy (GFRRS) were compared with the reference GFR (GFRRef) acquired using the two plasma sample method. The correlation and agreement between GFRMRR and GFRRef, GFRRS and GFRRef, and single-kidney GFRMRR (skGFRMRR) and single-kidney GFRRS (skGFRRS) were assessed. The interrater reliability of DCE-MRR and the interrater reliability of renal scintigraphy (RS) were measured. RESULTS. Both GFRMRR and GFRRS correlated well with GFRRef. In patients with hydronephrosis, DCE-MRR and RS overestimated GFR by 12.8 ± 13.9 mL/min (mean ± SD) and 11.5 ± 12.3 mL/min, respectively. The skGFRRS was higher than skGFRMRR by 5.7 ± 3.8 mL/min in high-grade hydronephrotic kidneys (p = 0.004). Good interrater reliability was observed for skGFRMRR (intraclass correlation coefficient [ICC] = 0.82-0.92) and skGFRRS (ICC = 0.79-0.90) for both nonhydronephrotic kidneys and hydronephrotic kidneys. The overall mean SDs of repeated measurements from three investigators were 4.0 and 3.8 mL/min for skGFRMRR and skGFRRS, respectively. CONCLUSION. Both DCE-MRR and RS tend to overestimate GFR in patients with hydronephrosis. RS-derived skGFR is slightly higher than that of DCE-MRR in kidneys with high-grade hydronephrosis. DCE-MRR is comparable to RS and may serve as an alternative noninvasive method for GFR measurement.
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Analytical validation of single-kidney glomerular filtration rate and split renal function as measured with magnetic resonance renography. Magn Reson Imaging 2019; 59:53-60. [PMID: 30849485 DOI: 10.1016/j.mri.2019.03.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 03/01/2019] [Accepted: 03/04/2019] [Indexed: 01/04/2023]
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Mehl JN, Lüpke M, Brenner AC, Dziallas P, Wefstaedt P, Seifert H. Measurement of single kidney glomerular filtration rate in dogs using dynamic contrast-enhanced magnetic resonance imaging and the Rutland-Patlak plot technique. Acta Vet Scand 2018; 60:72. [PMID: 30400988 PMCID: PMC6219261 DOI: 10.1186/s13028-018-0423-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 10/24/2018] [Indexed: 12/14/2022] Open
Abstract
Background Nephropathies are among the most common diseases in dogs. Regular examination of the kidney function plays an important role for an adequate treatment scheme. The determination of the glomerular filtration rate (GFR) is seen as the gold standard in assessing the kidney status. Most of the tests have the disadvantage that only the complete glomerular filtration rate of both kidneys can be assessed and not the single kidney glomerular filtration rate. Imaging examination techniques like dynamic contrast-enhanced magnetic resonance imaging have the potential to evaluate the single kidney GFR. There are studies in human medicine describing the determination of the single kidney GFR using this technique. To our knowledge there are no such studies for dogs. Results An exponential fit was found to describe the functional interrelation between signal intensity and contrast medium concentrations. The changes of contrast medium concentrations during the contrast medium bolus propagation were calculated. The extreme values of contrast medium concentrations in the kidneys were reached at nearly the same time in every individual dog (1st maximum aorta 8.5 s, 1st maximum in both kidneys after about 14.5 s; maximum concentration values varied between 17 and 125 µmol/mL in the aorta and between 4 and 15 µmol/mL in the kidneys). The glomerular filtration rate was calculated from the concentration changes of the contrast medium using a modified Rutland-Patlak plot technique. The GFR was 12.7 ± 2.9 mL/min m2 BS for the left kidney and 12.0 ± 2.2 mL/min/m2 BS for the right kidney. The mean values of the coefficient of determination of the regression lines were averagely 0.91 ± 0.08. Conclusions The propagation of contrast medium bolus could be depicted well. The contrast medium proceeded in a similar manner for every individual dog. Additionally, the evaluation of the single kidney function of the individual dogs is possible with this method. A standardized examination procedure would be recommended in order to minimize influencing parameters. Electronic supplementary material The online version of this article (10.1186/s13028-018-0423-3) contains supplementary material, which is available to authorized users.
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Abstract
Renal transplantation is the therapy of choice for patients with end-stage renal diseases. Improvement of immunosuppressive therapy has significantly increased the half-life of renal allografts over the past decade. Nevertheless, complications can still arise. An early detection of allograft dysfunction is mandatory for a good outcome. New advances in magnetic resonance imaging (MRI) have enabled the noninvasive assessment of different functional renal parameters in addition to anatomic imaging. Most of these techniques were widely tested on renal allografts in past decades and a lot of clinical data are available. The following review summarizes the comprehensive, functional MRI techniques for the noninvasive assessment of renal allograft function and highlights their potential for the investigations of different etiologies of graft dysfunction.
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Jiang K, Tang H, Mishra PK, Macura SI, Lerman LO. Measurement of Murine Single-Kidney Glomerular Filtration Rate Using Dynamic Contrast-Enhanced MRI. Magn Reson Med 2018; 79:2935-2943. [PMID: 29034514 PMCID: PMC5843517 DOI: 10.1002/mrm.26955] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 08/23/2017] [Accepted: 09/11/2017] [Indexed: 01/17/2023]
Abstract
PURPOSE To develop and validate a method for measuring murine single-kidney glomerular filtration rate (GFR) using dynamic contrast-enhanced MRI (DCE-MRI). METHODS This prospective study was approved by the Institutional Animal Care and Use Committee. A fast longitudinal relaxation time (T1 ) measurement method was implemented to capture gadolinium dynamics (1 s/scan), and a modified two-compartment model was developed to quantify GFR as well as renal perfusion using 16.4T MRI in mice 2 weeks after unilateral renal artery stenosis (RAS, n = 6) or sham (n = 8) surgeries. This approach was validated by comparing model-derived GFR and perfusion to those obtained by fluorescein isothiocyanante (FITC)-inulin clearance and arterial spin labeling (ASL), respectively, using the Pearson's and Spearman's rank correlations and Bland-Altman analysis. RESULTS The compartmental model provided a good fitting to measured gadolinium dynamics in both normal and RAS kidneys. The proposed DCE-MRI method offered assessment of single-kidney GFR and perfusion, comparable to the FITC-inulin clearance (Pearson's correlation coefficient r = 0.95 and Spearman's correlation coefficient ρ = 0.94, P < 0.0001, and mean difference -7.0 ± 11.0 μL/min) and ASL (r = 0.92 and ρ = 0.84, P < 0.0001, and mean difference 4.4 ± 66.1 mL/100 g/min) methods. CONCLUSION The proposed DCE-MRI method may be useful for reliable noninvasive measurements of single-kidney GFR and perfusion in mice. Magn Reson Med 79:2935-2943, 2018. © 2017 International Society for Magnetic Resonance in Medicine.
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Affiliation(s)
- Kai Jiang
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
| | - Hui Tang
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
| | - Prasanna K. Mishra
- Biochemistry and Molecular Biology, Mayo Clinic, Rochester, Minnesota, USA
| | - Slobodan I. Macura
- Biochemistry and Molecular Biology, Mayo Clinic, Rochester, Minnesota, USA
| | - Lilach O. Lerman
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
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Bane O, Hectors S, Wagner M, Arlinghaus LL, Aryal M, Cao Y, Chenevert T, Fennessy F, Huang W, Hylton N, Kalpathy-Cramer J, Keenan K, Malyarenko D, Mulkern R, Newitt D, Russek SE, Stupic KF, Tudorica A, Wilmes L, Yankeelov TE, Yen YF, Boss M, Taouli B. Accuracy, repeatability, and interplatform reproducibility of T 1 quantification methods used for DCE-MRI: Results from a multicenter phantom study. Magn Reson Med 2018; 79:2564-2575. [PMID: 28913930 PMCID: PMC5821553 DOI: 10.1002/mrm.26903] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Revised: 08/14/2017] [Accepted: 08/16/2017] [Indexed: 02/05/2023]
Abstract
PURPOSE To determine the in vitro accuracy, test-retest repeatability, and interplatform reproducibility of T1 quantification protocols used for dynamic contrast-enhanced MRI at 1.5 and 3 T. METHODS A T1 phantom with 14 samples was imaged at eight centers with a common inversion-recovery spin-echo (IR-SE) protocol and a variable flip angle (VFA) protocol using seven flip angles, as well as site-specific protocols (VFA with different flip angles, variable repetition time, proton density, and Look-Locker inversion recovery). Factors influencing the accuracy (deviation from reference NMR T1 measurements) and repeatability were assessed using general linear mixed models. Interplatform reproducibility was assessed using coefficients of variation. RESULTS For the common IR-SE protocol, accuracy (median error across platforms = 1.4-5.5%) was influenced predominantly by T1 sample (P < 10-6 ), whereas test-retest repeatability (median error = 0.2-8.3%) was influenced by the scanner (P < 10-6 ). For the common VFA protocol, accuracy (median error = 5.7-32.2%) was influenced by field strength (P = 0.006), whereas repeatability (median error = 0.7-25.8%) was influenced by the scanner (P < 0.0001). Interplatform reproducibility with the common VFA was lower at 3 T than 1.5 T (P = 0.004), and lower than that of the common IR-SE protocol (coefficient of variation 1.5T: VFA/IR-SE = 11.13%/8.21%, P = 0.028; 3 T: VFA/IR-SE = 22.87%/5.46%, P = 0.001). Among the site-specific protocols, Look-Locker inversion recovery and VFA (2-3 flip angles) protocols showed the best accuracy and repeatability (errors < 15%). CONCLUSIONS The VFA protocols with 2 to 3 flip angles optimized for different applications achieved acceptable balance of extensive spatial coverage, accuracy, and repeatability in T1 quantification (errors < 15%). Further optimization in terms of flip-angle choice for each tissue application, and the use of B1 correction, are needed to improve the robustness of VFA protocols for T1 mapping. Magn Reson Med 79:2564-2575, 2018. © 2017 International Society for Magnetic Resonance in Medicine.
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Affiliation(s)
- Octavia Bane
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai,Radiology, Icahn School of Medicine at Mount Sinai
| | - Stefanie Hectors
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai,Radiology, Icahn School of Medicine at Mount Sinai
| | - Mathilde Wagner
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai,Radiology, Icahn School of Medicine at Mount Sinai
| | | | | | - Yue Cao
- Radiation Oncology, University of Michigan
| | | | | | - Wei Huang
- Advanced Imaging Research Center, Knight Cancer Institute, Oregon Health and Science University
| | - Nola Hylton
- Radiology, University of California San Francisco
| | | | | | | | | | - David Newitt
- Radiology, University of California San Francisco
| | | | | | | | - Lisa Wilmes
- Radiology, University of California San Francisco
| | | | - Yi-Fei Yen
- Radiology, Massachusetts General Hospital
| | | | - Bachir Taouli
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai,Radiology, Icahn School of Medicine at Mount Sinai
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Renal Cell Carcinoma Perfusion before and after Radiofrequency Ablation Measured with Dynamic Contrast Enhanced MRI: A Pilot Study. Diagnostics (Basel) 2018; 8:diagnostics8010003. [PMID: 29316711 PMCID: PMC5871986 DOI: 10.3390/diagnostics8010003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 12/28/2017] [Accepted: 01/02/2018] [Indexed: 01/31/2023] Open
Abstract
Aim: To investigate if the early treatment effects of radiofrequency ablation (RFA) on renal cell carcinoma (RCC) can be detected with dynamic contrast enhanced (DCE)-MRI and to correlate RCC perfusion with RFA treatment time. Materials and methods: 20 patients undergoing RFA of their 21 RCCs were evaluated with DCE-MRI before and at one month after RFA treatment. Perfusion was estimated using the maximum slope technique at two independent sittings. Total RCC blood flow was correlated with total RFA treatment time, tumour location, size and histology. Results: DCE-MRI examinations were successfully evaluated for 21 RCCs (size from 1.3 to 4 cm). Perfusion of the RCCs decreased significantly (p < 0.0001) from a mean of 203 (±80) mL/min/100 mL before RFA to 8.1 (±3.1) mL/min/100 mL after RFA with low intra-observer variability (r ≥ 0.99, p < 0.0001). There was an excellent correlation (r = 0.95) between time to complete ablation and pre-treatment total RCC blood flow. Tumours with an exophytic location exhibit the lowest mean RFA treatment time. Conclusion: DCE-MRI can detect early treatment effects by measuring RCC perfusion before and after RFA. Perfusion significantly decreases in the zone of ablation, suggesting that it may be useful for the assessment of treatment efficacy. Pre-RFA RCC blood flow may be used to predict RFA treatment time.
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de Boer A, Leiner T, Vink EE, Blankestijn PJ, van den Berg CAT. Modified dixon-based renal dynamic contrast-enhanced MRI facilitates automated registration and perfusion analysis. Magn Reson Med 2017; 80:66-76. [PMID: 29134673 PMCID: PMC5900902 DOI: 10.1002/mrm.26999] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 10/17/2017] [Accepted: 10/18/2017] [Indexed: 12/24/2022]
Abstract
Purpose Renal dynamic contrast‐enhanced (DCE) MRI provides information on renal perfusion and filtration. However, clinical implementation is hampered by challenges in postprocessing as a result of misalignment of the kidneys due to respiration. We propose to perform automated image registration using the fat‐only images derived from a modified Dixon reconstruction of a dual‐echo acquisition because these provide consistent contrast over the dynamic series. Methods DCE data of 10 hypertensive patients was used. Dual‐echo images were acquired at 1.5 T with temporal resolution of 3.9 s during contrast agent injection. Dixon fat, water, and in‐phase and opposed‐phase (OP) images were reconstructed. Postprocessing was automated. Registration was performed both to fat images and OP images for comparison. Perfusion and filtration values were extracted from a two‐compartment model fit. Results Automatic registration to fat images performed better than automatic registration to OP images with visible contrast enhancement. Median vertical misalignment of the kidneys was 14 mm prior to registration, compared to 3 mm and 5 mm with registration to fat images and OP images, respectively (P = 0.03). Mean perfusion values and MR‐based glomerular filtration rates (GFR) were 233 ± 64 mL/100 mL/min and 60 ± 36 mL/minute, respectively, based on fat‐registered images. MR‐based GFR correlated with creatinine‐based GFR (P = 0.04) for fat‐registered images. For unregistered and OP‐registered images, this correlation was not significant. Conclusion Absence of contrast changes on Dixon fat images improves registration in renal DCE MRI and enables automated postprocessing, resulting in a more accurate estimation of GFR. Magn Reson Med 80:66–76, 2018. © 2017 The Authors Magnetic Resonance in Medicine published by Wiley Periodicals, Inc. on behalf of International Society for Magnetic Resonance in Medicine. This is an open access article under the terms of the Creative Commons Attribution NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
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Affiliation(s)
- Anneloes de Boer
- Utrecht University Medical Center, Utrecht University, Utrecht, The Netherlands
| | - Tim Leiner
- Utrecht University Medical Center, Utrecht University, Utrecht, The Netherlands
| | - Eva E Vink
- Utrecht University Medical Center, Utrecht University, Utrecht, The Netherlands
| | - Peter J Blankestijn
- Utrecht University Medical Center, Utrecht University, Utrecht, The Netherlands
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Eikefjord E, Andersen E, Hodneland E, Hanson EA, Sourbron S, Svarstad E, Lundervold A, Rørvik JT. Dynamic contrast-enhanced MRI measurement of renal function in healthy participants. Acta Radiol 2017; 58:748-757. [PMID: 27694276 DOI: 10.1177/0284185116666417] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background High repeatability, accuracy, and precision for renal function measurements need to be achieved to establish renal dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) as a clinically useful diagnostic tool. Purpose To investigate the repeatability, accuracy, and precision of DCE-MRI measured renal perfusion and glomerular filtration rate (GFR) using iohexol-GFR as the reference method. Material and Methods Twenty healthy non-smoking volunteers underwent repeated DCE-MRI and an iohexol-GFR within a period of 10 days. Single-kidney (SK) MRI measurements of perfusion (blood flow, Fb) and filtration (GFR) were derived from parenchymal intensity time curves fitted to a two-compartment filtration model. The repeatability of the SK-MRI measurements was assessed using coefficient of variation (CV). Using iohexol-GFR as reference method, the accuracy of total MR-GFR was determined by mean difference (MD) and precision by limits of agreement (LoA). Results SK-Fb (MR1, 345 ± 84; MR2, 371 ± 103 mL/100 mL/min) and SK-GFR (MR1, 52 ± 14; MR2, 54 ± 10 mL/min/1.73 m2) measurements achieved a repeatability (CV) in the range of 15-22%. With reference to iohexol-GFR, MR-GFR was determined with a low mean difference but high LoA (MR1, MD 1.5 mL/min/1.73 m2, LoA [-42, 45]; MR2, MD 6.1 mL/min/1.73 m2, LoA [-26, 38]). Eighty percent and 90% of MR-GFR measurements were determined within ± 30% of the iohexol-GFR for MR1 and MR2, respectively. Conclusion Good repeatability of SK-MRI measurements and good agreement between MR-GFR and iohexol-GFR provide a high clinical potential of DCE-MRI for renal function assessment. A moderate precision in MR-derived estimates indicates that the method cannot yet be used in clinical routine.
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Affiliation(s)
- Eli Eikefjord
- Department of Radiology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Erling Andersen
- Department of Radiology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Engineering, Haukeland University Hospital, Bergen, Norway
| | - Erlend Hodneland
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Christian Michelsen Research (CMR) AS, Bergen, Norway
| | - Erik A Hanson
- Department of Mathematics, University of Bergen, Bergen, Norway
| | - Steven Sourbron
- Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Einar Svarstad
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Arvid Lundervold
- Department of Radiology, Haukeland University Hospital, Bergen, Norway
- Department of Biomedicine, University of Bergen, Bergen, Norway
| | - Jarle T Rørvik
- Department of Radiology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
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Zhang JL. Functional Magnetic Resonance Imaging of the Kidneys-With and Without Gadolinium-Based Contrast. Adv Chronic Kidney Dis 2017; 24:162-168. [PMID: 28501079 DOI: 10.1053/j.ackd.2017.03.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Assessment of renal function with magnetic resonance imaging (MRI) has been actively explored in the past decade. In this review, we introduce the principle of MRI and review recent progress of MRI methods (contrast enhanced and noncontrast) in assessing renal function. Contrast-enhanced MRI using ultra-low dose of gadolinium-based agent has been validated for measuring single-kidney glomerular filtration rate and renal plasma flow accurately. For routine functional test, contrast-enhanced MRI may not replace the simple serum-creatinine method. However, for patients with renal diseases, it is often worthy to perform MRI to accurately monitor renal function, particularly for the diseased kidney. As contrast-enhanced MRI is already an established clinical tool for characterizing renal structural abnormalities, including renal mass and ureteral obstruction, it is possible to adapt the clinical MRI protocol to measure single-kidney glomerular filtration rate and renal plasma flow, as demonstrated by recent studies. What makes MRI unique is the promise of its noncontrast methods. These methods include arterial spin labeling for tissue perfusion, blood oxygen-level dependent for blood and tissue oxygenation, and diffusion-weighted imaging for water diffusion. For each method, we reviewed recent findings and summarized challenges.
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Zhang YD, Xue CQ, Wu CJ, Tao J, Zhou WL, Shi HB. Feasibility of triphasic CT with a modified two-point Patlak plot to determine spit kidney glomerular filtration rate in clinical practice. Abdom Radiol (NY) 2017; 42:226-235. [PMID: 27503300 DOI: 10.1007/s00261-016-0858-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
PURPOSE To investigate whether triphasic CT with a simplified Patlak plot can be used in clinical practice for the estimate of split kidney glomerular filtration rate (SKGFR). MATERIALS AND METHODS The animal experiment included 15 rabbits that underwent 40 dynamic contrast-enhanced CT scans of the kidneys with 1.5 s time interval. Patlak-derived SKGFR was obtained using standard forty-point, two-point (unenhanced phase, arterial phase t α, and portovenous phase t β), and a modified two-point (MTP) (unenhanced, t α, t β, and a virtual t τ [t τ = (t α + t β)/2]) image data, respectively. The MTP-Patlak plot approach was then validated in 13 patients who underwent a triphasic renal contrast-enhanced CT examination. SKGFR measured by 99mTc-DTPA clearance was as a standard reference. RESULTS MTP-Patlak significantly reduced input function errors than two-point Patlak (21.1 ± 16.2 % vs 30.8 ± 15.2 %, p < 0.01) and showed good concordance with standard Patlak for measurement of SKGFR in animal experiment (1.20 ± 0.38 mL/g/min vs 1.51 ± 0.43 mL/g/min; linear correlation coefficient r = 0.87, p < 0.001). Human study showed that mean SKGFR was 45.7 mL/min (range, 26.5-86.2 mL/min) obtained from 99mTc-DTPA, and 38.2 mL/min (range, 18.6-79.3 mL/min) obtained from triphasic CT using MTP-Patlak plot. Linear correlation between the two methods was r = 0.75 (p < 0.01). The mean difference between SKGFRs as determined with the two methods was 7.4 ± 9.0 mL/min. CONCLUSION The MTP-Patlak approach, featured with simplicity, is feasible in a clinically indicated CT examination for the evaluation of split renal function.
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Affiliation(s)
- Yu-Dong Zhang
- Department of Radiology, The First Affiliated Hospital with Nanjing Medical University, 300, Guangzhou Road, Nanjing, 210009, Jiangsu Province, China.
| | - Chen-Qi Xue
- Department of Nuclear Medicine, The First Affiliated Hospital with Nanjing Medical University, Nanjing, 210009, China
| | - Chen-Jiang Wu
- Department of Radiology, The First Affiliated Hospital with Nanjing Medical University, 300, Guangzhou Road, Nanjing, 210009, Jiangsu Province, China
| | - Jun Tao
- Department of Urology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, 210009, China
| | - Wan-Li Zhou
- Department of Urology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, 210009, China
| | - Hai-Bin Shi
- Department of Radiology, The First Affiliated Hospital with Nanjing Medical University, 300, Guangzhou Road, Nanjing, 210009, Jiangsu Province, China
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Li H, Bao N, Xu X, Zhang Y, Jin S, Jin Y, Sun H. A renal vascular compartment segmentation method based on dynamic contrast-enhanced images. Technol Health Care 2016; 24 Suppl 2:S631-9. [DOI: 10.3233/thc-161190] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Hong Li
- Sino-Dutch Biomedical and Information Engineering School, Northeastern University, Shenyang, Liaoning, China
| | - Nan Bao
- Sino-Dutch Biomedical and Information Engineering School, Northeastern University, Shenyang, Liaoning, China
| | - Xieping Xu
- Sino-Dutch Biomedical and Information Engineering School, Northeastern University, Shenyang, Liaoning, China
| | - Yaonan Zhang
- Sino-Dutch Biomedical and Information Engineering School, Northeastern University, Shenyang, Liaoning, China
| | - Shikai Jin
- Sino-Dutch Biomedical and Information Engineering School, Northeastern University, Shenyang, Liaoning, China
| | - Yueming Jin
- Sino-Dutch Biomedical and Information Engineering School, Northeastern University, Shenyang, Liaoning, China
| | - Haoran Sun
- Department of Radiology, Tianjin Medical University General Hospital, Tianjin, China
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Tipirneni-Sajja A, Loeffler RB, Oesingmann N, Bissler J, Song R, McCarville B, Jones DP, Hudson M, Spunt SL, Hillenbrand CM. Measurement of glomerular filtration rate by dynamic contrast-enhanced magnetic resonance imaging using a subject-specific two-compartment model. Physiol Rep 2016; 4:4/7/e12755. [PMID: 27081161 PMCID: PMC4831325 DOI: 10.14814/phy2.12755] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 03/12/2016] [Indexed: 12/13/2022] Open
Abstract
Measuring glomerular filtration rate (GFR) by dynamic contrast‐enhanced (DCE) magnetic resonance imaging (MRI) as part of standard of care clinical MRI exams (e.g., in pediatric solid tumor patients) has the potential to reduce diagnostic burden. However, enthusiasm for this relatively new GFR test may be curbed by the limited amount of cross‐calibration studies with reference GFR techniques and the vast variety of MR tracer model algorithms causing confusion on the choice of model. To advance MRI‐based GFR quantification via improved GFR modeling and comparison with associated 99mTc‐DTPA‐GFR, 29 long‐term Wilms' tumor survivors (19.0–43.3 years, [median 32.0 ± 6.0 years]) treated with nephrectomy, nonnephrotoxic chemotherapy ± radiotherapy underwent MRI with Gd‐DTPA administration and a 99mTc‐DTPA GFR test. For DCE‐MRI‐based GFR estimation, a subject‐specific two‐compartment (SS‐2C) model was developed that uses individual hematocrit values, automatically defines subject‐specific uptake intervals, and fits tracer‐uptake curves by incorporating these measures. The association between reference 99mTc‐DTPA GFR and MR‐GFRs obtained by SS‐2C, three published 2C uptake, and inflow–outflow models was investigated via linear regression analysis. Uptake intervals varied from 64 sec to 141 sec [96 sec ± 21 sec] and hematocrit values ranged from 30% to 49% [41% ± 4%]; these parameters can therefore not be assumed as constants in 2C modeling. Our MR‐GFR estimates using the SS‐2C model showed accordingly the highest correlation with 99mTc‐DTPA‐GFRs (R2 = 0.76, P < 0.001) compared with other models (R2‐range: 0.36–0.66). In conclusion, SS‐2C modeling of DCE‐MRI data improved the association between GFR obtained by 99mTc‐DTPA and Gd‐DTPA DCE‐MRI to such a degree that this approach could turn into a viable, diagnostic GFR assay without radiation exposure to the patient.
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Affiliation(s)
- Aaryani Tipirneni-Sajja
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, Tennessee Department of Biomedical Engineering, University of Memphis, Memphis, Tennessee
| | - Ralf B Loeffler
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, Tennessee
| | | | - John Bissler
- Division of Nephrology, St. Jude Children's Research Hospital, Memphis, Tennessee Department of Pediatric Nephrology, Le Bonheur Children's Hospital, Memphis, Tennessee
| | - Ruitian Song
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Beth McCarville
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Deborah P Jones
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Melissa Hudson
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Sheri L Spunt
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Claudia M Hillenbrand
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, Tennessee
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Conlin CC, Zhang JL, Rousset F, Vachet C, Zhao Y, Morton KA, Carlston K, Gerig G, Lee VS. Performance of an efficient image-registration algorithm in processing MR renography data. J Magn Reson Imaging 2016; 43:391-7. [PMID: 26174884 PMCID: PMC4713380 DOI: 10.1002/jmri.25000] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 06/24/2015] [Indexed: 11/10/2022] Open
Abstract
PURPOSE To evaluate the performance of an edge-based registration technique in correcting for respiratory motion artifacts in magnetic resonance renographic (MRR) data and to examine the efficiency of a semiautomatic software package in processing renographic data from a cohort of clinical patients. MATERIALS AND METHODS The developed software incorporates an image-registration algorithm based on the generalized Hough transform of edge maps. It was used to estimate glomerular filtration rate (GFR), renal plasma flow (RPF), and mean transit time (MTT) from 36 patients who underwent free-breathing MRR at 3T using saturation-recovery turbo-FLASH. The processing time required for each patient was recorded. Renal parameter estimates and model-fitting residues from the software were compared to those from a previously reported technique. Interreader variability in the software was quantified by the standard deviation of parameter estimates among three readers. GFR estimates from our software were also compared to a reference standard from nuclear medicine. RESULTS The time taken to process one patient's data with the software averaged 12 ± 4 minutes. The applied image registration effectively reduced motion artifacts in dynamic images by providing renal tracer-retention curves with significantly smaller fitting residues (P < 0.01) than unregistered data or data registered by the previously reported technique. Interreader variability was less than 10% for all parameters. GFR estimates from the proposed method showed greater concordance with reference values (P < 0.05). CONCLUSION These results suggest that the proposed software can process MRR data efficiently and accurately. Its incorporated registration technique based on the generalized Hough transform effectively reduces respiratory motion artifacts in free-breathing renographic acquisitions.
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Affiliation(s)
- Christopher C Conlin
- Department of Radiology, University of Utah, Salt Lake City, Utah, USA
- Department of Bioengineering, University of Utah, Salt Lake City, Utah, USA
| | - Jeff L Zhang
- Department of Radiology, University of Utah, Salt Lake City, Utah, USA
- Department of Bioengineering, University of Utah, Salt Lake City, Utah, USA
| | - Florian Rousset
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, Utah, USA
- CPE Lyon, Lyon, France
| | - Clement Vachet
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, Utah, USA
| | - Yangyang Zhao
- Department of Bioengineering, University of Utah, Salt Lake City, Utah, USA
| | - Kathryn A Morton
- Department of Radiology, University of Utah, Salt Lake City, Utah, USA
| | - Kristi Carlston
- Department of Radiology, University of Utah, Salt Lake City, Utah, USA
| | - Guido Gerig
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, Utah, USA
| | - Vivian S Lee
- Department of Radiology, University of Utah, Salt Lake City, Utah, USA
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Zöllner FG, Daab M, Sourbron SP, Schad LR, Schoenberg SO, Weisser G. An open source software for analysis of dynamic contrast enhanced magnetic resonance images: UMMPerfusion revisited. BMC Med Imaging 2016; 16:7. [PMID: 26767969 PMCID: PMC4712457 DOI: 10.1186/s12880-016-0109-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 01/06/2016] [Indexed: 12/11/2022] Open
Abstract
Background Perfusion imaging has become an important image based tool to derive the physiological information in various applications, like tumor diagnostics and therapy, stroke, (cardio-) vascular diseases, or functional assessment of organs. However, even after 20 years of intense research in this field, perfusion imaging still remains a research tool without a broad clinical usage. One problem is the lack of standardization in technical aspects which have to be considered for successful quantitative evaluation; the second problem is a lack of tools that allow a direct integration into the diagnostic workflow in radiology. Results Five compartment models, namely, a one compartment model (1CP), a two compartment exchange (2CXM), a two compartment uptake model (2CUM), a two compartment filtration model (2FM) and eventually the extended Toft’s model (ETM) were implemented as plugin for the DICOM workstation OsiriX. Moreover, the plugin has a clean graphical user interface and provides means for quality management during the perfusion data analysis. Based on reference test data, the implementation was validated against a reference implementation. No differences were found in the calculated parameters. Conclusion We developed open source software to analyse DCE-MRI perfusion data. The software is designed as plugin for the DICOM Workstation OsiriX. It features a clean GUI and provides a simple workflow for data analysis while it could also be seen as a toolbox providing an implementation of several recent compartment models to be applied in research tasks. Integration into the infrastructure of a radiology department is given via OsiriX. Results can be saved automatically and reports generated automatically during data analysis ensure certain quality control.
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Affiliation(s)
- Frank G Zöllner
- Computer Assisted Clinical Medicine, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
| | - Markus Daab
- Computer Assisted Clinical Medicine, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
| | | | - Lothar R Schad
- Computer Assisted Clinical Medicine, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
| | - Stefan O Schoenberg
- Department of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany.
| | - Gerald Weisser
- Department of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany.
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Lanzman RS, Notohamiprodjo M, Wittsack HJ. [Functional magnetic resonance imaging of the kidneys]. Radiologe 2015; 55:1077-87. [PMID: 26628260 DOI: 10.1007/s00117-015-0044-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Interest in functional renal magnetic resonance imaging (MRI) has significantly increased in recent years. This review article provides an overview of the most important functional imaging techniques and their potential clinical applications for assessment of native and transplanted kidneys, with special emphasis on the clarification of renal tumors.
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Khalifa F, Soliman A, El-Baz A, Abou El-Ghar M, El-Diasty T, Gimel'farb G, Ouseph R, Dwyer AC. Models and methods for analyzing DCE-MRI: a review. Med Phys 2015; 41:124301. [PMID: 25471985 DOI: 10.1118/1.4898202] [Citation(s) in RCA: 197] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To present a review of most commonly used techniques to analyze dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI), discusses their strengths and weaknesses, and outlines recent clinical applications of findings from these approaches. METHODS DCE-MRI allows for noninvasive quantitative analysis of contrast agent (CA) transient in soft tissues. Thus, it is an important and well-established tool to reveal microvasculature and perfusion in various clinical applications. In the last three decades, a host of nonparametric and parametric models and methods have been developed in order to quantify the CA's perfusion into tissue and estimate perfusion-related parameters (indexes) from signal- or concentration-time curves. These indexes are widely used in various clinical applications for the detection, characterization, and therapy monitoring of different diseases. RESULTS Promising theoretical findings and experimental results for the reviewed models and techniques in a variety of clinical applications suggest that DCE-MRI is a clinically relevant imaging modality, which can be used for early diagnosis of different diseases, such as breast and prostate cancer, renal rejection, and liver tumors. CONCLUSIONS Both nonparametric and parametric approaches for DCE-MRI analysis possess the ability to quantify tissue perfusion.
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Affiliation(s)
- Fahmi Khalifa
- BioImaging Laboratory, Department of Bioengineering, University of Louisville, Louisville, Kentucky 40292 and Electronics and Communication Engineering Department, Mansoura University, Mansoura 35516, Egypt
| | - Ahmed Soliman
- BioImaging Laboratory, Department of Bioengineering, University of Louisville, Louisville, Kentucky 40292
| | - Ayman El-Baz
- BioImaging Laboratory, Department of Bioengineering, University of Louisville, Louisville, Kentucky 40292
| | - Mohamed Abou El-Ghar
- Radiology Department, Urology and Nephrology Center, Mansoura University, Mansoura 35516, Egypt
| | - Tarek El-Diasty
- Radiology Department, Urology and Nephrology Center, Mansoura University, Mansoura 35516, Egypt
| | - Georgy Gimel'farb
- Department of Computer Science, University of Auckland, Auckland 1142, New Zealand
| | - Rosemary Ouseph
- Kidney Transplantation-Kidney Disease Center, University of Louisville, Louisville, Kentucky 40202
| | - Amy C Dwyer
- Kidney Transplantation-Kidney Disease Center, University of Louisville, Louisville, Kentucky 40202
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Odudu A, Vassallo D, Kalra PA. From anatomy to function: diagnosis of atherosclerotic renal artery stenosis. Expert Rev Cardiovasc Ther 2015; 13:1357-75. [DOI: 10.1586/14779072.2015.1100077] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Xie L, Layton AT, Wang N, Larson PEZ, Zhang JL, Lee VS, Liu C, Johnson GA. Dynamic contrast-enhanced quantitative susceptibility mapping with ultrashort echo time MRI for evaluating renal function. Am J Physiol Renal Physiol 2015; 310:F174-82. [PMID: 26447222 DOI: 10.1152/ajprenal.00351.2015] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 10/06/2015] [Indexed: 12/30/2022] Open
Abstract
Dynamic contrast-enhanced (DCE) MRI can provide key insight into renal function. DCE MRI is typically achieved through an injection of a gadolinium (Gd)-based contrast agent, which has desirable T1 quenching and tracer kinetics. However, significant T2* blooming effects and signal voids can arise when Gd becomes very concentrated, especially in the renal medulla and pelvis. One MRI sequence designed to alleviate T2* effects is the ultrashort echo time (UTE) sequence. In the present study, we observed T2* blooming in the inner medulla of the mouse kidney, despite using UTE at an echo time of 20 microseconds and a low dose of 0.03 mmol/kg Gd. We applied quantitative susceptibility mapping (QSM) and resolved the signal void into a positive susceptibility signal. The susceptibility values [in parts per million (ppm)] were converted into molar concentrations of Gd using a calibration curve. We determined the concentrating mechanism (referred to as the concentrating index) as a ratio of maximum Gd concentration in the inner medulla to the renal artery. The concentrating index was assessed longitudinally over a 17-wk course (3, 5, 7, 9, 13, 17 wk of age). We conclude that the UTE-based DCE method is limited in resolving extreme T2* content caused by the kidney's strong concentrating mechanism. QSM was able to resolve and confirm the source of the blooming effect to be the large positive susceptibility of concentrated Gd. UTE with QSM can complement traditional magnitude UTE and offer a powerful tool to study renal pathophysiology.
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Affiliation(s)
- Luke Xie
- Center for In Vivo Microscopy, Department of Radiology, Duke University Medical Center, Durham, North Carolina; Utah Center for Advanced Imaging Research, Department of Radiology, University of Utah, Salt Lake City, Utah
| | - Anita T Layton
- Department of Mathematics, Duke University, Durham, North Carolina
| | - Nian Wang
- Brain Imaging and Analysis Center, Duke University Medical Center, Durham, North Carolina
| | - Peder E Z Larson
- Department of Radiology and Biomedical Engineering, University of California, San Francisco, California; and
| | - Jeff L Zhang
- Utah Center for Advanced Imaging Research, Department of Radiology, University of Utah, Salt Lake City, Utah
| | - Vivian S Lee
- Utah Center for Advanced Imaging Research, Department of Radiology, University of Utah, Salt Lake City, Utah
| | - Chunlei Liu
- Center for In Vivo Microscopy, Department of Radiology, Duke University Medical Center, Durham, North Carolina; Brain Imaging and Analysis Center, Duke University Medical Center, Durham, North Carolina
| | - G Allan Johnson
- Center for In Vivo Microscopy, Department of Radiology, Duke University Medical Center, Durham, North Carolina
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Beeman SC, Osei-Owusu P, Duan C, Engelbach J, Bretthorst GL, Ackerman JJH, Blumer KJ, Garbow JR. Renal DCE-MRI Model Selection Using Bayesian Probability Theory. ACTA ACUST UNITED AC 2015; 1:61-68. [PMID: 30042955 PMCID: PMC6024409 DOI: 10.18383/j.tom.2015.00133] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The goal of this work was to demonstrate the utility of Bayesian probability theory-based model selection for choosing the optimal mathematical model from among 4 competing models of renal dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) data. DCE-MRI data were collected on 21 mice with high (n = 7), low (n = 7), or normal (n = 7) renal blood flow (RBF). Model parameters and posterior probabilities of 4 renal DCE-MRI models were estimated using Bayesian-based methods. Models investigated included (1) an empirical model that contained a monoexponential decay (washout) term and a constant offset, (2) an empirical model with a biexponential decay term (empirical/biexponential model), (3) the Patlak–Rutland model, and (4) the 2-compartment kidney model. Joint Bayesian model selection/parameter estimation demonstrated that the empirical/biexponential model was strongly favored for all 3 cohorts, the modeled DCE signals that characterized each of the 3 cohorts were distinctly different, and individual empirical/biexponential model parameter values clearly distinguished cohorts of low and high RBF from one another. The Bayesian methods can be readily extended to a variety of model analyses, making it a versatile and valuable tool for model selection and parameter estimation.
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Affiliation(s)
| | | | | | | | | | - Joseph J H Ackerman
- Departments of Radiology.,Chemistry, and.,Medicine, Washington University, St. Louis, MO
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Dynamic contrast-enhanced magnetic resonance imaging assessment of kidney function and renal masses: single slice versus whole organ/tumor. Invest Radiol 2015; 49:720-7. [PMID: 24901546 DOI: 10.1097/rli.0000000000000075] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVES The aim of this study was to compare single-slice and 3-dimensional (3D) analysis for magnetic resonance renography (plasma flow [FP], plasma volume [VP], and glomerular filtration rate [GFR]) and for dynamic contrast-enhanced magnetic resonance imaging (MRI) of renal tumors (FP, VP, permeability-surface area product), respectively. MATERIAL AND METHODS We prospectively included 22 patients (43 kidneys with 22 suspicious renal lesions) and performed preoperative and postoperative imaging before and after partial nephrectomy, respectively. Of the 22 renal lesions, 15 turned out to be renal cell carcinoma and were included in the tumor analysis, altogether leading to 86 renal and 15 tumor MRI scans, respectively. Dynamic contrast-enhanced MRI was performed with a time-resolved angiography with stochastic trajectories sequence (spatial resolution, 2.6 × 2.6 × 2.6 mm3; temporal resolution, 2.5 seconds) at 3 T (Magnetom Verio; Siemens Healthcare Sector) after injection of 0.05 mmol/kg body weight Gadobutrol (Bayer Healthcare Pharmaceuticals). Analysis was performed using regions of interest encompassing a single central slice and the whole kidney/tumor, respectively. A 2-compartment model yielding FP, VP, GFR, or tumor permeability-surface area product was used for kinetic modelling. Modelling was performed based on relative contrast enhancement to account for coil-related inhomogeneity. Significance in difference, agreement, and goodness of fit of the data to the curve was assessed with paired t tests, Bland-Altman plots, and χ2 test, respectively. RESULTS Bland-Altman analysis revealed a good agreement between both types of measurement for kidneys and tumors, respectively. Results between single-slice and whole-kidney regions of interest showed significant differences for Fp (single slice, 256.1 ± 104.1 mL/100 mL/min; whole kidney, 217.2 ± 92.5 mL/100 mL/min; P < 0.01). Regarding VP and GFR, no significant differences were observed. The χ2 test showed a significantly better goodness of fit of the data to the curve for whole kidneys (0.30% ± 0.18%) than for single slices (0.43% ± 0.26%) (P < 0.01). In contrast to renal assessment, tumor analysis showed no significant differences regarding functional parameters and χ test, respectively. CONCLUSION In dynamic contrast-enhanced MRI of the kidney, both 3D whole-organ/tumor and single-slice analyses provide roughly comparable values in functional analysis. However, 3D assessment is considerably more precise and should be preferred if available.
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Liu W, Sung K, Ruan D. Shape-based motion correction in dynamic contrast-enhanced MRI for quantitative assessment of renal function. Med Phys 2014; 41:122302. [PMID: 25471978 PMCID: PMC4240783 DOI: 10.1118/1.4900600] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE To incorporate a newly developed shape-based motion estimation scheme into magnetic resonance urography (MRU) and verify its efficacy in facilitating quantitative functional analysis. METHODS The authors propose a motion compensation scheme in MRU that consists of three sequential modules: MRU image acquisition, motion compensation, and quantitative functional analysis. They designed two sets of complementary experiments to evaluate the performance of the proposed method. In the first experiment, dynamic contrast enhanced (DCE) MR images were acquired from three sedated subjects, from which clinically valid estimates were derived and served as the "ground truth." Physiologically sound motion was then simulated to synthesize image sequences influenced by respiratory motion. Quantitative assessment and comparison were performed on functional estimates of Patlak number, glomerular filtration rate, and Patlak differential renal function without and with motion compensation against the ground truth. In the second experiment, the authors acquired a temporal series of noncontrast MR images under free breathing from a healthy adult subject. The performance of the proposed method on compensating real motion was evaluated by comparing the standard deviation of the obtained temporal intensity curves before and after motion compensation. RESULTS On DCE-MR images with simulated motion, the generated relative enhancement curves exhibited large perturbations and the Patlak numbers of the left and right kidney were significantly underestimated up to 35% and 34%, respectively, compared with the ground truth. After motion compensation, the relative enhancement curves exhibited much less perturbations and Patlak estimation errors reduced within 3% and 4% for the left and right kidneys, respectively. On clinical free-breathing MR images, the temporal intensity curves exhibited significantly reduced variations after motion compensation, with standard deviation decreased from 30.3 and 38.2 to 8.3 and 11.7 within two manually selected regions of interest, respectively. CONCLUSIONS The developed motion compensation method has demonstrated its ability to facilitate quantitative MRU functional analysis, with improved accuracy of pharmacokinetic modeling and quantitative parameter estimations. Future work will consider performing more intensive clinical verifications with sophisticated pharmacokinetic models and generalizing the proposed method to other quantitative DCE analysis, such as on liver or prostate function.
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Affiliation(s)
- Wenyang Liu
- Department of Bioengineering, University of California, Los Angeles 90095
| | - Kyunghyun Sung
- Department of Bioengineering, University of California, Los Angeles 90095 and Department of Radiological Sciences, University of California, Los Angeles 90095
| | - Dan Ruan
- Department of Bioengineering, University of California, Los Angeles 90095 and Department of Radiation Oncology, University of California, Los Angeles 90095
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Durand E. Comparison of magnetic resonance imaging with radionuclide methods of evaluating the kidney. Semin Nucl Med 2014; 44:82-92. [PMID: 24484746 DOI: 10.1053/j.semnuclmed.2013.10.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Nuclear medicine and MRI provide information about renal perfusion, function (glomerular filtration rate), and drainage. Some tracers that are used in nuclear medicine (technetium-diethylene triamine pentaacetic acid ([(99m)Tc-DTPA] and (51)chromium-EDTA) and some contrast media (CM) that are used for MRI (gadolinium-DTPA for instance) share the same pharmacokinetic properties, though, detection techniques are different (low-spatial resolution 2-dimensional projection with a good concentration-to-signal linearity for nuclear medicine and high-resolution 3-dimensional localization with nonlinear behavior for MRI). Thus, though based on the same principles, the methods are not the same and they provide somewhat different information. Many MRI perfusion studies have been conducted; some of them were compared with nuclear medicine with no good agreement. Phase contrast can reliably assess global renal blood flow but not perfusion at a tissular level. Arterial spin labeling has not proven to be a reliable tool to measure renal perfusion. Techniques using CM theoretically can assess perfusion at the tissular level, but they have not proven to be precise. To assess renal function, many models have been proposed. Some MRI techniques using CM, both semiquantitative (Patlak) and quantitative, have shown ability to roughly assess relative function. Some quantitative methods (Annet's and Lee's methods) have even showed that they could roughly estimate absolute renal function, with better results than estimated glomerular filtration rate. Quantification of drainage has not been much studied using MRI.
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Affiliation(s)
- Emmanuel Durand
- Biophysique et Médecine Nucléaire, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.
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Chen B, Zhang Y, Song X, Wang X, Zhang J, Fang J. Quantitative estimation of renal function with dynamic contrast-enhanced MRI using a modified two-compartment model. PLoS One 2014; 9:e105087. [PMID: 25141138 PMCID: PMC4139329 DOI: 10.1371/journal.pone.0105087] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Accepted: 07/19/2014] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To establish a simple two-compartment model for glomerular filtration rate (GFR) and renal plasma flow (RPF) estimations by dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI). MATERIALS AND METHODS A total of eight New Zealand white rabbits were included in DCE-MRI. The two-compartment model was modified with the impulse residue function in this study. First, the reliability of GFR measurement of the proposed model was compared with other published models in Monte Carlo simulation at different noise levels. Then, functional parameters were estimated in six healthy rabbits to test the feasibility of the new model. Moreover, in order to investigate its validity of GFR estimation, two rabbits underwent acute ischemia surgical procedure in unilateral kidney before DCE-MRI, and pixel-wise measurements were implemented to detect the cortical GFR alterations between normal and abnormal kidneys. RESULTS The lowest variability of GFR and RPF measurements were found in the proposed model in the comparison. Mean GFR was 3.03±1.1 ml/min and mean RPF was 2.64±0.5 ml/g/min in normal animals, which were in good agreement with the published values. Moreover, large GFR decline was found in dysfunction kidneys comparing to the contralateral control group. CONCLUSION Results in our study demonstrate that measurement of renal kinetic parameters based on the proposed model is feasible and it has the ability to discriminate GFR changes in healthy and diseased kidneys.
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Affiliation(s)
- Bin Chen
- Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, China
| | - Yudong Zhang
- Department of Radiology, Peking University First Hospital, Beijing, China
| | - Xiaojian Song
- Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, China
- Department of Electrical Engineering, Chengdu University of Information Technology, Chengdu, Sichuan, China
| | - Xiaoying Wang
- Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, China
- Department of Radiology, Peking University First Hospital, Beijing, China
- * E-mail: (XW); (JZ)
| | - Jue Zhang
- Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, China
- College of Engineering, Peking University, Beijing, China
- * E-mail: (XW); (JZ)
| | - Jing Fang
- Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, China
- College of Engineering, Peking University, Beijing, China
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Zhang JL, Morrell G, Rusinek H, Sigmund EE, Chandarana H, Lerman LO, Prasad PV, Niles D, Artz N, Fain S, Vivier PH, Cheung AK, Lee VS. New magnetic resonance imaging methods in nephrology. Kidney Int 2014; 85:768-78. [PMID: 24067433 PMCID: PMC3965662 DOI: 10.1038/ki.2013.361] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Revised: 07/16/2013] [Accepted: 07/17/2013] [Indexed: 02/06/2023]
Abstract
Established as a method to study anatomic changes, such as renal tumors or atherosclerotic vascular disease, magnetic resonance imaging (MRI) to interrogate renal function has only recently begun to come of age. In this review, we briefly introduce some of the most important MRI techniques for renal functional imaging, and then review current findings on their use for diagnosis and monitoring of major kidney diseases. Specific applications include renovascular disease, diabetic nephropathy, renal transplants, renal masses, acute kidney injury, and pediatric anomalies. With this review, we hope to encourage more collaboration between nephrologists and radiologists to accelerate the development and application of modern MRI tools in nephrology clinics.
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Affiliation(s)
- Jeff L Zhang
- Department of Radiology, University of Utah, Salt Lake City, Utah, USA
| | - Glen Morrell
- Department of Radiology, University of Utah, Salt Lake City, Utah, USA
| | - Henry Rusinek
- Department of Radiology, New York University, New York, New York, USA
| | - Eric E Sigmund
- Department of Radiology, New York University, New York, New York, USA
| | - Hersh Chandarana
- Department of Radiology, New York University, New York, New York, USA
| | - Lilach O Lerman
- Department of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | | | - David Niles
- Department of Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Nathan Artz
- Department of Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Sean Fain
- Department of Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | | | - Alfred K Cheung
- Division of Nephrology and Hypertension, University of Utah, Salt Lake City, Utah, USA
| | - Vivian S Lee
- Department of Radiology, University of Utah, Salt Lake City, Utah, USA
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Helck A, Schönermarck U, Habicht A, Notohamiprodjo M, Stangl M, Klotz E, Nikolaou K, la Fougère C, Clevert DA, Reiser M, Becker C. Determination of split renal function using dynamic CT-angiography: preliminary results. PLoS One 2014; 9:e91774. [PMID: 24618919 PMCID: PMC3950217 DOI: 10.1371/journal.pone.0091774] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2013] [Accepted: 02/13/2014] [Indexed: 12/28/2022] Open
Abstract
Objectives To determine the feasibility of a dynamic CT angiography-protocol with regard to simultaneous assessment of renal anatomy and function. Methods 7 healthy potential kidney donors (58±7 years) underwent a dynamic computed tomography angiography (CTA) using a 128-slice CT-scanner with continuous bi-directional table movement, allowing the coverage of a scan range of 18 cm within 1.75 sec. Twelve scans of the kidneys (n = 14) were acquired every 3.5 seconds with the aim to simultaneously obtain CTA and renal function data. Image quality was assessed quantitatively (HU-measurements) and qualitatively (grade 1–4, 1 = best). The glomerular filtration rate (GFR) was calculated by a modified Patlak method and compared with the split renal function obtained with renal scintigraphy. Results Mean maximum attenuation was 464±58 HU, 435±48 HU and 277±29 HU in the aorta, renal arteries, and renal veins, respectively. The abdominal aorta and all renal vessels were depicted excellently (grade 1.0). The image quality score for cortex differentiation was 1.6±0.49, for the renal parenchyma 2.4±0.49. GFR obtained from dynamic CTA correlated well with renal scintigraphy with a correlation coefficient of r = 0.84; P = 0.0002 (n = 14). The average absolute deviation was 1.6 mL/min. The average effective dose was 8.96 mSv. Conclusion Comprehensive assessment of renal anatomy and function is feasible using a single dynamic CT angiography examination. The proposed protocol may help to improve management in case of asymmetric kidney function as well as to simplify evaluation of potential living kidney donors.
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Affiliation(s)
- Andreas Helck
- Institute for Clinical Radiology, University Hospital Grosshadern (LMU), Munich, Germany
- * E-mail:
| | - Ulf Schönermarck
- Department of Internal Medicine IV, University Hospital Grosshadern (LMU), Munich, Germany
| | - Antje Habicht
- Transplant Center Munich, University Hospital Grosshadern (LMU), Munich, Germany
| | - Mike Notohamiprodjo
- Institute for Clinical Radiology, University Hospital Grosshadern (LMU), Munich, Germany
| | - Manfred Stangl
- Department of Surgery, University Hospital Grosshadern (LMU), Munich, Germany
| | - Ernst Klotz
- Siemens Healthcare, Computed Tomography, Forchheim, Germany
| | - Konstantin Nikolaou
- Institute for Clinical Radiology, University Hospital Grosshadern (LMU), Munich, Germany
| | - Christian la Fougère
- Department of Nuclear Medicine, University Hospital Grosshadern (LMU), Munich, Germany
| | - Dirk Andrè Clevert
- Institute for Clinical Radiology, University Hospital Grosshadern (LMU), Munich, Germany
| | - Maximilian Reiser
- Institute for Clinical Radiology, University Hospital Grosshadern (LMU), Munich, Germany
| | - Christoph Becker
- Institute for Clinical Radiology, University Hospital Grosshadern (LMU), Munich, Germany
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Cutajar M, Thomas DL, Hales PW, Banks T, Clark CA, Gordon I. Comparison of ASL and DCE MRI for the non-invasive measurement of renal blood flow: quantification and reproducibility. Eur Radiol 2014; 24:1300-8. [PMID: 24599625 DOI: 10.1007/s00330-014-3130-0] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Revised: 02/06/2014] [Accepted: 02/13/2014] [Indexed: 12/27/2022]
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Ebrahimi B, Textor SC, Lerman LO. Renal relevant radiology: renal functional magnetic resonance imaging. Clin J Am Soc Nephrol 2013; 9:395-405. [PMID: 24370767 DOI: 10.2215/cjn.02900313] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Because of its noninvasive nature and provision of quantitative measures of a wide variety of physiologic parameters, functional magnetic resonance imaging (MRI) shows great potential for research and clinical applications. Over the past decade, application of functional MRI extended beyond detection of cerebral activity, and techniques for abdominal functional MRI evolved. Assessment of renal perfusion, glomerular filtration, interstitial diffusion, and parenchymal oxygenation turned this modality into an essential research and potentially diagnostic tool. Variations in many renal physiologic markers can be detected using functional MRI before morphologic changes become evident in anatomic magnetic resonance images. Moreover, the framework of functional MRI opened a window of opportunity to develop novel pathophysiologic markers. This article reviews applications of some well validated functional MRI techniques, including perfusion, diffusion-weighted imaging, and blood oxygen level-dependent MRI, as well as some emerging new techniques such as magnetic resonance elastography, which might evolve into clinically useful tools.
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Affiliation(s)
- Behzad Ebrahimi
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
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Charlton JR, Beeman SC, Bennett KM. MRI-detectable nanoparticles: the potential role in the diagnosis of and therapy for chronic kidney disease. Adv Chronic Kidney Dis 2013; 20:479-87. [PMID: 24206600 DOI: 10.1053/j.ackd.2013.06.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Revised: 05/23/2013] [Accepted: 06/03/2013] [Indexed: 12/30/2022]
Abstract
Chronic kidney disease (CKD) is a common, deadly, and expensive threat to public health. Patients susceptible to the development of CKD are difficult to identify because there are few noninvasive clinical techniques and markers to assess early kidney dysfunction. Noninvasive imaging techniques are being developed to quantitatively measure kidney morphology and function in preclinical research and in clinical trials. Magnetic resonance imaging (MRI) techniques in particular have the potential to provide structural and functional information in the kidney. Novel molecular imaging techniques, using targeted magnetic nanoparticles that exploit the characteristics of the endogenous protein, ferritin, have been developed in conjunction with MRI to count every perfused glomerulus in the kidney and measure their individual volumes. This technique could open the door to the possibility of prospectively assessing and eventually reducing a patient's risk for progression to CKD. This review highlights the potential clinical benefits of early detection in patients predisposed to CKD and discusses technologic and regulatory hurdles to the translation of these molecular MRI techniques to provide early diagnosis of CKD.
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Zhang YD, Wang J, Zhang J, Wang X, Jiang X. Effect of iodinated contrast media on renal function evaluated with dynamic three-dimensional MR renography. Radiology 2013; 270:409-15. [PMID: 24091357 DOI: 10.1148/radiol.13122495] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To assess the hemodynamic effect of iodinated contrast media (CM) on glomerular filtration rate (GFR) by using dynamic three-dimensional magnetic resonance (MR) renography in a rabbit model. MATERIALS AND METHODS This study was approved by the university animal care and use committee. Twelve healthy male New Zealand rabbits (body mass range, 2.5-3.0 kg) were included. Two of them were sacrificed before MR examination to obtain renal histologic samples as controls. The other ten rabbits completed 4-minute dynamic contrast material-enhanced MR imaging 24 hours before and 20 minutes after intravenous injection of iopamidol (370 mg of iodine per milliliter) at a dose of 6 mL per kilogram of body weight. Blood volume (V(B)), GFR, and tubule volume (V(E)) of the renal cortex were determined with a two-compartment kinetic model. Maximum upslope (K(m)), peak concentration (P(c)), and initial 60-second area under the curve (IAUC) of the whole kidney renogram curve were measured with semiquantitative analysis. The self-control data were compared by using the Student paired t test. RESULTS Iopamidol significantly decreased cortical V(B) (mean, 42.53% ± 10.16 [standard deviation] before CM administration vs 27.23% ± 16.13 after CM administration; P < .01), V(E) (mean, 22.40% ± 11.69 before CM administration vs 11.51% ± 6.58 after CM administration; P < .01), and GFR (mean, 31.92 mL/100 g per minute ± 12.52 before CM administration vs 21.48 mL/100 g per minute ± 10.02 after CM administration; P < .01). Results of whole-kidney renogram analysis showed a decrease in K(m), P(c), and IAUC caused by iopamidol administration. CONCLUSION High-dose iopamidol resulted in a marked decrease in renal function, which could be detected at dynamic three-dimensional MR renography.
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Affiliation(s)
- Yu-Dong Zhang
- From the Center for MRI Research, Peking University, Beijing, China (J.W.); Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, China (J.Z.); and Department of Radiology, Peking University First Hospital, 8 Xishiku Street, Xicheng District, Beijing, China 100034 (Y.D.Z., X.W., X.J.)
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Liss P, Cox EF, Eckerbom P, Francis ST. Imaging of intrarenal haemodynamics and oxygen metabolism. Clin Exp Pharmacol Physiol 2013; 40:158-67. [PMID: 23252679 DOI: 10.1111/1440-1681.12042] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Revised: 12/07/2012] [Accepted: 12/12/2012] [Indexed: 01/07/2023]
Abstract
The interruption of blood flow results in impaired oxygenation and metabolism. This can lead to electrophysiological changes, functional impairment and symptoms in quick succession. Quantitative measures of organ perfusion, perfusion reserve and tissue oxygenation are crucial to assess normal tissue metabolism and function. Magnetic resonance imaging (MRI) provides a number of quantitative methods to assess physiology in the kidney. Blood oxygenation level-dependent (BOLD) MRI provides a method for the assessment of oxygenation. Blood flow to the kidney can be assessed using phase contrast MRI. Dynamic contrast-enhanced MRI and arterial spin labelling (ASL) provide methods to assess tissue perfusion, ASL using the magnetization of endogenous water protons and thus providing a non-invasive method to assess perfusion. The application of diffusion-weighted MRI allows molecular motion in the kidney to be measured. Novel techniques can also be used to assess oxygenation in the renal arteries and veins and, combined with flow measures, provide an estimation of oxygen metabolism. Magnetic resonance imaging provides a synergy of non-invasive techniques to study renal function and the demand for these techniques is likely to be driven by the incentive to avoid the use of contrast media, to avoid radiation and to avoid complications with intervention procedures.
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Affiliation(s)
- Per Liss
- Department of Radiology, Center for Medical Imaging, Uppsala University Hospital, Uppsala University, Uppsala, Sweden
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Zöllner FG, Weisser G, Reich M, Kaiser S, Schoenberg SO, Sourbron SP, Schad LR. UMMPerfusion: an open source software tool towards quantitative MRI perfusion analysis in clinical routine. J Digit Imaging 2013; 26:344-52. [PMID: 22832894 DOI: 10.1007/s10278-012-9510-6] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
To develop a generic Open Source MRI perfusion analysis tool for quantitative parameter mapping to be used in a clinical workflow and methods for quality management of perfusion data. We implemented a classic, pixel-by-pixel deconvolution approach to quantify T1-weighted contrast-enhanced dynamic MR imaging (DCE-MRI) perfusion data as an OsiriX plug-in. It features parallel computing capabilities and an automated reporting scheme for quality management. Furthermore, by our implementation design, it could be easily extendable to other perfusion algorithms. Obtained results are saved as DICOM objects and directly added to the patient study. The plug-in was evaluated on ten MR perfusion data sets of the prostate and a calibration data set by comparing obtained parametric maps (plasma flow, volume of distribution, and mean transit time) to a widely used reference implementation in IDL. For all data, parametric maps could be calculated and the plug-in worked correctly and stable. On average, a deviation of 0.032 ± 0.02 ml/100 ml/min for the plasma flow, 0.004 ± 0.0007 ml/100 ml for the volume of distribution, and 0.037 ± 0.03 s for the mean transit time between our implementation and a reference implementation was observed. By using computer hardware with eight CPU cores, calculation time could be reduced by a factor of 2.5. We developed successfully an Open Source OsiriX plug-in for T1-DCE-MRI perfusion analysis in a routine quality managed clinical environment. Using model-free deconvolution, it allows for perfusion analysis in various clinical applications. By our plug-in, information about measured physiological processes can be obtained and transferred into clinical practice.
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Affiliation(s)
- Frank G Zöllner
- Computer Assisted Clinical Medicine, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
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MR renographic measurement of renal function in patients undergoing partial nephrectomy. AJR Am J Roentgenol 2013; 200:1204-9. [PMID: 23701054 DOI: 10.2214/ajr.12.10276] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this review is to describe the role of functional renal MRI, or MR renography, in the care of patients with renal masses undergoing partial nephrectomy. CONCLUSION MR renography can be used to monitor renal functional outcome for patients undergoing partial nephrectomy and may help guide patient selection in this population with elevated risk of chronic kidney disease.
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Sourbron SP, Buckley DL. Classic models for dynamic contrast-enhanced MRI. NMR IN BIOMEDICINE 2013; 26:1004-1027. [PMID: 23674304 DOI: 10.1002/nbm.2940] [Citation(s) in RCA: 272] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2012] [Revised: 02/12/2013] [Accepted: 02/12/2013] [Indexed: 06/02/2023]
Abstract
Dynamic contrast-enhanced MRI (DCE-MRI) is a functional MRI method where T1 -weighted MR images are acquired dynamically after bolus injection of a contrast agent. The data can be interpreted in terms of physiological tissue characteristics by applying the principles of tracer-kinetic modelling. In the brain, DCE-MRI enables measurement of cerebral blood flow (CBF), cerebral blood volume (CBV), blood-brain barrier (BBB) permeability-surface area product (PS) and the volume of the interstitium (ve ). These parameters can be combined to form others such as the volume-transfer constant K(trans) , the extraction fraction E and the contrast-agent mean transit times through the intra- and extravascular spaces. A first generation of tracer-kinetic models for DCE-MRI was developed in the early 1990s and has become a standard in many applications. Subsequent improvements in DCE-MRI data quality have driven the development of a second generation of more complex models. They are increasingly used, but it is not always clear how they relate to the models of the first generation or to the model-free deconvolution methods for tissues with intact BBB. This lack of understanding is leading to increasing confusion on when to use which model and how to interpret the parameters. The purpose of this review is to clarify the relation between models of the first and second generations and between model-based and model-free methods. All quantities are defined using a generic terminology to ensure the widest possible scope and to reveal the link between applications in the brain and in other organs.
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Lim SW, Chrysochou C, Buckley DL, Kalra PA, Sourbron SP. Prediction and assessment of responses to renal artery revascularization with dynamic contrast-enhanced magnetic resonance imaging: a pilot study. Am J Physiol Renal Physiol 2013; 305:F672-8. [PMID: 23804449 DOI: 10.1152/ajprenal.00007.2013] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The aim of this study was to assess the potential of dynamic contrast-enhanced (DCE) MRI to predict and evaluate functional outcomes after renal artery revascularization for renal artery stenosis (RAS). The single-kidney glomerular filtration rate (SK-GFR) was measured in 15 patients with atherosclerotic RAS with DCE-MRI and radioisotopes at baseline and 4 mo after revascularization. DCE-MRI also produced measurements of blood flow, blood volume, extraction fraction, tubular transit time, and functional volume. Stented kidneys (n = 22) were divided into three response groups on the basis of the changes in radioisotope SK-GFR: improved (n = 5), stable (n = 13), and deteriorated (n = 4). A good agreement was found between SK-GFR values from DCE-MRI and radioisotopes (correlation coefficient: 0.91). Before intervention, kidneys that improved had lower extraction fraction, higher blood volume, longer tubular transit time, and lower SK-GFR. After intervention, improved kidneys had increased functional volume, and deteriorated kidneys had reduced functional volume and extraction fraction. Revascularization improved blood flow and blood volume in all groups. This pilot study led to the hypothesis that well-vascularized kidneys with reduced extraction fractions are most likely to benefit from revascularization. More generally, DCE-MRI has the potential to replace radioisotope measurement of SK-GFR and may improve patient management by providing additional information on tissue perfusion.
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Affiliation(s)
- Su Wei Lim
- Div. of Medical Physics, Univ. of Leeds, Level 8, Worsley Bldg., Leeds LS2 9JT, UK
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