1
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Metens T. Editorial for "The Use of Diffusion Tensor Imaging in the Identification of Acute Rejection and Chronic Allograft Nephropathy After Renal Transplantation". J Magn Reson Imaging 2024; 59:2089-2090. [PMID: 37814988 DOI: 10.1002/jmri.29055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 09/27/2023] [Indexed: 10/11/2023] Open
Affiliation(s)
- Thierry Metens
- Department of Radiology, Hôpital Erasme HUB, Faculté de Médecine and Ecole Polytechnique de Bruxelles, Université libre de Bruxelles, Brussels, Belgium
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2
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Zhao K, Seeliger E, Niendorf T, Liu Z. Noninvasive Assessment of Diabetic Kidney Disease With MRI: Hype or Hope? J Magn Reson Imaging 2024; 59:1494-1513. [PMID: 37675919 DOI: 10.1002/jmri.29000] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 08/22/2023] [Accepted: 08/23/2023] [Indexed: 09/08/2023] Open
Abstract
Owing to the increasing prevalence of diabetic mellitus, diabetic kidney disease (DKD) is presently the leading cause of chronic kidney disease and end-stage renal disease worldwide. Early identification and disease interception is of paramount clinical importance for DKD management. However, current diagnostic, disease monitoring and prognostic tools are not satisfactory, due to their low sensitivity, low specificity, or invasiveness. Magnetic resonance imaging (MRI) is noninvasive and offers a host of contrast mechanisms that are sensitive to pathophysiological changes and risk factors associated with DKD. MRI tissue characterization involves structural and functional information including renal morphology (kidney volume (TKV) and parenchyma thickness using T1- or T2-weighted MRI), renal microstructure (diffusion weighted imaging, DWI), renal tissue oxygenation (blood oxygenation level dependent MRI, BOLD), renal hemodynamics (arterial spin labeling and phase contrast MRI), fibrosis (DWI) and abdominal or perirenal fat fraction (Dixon MRI). Recent (pre)clinical studies demonstrated the feasibility and potential value of DKD evaluation with MRI. Recognizing this opportunity, this review outlines key concepts and current trends in renal MRI technology for furthering our understanding of the mechanisms underlying DKD and for supplementing clinical decision-making in DKD. Progress in preclinical MRI of DKD is surveyed, and challenges for clinical translation of renal MRI are discussed. Future directions of DKD assessment and renal tissue characterization with (multi)parametric MRI are explored. Opportunities for discovery and clinical break-through are discussed including biological validation of the MRI findings, large-scale population studies, standardization of DKD protocols, the synergistic connection with data science to advance comprehensive texture analysis, and the development of smart and automatic data analysis and data visualization tools to further the concepts of virtual biopsy and personalized DKD precision medicine. We hope that this review will convey this vision and inspire the reader to become pioneers in noninvasive assessment and management of DKD with MRI. LEVEL OF EVIDENCE: 1 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Kaixuan Zhao
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image Analysis and Application, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Erdmann Seeliger
- Institute of Translational Physiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Thoralf Niendorf
- Berlin Ultrahigh Field Facility (B.U.F.F.), Max Delbrueck Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany
| | - Zaiyi Liu
- Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image Analysis and Application, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
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3
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Rasmussen CW, Bøgh N, Ringgaard S, Birn H, Vaeggemose M, Schulte RF, Laustsen C. Daytime Variation in Kidney Perfusion, Oxygenation, and Sodium Concentration Assessed by Multiparametric MRI in Healthy Volunteers. J Magn Reson Imaging 2024; 59:1603-1611. [PMID: 37656067 DOI: 10.1002/jmri.28983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 08/14/2023] [Accepted: 08/15/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND MRI can provide information on kidney structure, perfusion, and oxygenation. Furthermore, it allows for the assessment of kidney sodium concentrations and handling, allowing multiparametric evaluation of kidney physiology. Multiparametric MRI is promising for establishing prognosis and monitoring treatment responses in kidney diseases, but its intraindividual variation during the day is unresolved. PURPOSE To investigate the variation in multiparametric MRI measurements from the morning to the evening. STUDY TYPE Prospective. POPULATION Ten healthy volunteers, aged 29 ± 5 without history of kidney disease. FIELD STRENGTH/SEQUENCE 3 T/T1 mapping, blood-oxygen level dependent imaging, arterial spin labeling perfusion imaging, diffusion weighted imaging, and sodium imaging. ASSESSMENT A multiparametric MRI protocol, yielding T1, R2*, ADC, renal blood flow and renal sodium levels, was acquired in the morning, noon, and evening. The participants were fasting prior to the first examination. Urine biochemical analyses were performed to complement MRI data. The cortex and medulla were analyzed separately in a semi-automatic fashion, and gradients of total sodium concentration (TSC) and R2* gradients were calculated from outer cortex to inner medulla. STATISTICAL TEST Analyses of variance and mixed-effects models to estimate differences from time of day. Coefficients of variation to assess variability within and between participants. A P-value <0.05 was considered statistically significant. RESULTS The coefficients of variation varied from 5% to 18% for proton-based parametric sequences, while it was 38% for TSC over a day. DATA CONCLUSION Multiparametric MRI is stable over the day. The coefficients of variation over a day were lower for proton multiparametric MRI, but higher for sodium MRI. EVIDENCE LEVEL 2 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Camilla W Rasmussen
- The MR Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Nikolaj Bøgh
- The MR Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Steffen Ringgaard
- The MR Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Henrik Birn
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Michael Vaeggemose
- The MR Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- GE HealthCare, Broendby, Denmark
| | | | - Christoffer Laustsen
- The MR Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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4
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Wu M, Zhang JL. MR Perfusion Imaging for Kidney Disease. Magn Reson Imaging Clin N Am 2024; 32:161-170. [PMID: 38007278 DOI: 10.1016/j.mric.2023.09.004] [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: 11/27/2023]
Abstract
Renal perfusion reflects overall function of a kidney. As an important indicator of kidney diseases, renal perfusion can be noninvasively measured by multiple methods of MR imaging, such as dynamic contrast-enhanced MR imaging, intravoxel incoherent motion analysis, and arterial spin labeling method. In this article we introduce the principle of the methods, review their recent technical improvements, and then focus on summarizing recent applications of the methods in assessing various renal diseases. By this review, we demonstrate the capability and clinical potential of the imaging methods, with the hope of accelerating their adoption to clinical practice.
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Affiliation(s)
- Mingyan Wu
- Central Research Institute, UIH Group, Shanghai, China; School of Biomedical Engineering Building, Room 409, 393 Huaxia Middle Road, Shanghai 201210, China
| | - Jeff L Zhang
- School of Biomedical Engineering, ShanghaiTech University, Room 409, School of Biomedical Engineering Building, 393 Huaxia Middle Road, Shanghai 201210, China.
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5
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Wáng YXJ, Ma FZ. A tri-phasic relationship between T2 relaxation time and magnetic resonance imaging (MRI)-derived apparent diffusion coefficient (ADC). Quant Imaging Med Surg 2023; 13:8873-8880. [PMID: 38106328 PMCID: PMC10722059 DOI: 10.21037/qims-23-1342] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 09/27/2023] [Indexed: 12/19/2023]
Affiliation(s)
- Yi Xiang J Wáng
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Fu-Zhao Ma
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
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6
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Bane O, Seeliger E, Cox E, Stabinska J, Bechler E, Lewis S, Hickson LJ, Francis S, Sigmund E, Niendorf T. Renal MRI: From Nephron to NMR Signal. J Magn Reson Imaging 2023; 58:1660-1679. [PMID: 37243378 PMCID: PMC11025392 DOI: 10.1002/jmri.28828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 05/11/2023] [Accepted: 05/12/2023] [Indexed: 05/28/2023] Open
Abstract
Renal diseases pose a significant socio-economic burden on healthcare systems. The development of better diagnostics and prognostics is well-recognized as a key strategy to resolve these challenges. Central to these developments are MRI biomarkers, due to their potential for monitoring of early pathophysiological changes, renal disease progression or treatment effects. The surge in renal MRI involves major cross-domain initiatives, large clinical studies, and educational programs. In parallel with these translational efforts, the need for greater (patho)physiological specificity remains, to enable engagement with clinical nephrologists and increase the associated health impact. The ISMRM 2022 Member Initiated Symposium (MIS) on renal MRI spotlighted this issue with the goal of inspiring more solutions from the ISMRM community. This work is a summary of the MIS presentations devoted to: 1) educating imaging scientists and clinicians on renal (patho)physiology and demands from clinical nephrologists, 2) elucidating the connection of MRI parameters with renal physiology, 3) presenting the current state of leading MR surrogates in assessing renal structure and functions as well as their next generation of innovation, and 4) describing the potential of these imaging markers for providing clinically meaningful renal characterization to guide or supplement clinical decision making. We hope to continue momentum of recent years and introduce new entrants to the development process, connecting (patho)physiology with (bio)physics, and conceiving new clinical applications. We envision this process to benefit from cross-disciplinary collaboration and analogous efforts in other body organs, but also to maximally leverage the unique opportunities of renal physiology. LEVEL OF EVIDENCE: 1 TECHNICAL EFFICACY STAGE: 2.
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Affiliation(s)
- Octavia Bane
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
- Icahn School of Medicine at Mount Sinai, BioMedical Engineering and Imaging Institute, New York City, New York, USA
| | - Erdmann Seeliger
- Institute of Translational Physiology, Charité-University Medicine Berlin, Berlin, Germany
| | - Eleanor Cox
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, UK
| | - Julia Stabinska
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Maryland, USA
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Eric Bechler
- Department of Diagnostic and Interventional Radiology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Sara Lewis
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - LaTonya J Hickson
- Division of Nephrology and Hypertension, Mayo Clinic, Jacksonville, Florida, USA
| | - Sue Francis
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, UK
| | - Eric Sigmund
- Bernard and Irene Schwartz Center for Biomedical Imaging Center for Advanced Imaging Innovation and Research (CAI2R), New York University Langone Health, New York City, New York, USA
| | - Thoralf Niendorf
- Berlin Ultrahigh Field Facility (B.U.F.F.), Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany
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7
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Friedli I, Baid-Agrawal S, Unwin R, Morell A, Johansson L, Hockings PD. Magnetic Resonance Imaging in Clinical Trials of Diabetic Kidney Disease. J Clin Med 2023; 12:4625. [PMID: 37510740 PMCID: PMC10380287 DOI: 10.3390/jcm12144625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 06/28/2023] [Accepted: 07/04/2023] [Indexed: 07/30/2023] Open
Abstract
Chronic kidney disease (CKD) associated with diabetes mellitus (DM) (known as diabetic kidney disease, DKD) is a serious and growing healthcare problem worldwide. In DM patients, DKD is generally diagnosed based on the presence of albuminuria and a reduced glomerular filtration rate. Diagnosis rarely includes an invasive kidney biopsy, although DKD has some characteristic histological features, and kidney fibrosis and nephron loss cause disease progression that eventually ends in kidney failure. Alternative sensitive and reliable non-invasive biomarkers are needed for DKD (and CKD in general) to improve timely diagnosis and aid disease monitoring without the need for a kidney biopsy. Such biomarkers may also serve as endpoints in clinical trials of new treatments. Non-invasive magnetic resonance imaging (MRI), particularly multiparametric MRI, may achieve these goals. In this article, we review emerging data on MRI techniques and their scientific, clinical, and economic value in DKD/CKD for diagnosis, assessment of disease pathogenesis and progression, and as potential biomarkers for clinical trial use that may also increase our understanding of the efficacy and mode(s) of action of potential DKD therapeutic interventions. We also consider how multi-site MRI studies are conducted and the challenges that should be addressed to increase wider application of MRI in DKD.
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Affiliation(s)
- Iris Friedli
- Antaros Medical, BioVenture Hub, 43183 Mölndal, Sweden
| | - Seema Baid-Agrawal
- Transplant Center, Sahlgrenska University Hospital, University of Gothenburg, 41345 Gothenburg, Sweden
| | - Robert Unwin
- AstraZeneca R&D BioPharmaceuticals, Translational Science and Experimental Medicine, Early Cardiovascular, Renal & Metabolic Diseases (CVRM), Granta Park, Cambridge CB21 6GH, UK
| | - Arvid Morell
- Antaros Medical, BioVenture Hub, 43183 Mölndal, Sweden
| | | | - Paul D Hockings
- Antaros Medical, BioVenture Hub, 43183 Mölndal, Sweden
- MedTech West, Chalmers University of Technology, 41345 Gothenburg, Sweden
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8
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Laothamatas I, Al Mubarak H, Reddy A, Wax R, Badani K, Taouli B, Bane O, Lewis S. Multiparametric MRI of Solid Renal Masses: Principles and Applications of Advanced Quantitative and Functional Methods for Tumor Diagnosis and Characterization. J Magn Reson Imaging 2023. [PMID: 37052601 DOI: 10.1002/jmri.28718] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/23/2023] [Accepted: 03/23/2023] [Indexed: 04/14/2023] Open
Abstract
Solid renal masses (SRMs) are increasingly detected and encompass both benign and malignant masses, with renal cell carcinoma (RCC) being the most common malignant SRM. Most patients with SRMs will undergo management without a priori pathologic confirmation. There is an unmet need to noninvasively diagnose and characterize RCCs, as significant variability in clinical behavior is observed and a wide range of differing management options exist. Cross-sectional imaging modalities, including magnetic resonance imaging (MRI), are increasingly used for SRM characterization. Multiparametric (mp) MRI techniques can provide insight into tumor biology by probing different physiologic/pathophysiologic processes noninvasively. These include sequences that probe tissue microstructure, including intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) and T1 relaxometry; oxygen metabolism (blood oxygen level dependent [BOLD-MRI]); as well as vascular flow and perfusion (dynamic contrast-enhanced MRI [DCE-MRI] and arterial spin labeling [ASL]). In this review, we will discuss each mpMRI method in terms of its principles, roles, and discuss the results of human studies for SRM assessment. Future validation of these methods may help to enable a personalized management approach for patients with SRM in the emerging era of precision medicine. EVIDENCE LEVEL: 5. TECHNICAL EFFICACY: 2.
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Affiliation(s)
- Indira Laothamatas
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Haitham Al Mubarak
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Arthi Reddy
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Rebecca Wax
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ketan Badani
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Bachir Taouli
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Octavia Bane
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Sara Lewis
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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9
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Sørensen SS, Gullaksen S, Vernstrøm L, Ringgaard S, Laustsen C, Funck KL, Laugesen E, Poulsen PL. Evaluation of renal oxygenation by BOLD-MRI in high-risk patients with type 2 diabetes and matched controls. Nephrol Dial Transplant 2023; 38:691-699. [PMID: 35612982 DOI: 10.1093/ndt/gfac186] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Diabetic kidney disease (DKD) accounts for ∼50% of end-stage kidney disease. Renal hypoxia is suggested as a main driver in the pathophysiology underlying chronic DKD. Blood oxygenation level-dependent magnetic resonance imaging (BOLD-MRI) has made noninvasive investigations of renal oxygenation in humans possible. Whether diabetes per se contributes to measurable changes in renal oxygenation by BOLD-MRI remains to be elucidated. We investigated whether renal oxygenation measured with BOLD-MRI differs between people with type 2 diabetes (T2DM) with normal to moderate chronic kidney disease (CKD) (Stages 1-3A) and matched controls. The repeatability of the BOLD-MRI method was also assessed. METHODS In this matched cross-sectional study, 20 people with T2DM (age 69.2 ± 4.7 years, duration of diabetes 10.5 ± 6.7 years, male 55.6%) and 20 matched nondiabetic controls (mean age 68.8 ± 5.4 years, male 55.%) underwent BOLD-MRI analysed with the 12-layer concentric object method (TLCO). To investigate the repeatability, seven in the T2DM group and nine in the control group were scanned twice. RESULTS A significant reduction in renal oxygenation from the cortex to medulla was found in both groups (P < .01) but no intergroup difference was detected [0.71/s (95% confidence interval -0.28-1.7), P = .16]. The median intraindividual coefficient of variation (CV) varied from 1.2% to 7.0%. CONCLUSION T2DM patients with normal to moderate CKD do not seem to have lower renal oxygenation when measured with BOLD-MRI and TLCO. BOLD-MRI has a low intraindividual CV and seems like a reliable method for investigation of renal oxygenation in T2DM.
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Affiliation(s)
- Steffen S Sørensen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Internal Medicine and Endocrinology, Aarhus University Hospital, Aarhus, Denmark
| | - Søren Gullaksen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Internal Medicine and Endocrinology, Aarhus University Hospital, Aarhus, Denmark
| | - Liv Vernstrøm
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Internal Medicine and Endocrinology, Aarhus University Hospital, Aarhus, Denmark
| | | | | | - Kristian L Funck
- Department of Internal Medicine and Endocrinology, Aarhus University Hospital, Aarhus, Denmark
| | - Esben Laugesen
- Department of Internal Medicine and Endocrinology, Aarhus University Hospital, Aarhus, Denmark
| | - Per L Poulsen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Steno Diabetes Center, Aarhus University Hospital, Aarhus, Denmark
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10
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Capability of arterial spin labeling and intravoxel incoherent motion diffusion-weighted imaging to detect early kidney injury in chronic kidney disease. Eur Radiol 2022; 33:3286-3294. [PMID: 36512040 DOI: 10.1007/s00330-022-09331-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 11/01/2022] [Accepted: 11/28/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To prospectively investigate the capability of arterial spin labeling (ASL) and intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) for the identification of early kidney injury in chronic kidney disease (CKD) patients with normal estimated glomerular filtration rate (eGFR). METHODS Fifty-four CKD patients confirmed by renal biopsy (normal eGFR group [eGFR ≥ 90 mL/min/1.73 m2]: n = 26; abnormal eGFR group [eGFR < 90 mL/min/1.73 m2]: n = 28) and 20 healthy volunteers (HV) were recruited. All subjects were examined by IVIM-DWI and ASL imaging. Renal blood flow (RBF) derived from ASL, true diffusion coefficient (D), pseudo-diffusion coefficient (D*), and perfusion fraction (f) derived from IVIM-DWI were measured from the renal cortex. One-way analysis of variance was used to compare MRI parameters among the three groups. The correlation between eGFR and MRI parameters was evaluated by Spearman correlation analysis. Diagnostic performances of MRI parameters for detecting kidney injury were assessed by receiver operating characteristic (ROC) curves. RESULTS The renal cortical D, D*, f, and RBF values showed statistically significant differences among the three groups. eGFR was positively correlated with MRI parameters (D: r = 0.299, D*: r = 0.569, f: r = 0.733, RBF: r = 0.586). The areas under the curve (AUCs) for discriminating CKD patients from HV were 0.725, 0.752, 0.947, and 0.884 by D, D*, f, and RBF, respectively. D, D*, f, RBF, and eGFR identified CKD patients with normal eGFR with AUCs of 0.735, 0.612, 0.917, 0.827, and 0.733, respectively, and AUC of f value was significantly larger than that of eGFR. CONCLUSION IVIM-DWI and ASL were useful for detecting underlying pathologic injury in early CKD patients with normal eGFR. KEY POINTS • The renal cortical f and RBF values in the control group were significantly higher than those in the normal eGFR group. • A negative correlation was observed between the renal cortical D, D*, f, and RBF values and SCr and 24 h-UPRO, while eGFR was significantly positively correlated with renal cortical D, D*, f, and RBF values. • The AUC of renal cortical f values was statistically larger than that of eGFR for the discrimination between the CKD with normal eGFR group and the control group.
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11
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Mei Y, Yang G, Guo Y, Zhao K, Wu S, Xu Z, Zhou S, Yan C, Seeliger E, Niendorf T, Xu Y, Feng Y. Parametric MRI Detects Aristolochic Acid Induced Acute Kidney Injury. Tomography 2022; 8:2902-2914. [PMID: 36548535 PMCID: PMC9786286 DOI: 10.3390/tomography8060243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 11/30/2022] [Accepted: 12/05/2022] [Indexed: 12/14/2022] Open
Abstract
Exposure to aristolochic acid (AA) is of increased concern due to carcinogenic and nephrotoxic effects, and incidence of aristolochic acid nephropathy (AAN) is increasing. This study characterizes renal alterations during the acute phase of AAN using parametric magnetic resonance imaging (MRI). An AAN and a control group of male Wistar rats received administration of aristolochic acid I (AAI) and polyethylene glycol (PEG), respectively, for six days. Both groups underwent MRI before and 2, 4 and 6 days after AAI or PEG administration. T2 relaxation times and apparent diffusion coefficients (ADCs) were determined for four renal layers. Serum creatinine levels (sCr) and blood urea nitrogen (BUN) were measured. Tubular injury scores (TIS) were evaluated based on histologic findings. Increased T2 values were detected since day 2 in the AAN group, but decreased ADCs and increased sCr levels and BUN were not detected until day 4. Significant linear correlations were observed between T2 of the cortex and the outer stripe of outer medulla and TIS. Our results demonstrate that parametric MRI facilitates early detection of renal injury induced by AAI in a rat model. T2 mapping may be a valuable tool for assessing kidney injury during the acute phase of AAN.
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Affiliation(s)
- Yingjie Mei
- School of Biomedical Engineering, Southern Medical University, Guangzhou 510515, China
| | - Guixiang Yang
- School of Biomedical Engineering, Southern Medical University, Guangzhou 510515, China
- Department of Medical Imaging Center, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Yihao Guo
- Department of Radiology, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou 570311, China
| | - Kaixuan Zhao
- School of Biomedical Engineering, Southern Medical University, Guangzhou 510515, China
| | - Shuyu Wu
- Radiotherapy Center, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou 510095, China
| | - Zhongbiao Xu
- Radiotherapy Center, Guangdong General Hospital, Guangzhou 510080, China
| | - Shan Zhou
- State Key Laboratory of Organ Failure Research, National Clinical Research Center of Kidney Disease, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Chenggong Yan
- Department of Medical Imaging Center, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Erdmann Seeliger
- Institute of Translational Physiology, Charité–Universitätsmedizin Berlin, 10117 Berlin, Germany
| | - Thoralf Niendorf
- Berlin Ultrahigh Field Facility (B.U.F.F.), Max Delbrück Center for Molecular Medicine in the Helmholtz Association, 13125 Berlin, Germany
| | - Yikai Xu
- Department of Medical Imaging Center, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Yanqiu Feng
- School of Biomedical Engineering, Southern Medical University, Guangzhou 510515, China
- Guangdong Provincial Key Laboratory of Medical Image Processing & Guangdong Province Engineering Laboratory for Medical Imaging and Diagnostic Technology, Southern Medical University, Guangzhou 510515, China
- Guangdong-Hong Kong-Macao Greater Bay Area Center for Brain Science and Brain-Inspired Intelligence & Key Laboratory of Mental Health of the Ministry of Education, Southern Medical University, Guangzhou 510515, China
- Department of Radiology, Shunde Hospital, Southern Medical University (The First People’s Hospital of Shunde, Foshan), Foshan 528399, China
- Correspondence:
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12
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Najac C, Boer VO, Kan HE, Webb AG, Ronen I. Improved detection limits of J-coupled neurometabolites in the human brain at 7 T with a J-refocused sLASER sequence. NMR IN BIOMEDICINE 2022; 35:e4801. [PMID: 35833462 PMCID: PMC9788253 DOI: 10.1002/nbm.4801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 07/02/2022] [Accepted: 07/12/2022] [Indexed: 06/15/2023]
Abstract
In a standard spin echo, the time evolution due to homonuclear couplings is not reversed, leading to echo time (TE)-dependent modulation of the signal amplitude and signal loss in the case of overlapping multiplet resonances. This has an adverse effect on quantification of several important metabolites such as glutamate and glutamine. Here, we propose a J-refocused variant of the sLASER sequence (J-sLASER) to improve quantification of J-coupled metabolites at ultrahigh field (UHF). The use of the sLASER sequence is particularly advantageous at UHF as it minimizes chemical shift displacement error and results in relatively homogenous refocusing. We simulated the MRS signal from brain metabolites over a broad range of TE values with sLASER and J-sLASER, and showed that the signal of J-coupled metabolites was increased with J-sLASER with TE values up to ~80 ms. We further simulated "brain-like" spectra with both sequences at the shortest TE available on our scanner. We showed that, despite the slightly longer TE, the J-sLASER sequence results in significantly lower Cramer-Rao lower bounds (CRLBs) for J-coupled metabolites compared with those obtained with sLASER. Following phantom validation, we acquired spectra from two brain regions in 10 healthy volunteers (age 38 ± 15 years) using both sequences. We showed that using J-sLASER results in a decrease of CRLBs for J-coupled metabolites. In particular, we measured a robust ~38% decrease in the mean CRLB (glutamine) in parietal white matter and posterior cingulate cortex (PCC). We further showed, in 10 additional healthy volunteers (age 34 ± 15 years), that metabolite quantification following two separate acquisitions with J-sLASER in the PCC was repeatable. The improvement in quantification of glutamine may in turn improve the independent quantification of glutamate, the main excitatory neurotransmitter in the brain, and will simultaneously help to track possible modulations of glutamine, which is a key player in the glutamatergic cycle in astrocytes.
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Affiliation(s)
- Chloé Najac
- C. J. Gorter Center for High Field MRI, Department of RadiologyLeiden University Medical CenterLeidenThe Netherlands
| | - Vincent O. Boer
- Danish Research Centre for Magnetic ResonanceCopenhagen University Hospital HvidovreHvidovreDenmark
| | - Hermien E. Kan
- C. J. Gorter Center for High Field MRI, Department of RadiologyLeiden University Medical CenterLeidenThe Netherlands
| | - Andrew G. Webb
- C. J. Gorter Center for High Field MRI, Department of RadiologyLeiden University Medical CenterLeidenThe Netherlands
| | - Itamar Ronen
- C. J. Gorter Center for High Field MRI, Department of RadiologyLeiden University Medical CenterLeidenThe Netherlands
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13
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Zhang Y. Editorial for "Multiparametric Magnetic Resonance Imaging of the Kidneys: Effects of Regional, Side, and Hydration Variations on Functional Quantifications". J Magn Reson Imaging 2022. [PMID: 36173376 DOI: 10.1002/jmri.28454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 09/19/2022] [Indexed: 11/08/2022] Open
Affiliation(s)
- Yue Zhang
- Department of Electronic and Information Engineering, BeiHai Vocational College, Beihai, China.,Department of Mechanical and Electrical Engineering, BeiHai Vocational College, Beihai, China
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14
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Dillman JR, Benoit SW, Gandhi DB, Trout AT, Tkach JA, VandenHeuvel K, Devarajan P. Multiparametric quantitative renal MRI in children and young adults: comparison between healthy individuals and patients with chronic kidney disease. Abdom Radiol (NY) 2022; 47:1840-1852. [PMID: 35237897 DOI: 10.1007/s00261-022-03456-x] [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] [Received: 12/21/2021] [Revised: 02/11/2022] [Accepted: 02/14/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE Multiparametric quantitative renal MRI may provide noninvasive radiologic biomarkers of chronic kidney disease (CKD) based on investigations in animal models and adults. We aimed to (1) obtain normative multiparametric quantitative MRI data from the kidneys of healthy children and young adults, (2) compare MRI measurements between healthy control participants and patients with CKD, and (3) determine if MRI measurements correlate with clinical and laboratory data as well as histology. METHODS This was a prospective, case-control study of 20 healthy controls and 12 CKD patients who underwent percutaneous renal biopsy ranging from 12 to 23 years of age between October 2018 and March 2020. Kidney function was documented and pathology assessed for fibrosis/inflammation. Utilizing a field strength of 1.5T, we examined renal T1, T2, and T2* relaxation mapping, MR elastography (MRE), and diffusion-weighted imaging (DWI). A single analyst made all manual measurements for quantitative MRI pulse sequences. Independent measurements from cortex, medulla, and whole kidney were obtained by drawing regions of interest on single slices from the upper, mid, and lower kidney. A weighted average was calculated for each kidney; if two kidneys, the right and left were averaged. Continuous variables were compared with Mann-Whitney U test; bivariate relationships were assessed using Spearman rank-order correlation. RESULTS Median estimated glomerular filtration rate (eGFR) was 112.3 ml/min/1.73 m2 in controls (n = 20, 10 females) and 55.0 ml/min/m2 in CKD patients (n = 12, 2 females) (p < 0.0001). Whole kidney (1333 vs. 1291 ms; p = 0.018) and cortical (1212 vs 1137 ms; p < 0.0001) T1 values were higher in CKD patients. Cortical T1 values correlated with eGFR (rho = - 0.62; p = 0.0003) and cystatin C (rho = 0.58; p = 0.0007). Whole kidney (1.87 vs. 2.02 10-3 mm2/s; p = 0.007), cortical (1.89 vs. 2.04 10-3 mm2/s; p = 0.008), and medullary (1.87 vs. 1.98 10-3 mm2/s; p = 0.0095) DWI apparent diffusion coefficients (ADC) were lower in CKD patients. Whole kidney ADC correlated with eGFR (rho = 0.45; p = 0.012) and cystatin C (rho = - 0.46; p = 0.009). Cortical histologic inflammation correlated with DWI ADC (rho = - 0.71; p = 0.011). CONCLUSION Renal T1 relaxation and DWI ADC measurements differ between pediatric healthy controls and CKD patients, correlate with laboratory markers of CKD, and may have histologic correlates.
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Affiliation(s)
- Jonathan R Dillman
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45244, USA.
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Stefanie W Benoit
- Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Deep B Gandhi
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45244, USA
| | - Andrew T Trout
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45244, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Jean A Tkach
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45244, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Katherine VandenHeuvel
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Division of Pathology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pathology and Laboratory Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Prasad Devarajan
- Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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15
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Multiparametric Functional MRI of the Kidney: Current State and Future Trends with Deep Learning Approaches. ROFO-FORTSCHR RONTG 2022; 194:983-992. [PMID: 35272360 DOI: 10.1055/a-1775-8633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Until today, assessment of renal function has remained a challenge for modern medicine. In many cases, kidney diseases accompanied by a decrease in renal function remain undetected and unsolved, since neither laboratory tests nor imaging diagnostics provide adequate information on kidney status. In recent years, developments in the field of functional magnetic resonance imaging with application to abdominal organs have opened new possibilities combining anatomic imaging with multiparametric functional information. The multiparametric approach enables the measurement of perfusion, diffusion, oxygenation, and tissue characterization in one examination, thus providing more comprehensive insight into pathophysiological processes of diseases as well as effects of therapeutic interventions. However, application of multiparametric fMRI in the kidneys is still restricted mainly to research areas and transfer to the clinical routine is still outstanding. One of the major challenges is the lack of a standardized protocol for acquisition and postprocessing including efficient strategies for data analysis. This article provides an overview of the most common fMRI techniques with application to the kidney together with new approaches regarding data analysis with deep learning. METHODS This article implies a selective literature review using the literature database PubMed in May 2021 supplemented by our own experiences in this field. RESULTS AND CONCLUSION Functional multiparametric MRI is a promising technique for assessing renal function in a more comprehensive approach by combining multiple parameters such as perfusion, diffusion, and BOLD imaging. New approaches with the application of deep learning techniques could substantially contribute to overcoming the challenge of handling the quantity of data and developing more efficient data postprocessing and analysis protocols. Thus, it can be hoped that multiparametric fMRI protocols can be sufficiently optimized to be used for routine renal examination and to assist clinicians in the diagnostics, monitoring, and treatment of kidney diseases in the future. KEY POINTS · Multiparametric fMRI is a technique performed without the use of radiation, contrast media, and invasive methods.. · Multiparametric fMRI provides more comprehensive insight into pathophysiological processes of kidney diseases by combining functional and structural parameters.. · For broader acceptance of fMRI biomarkers, there is a need for standardization of acquisition, postprocessing, and analysis protocols as well as more prospective studies.. · Deep learning techniques could significantly contribute to an optimization of data acquisition and the postprocessing and interpretation of larger quantities of data.. CITATION FORMAT · Zhang C, Schwartz M, Küstner T et al. Multiparametric Functional MRI of the Kidney: Current State and Future Trends with Deep Learning Approaches. Fortschr Röntgenstr 2022; DOI: 10.1055/a-1775-8633.
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16
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Makvandi K, Hockings PD, Jensen G, Unnerstall T, Leonhardt H, Jarl LV, Englund C, Francis S, Sundgren AK, Hulthe J, Baid-Agrawal S. Multiparametric Magnetic Resonance Imaging Allows Non-Invasive Functional and Structural Evaluation of Diabetic Kidney Disease. Clin Kidney J 2022; 15:1387-1402. [PMID: 35756740 PMCID: PMC9217657 DOI: 10.1093/ckj/sfac054] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Indexed: 11/15/2022] Open
Abstract
Background We sought to develop a novel non-contrast multiparametric MRI (mpMRI) protocol employing several complementary techniques in a single scan session for a comprehensive functional and structural evaluation of diabetic kidney disease (DKD). Methods In the cross-sectional part of this prospective observational study, 38 subjects ages 18‒79 years with type 2 diabetes and DKD [estimated glomerular filtration rate (eGFR) 15‒60 mL/min/1.73 m2] and 20 age- and gender-matched healthy volunteers (HVs) underwent mpMRI. Repeat mpMRI was performed on 23 DKD subjects and 10 HVs. By measured GFR (mGFR), 2 DKD subjects had GFR stage G2, 16 stage G3 and 20 stage G4/G5. A wide range of MRI biomarkers associated with kidney haemodynamics, oxygenation and macro/microstructure were evaluated. Their optimal sensitivity, specificity and repeatability to differentiate diabetic versus healthy kidneys and categorize various stages of disease as well as their correlation with mGFR/albuminuria was assessed. Results Several MRI biomarkers differentiated diabetic from healthy kidneys and distinct GFR stages (G3 versus G4/G5); mean arterial flow (MAF) was the strongest predictor (sensitivity 0.94 and 1.0, specificity 1.00 and 0.69; P = .04 and .004, respectively). Parameters significantly correlating with mGFR were specific measures of kidney haemodynamics, oxygenation, microstructure and macrostructure, with MAF being the strongest univariate predictor (r = 0.92; P < .0001). Conclusions A comprehensive and repeatable non-contrast mpMRI protocol was developed that, as a single, non-invasive tool, allows functional and structural assessment of DKD, which has the potential to provide valuable insights into underlying pathophysiology, disease progression and analysis of efficacy/mode of action of therapeutic interventions in DKD.
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Affiliation(s)
- Kianoush Makvandi
- Department of Molecular and Clinical Medicine/Nephrology, The Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Paul D Hockings
- Antaros Medical, Molndal, Sweden
- MedTech West, Chalmers University of Technology, Gothenburg, Sweden
| | - Gert Jensen
- Department of Molecular and Clinical Medicine/Nephrology, The Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Tim Unnerstall
- Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Henrik Leonhardt
- Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | | | - Susan Francis
- Sir Peter Mansfield Imaging Centre, University of Nottingham, Nottingham, UK
| | - Anna K Sundgren
- Late-Stage Development, Cardiovascular, Renal and Metabolism (CVRM), BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, MD, USA
| | | | - Seema Baid-Agrawal
- Department of Molecular and Clinical Medicine/Nephrology, The Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
- Transplant Center, Sahlgrenska University Hospital, Gothenburg, Sweden
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17
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Comparison of multiparametric magnetic resonance imaging sequences with laboratory parameters for prognosticating renal function in chronic kidney disease. Sci Rep 2021; 11:22129. [PMID: 34764322 PMCID: PMC8586015 DOI: 10.1038/s41598-021-01147-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 10/11/2021] [Indexed: 11/12/2022] Open
Abstract
Magnetic resonance imaging (MRI) is playing an increasingly important role in evaluating chronic kidney disease (CKD). It has the potential to be used not only for evaluation of physiological and pathological states, but also for prediction of disease course. Although different MRI sequences have been employed in renal disease, there are few studies that have compared the different sequences. We compared several multiparametric MRI sequences, and compared their results with the estimated glomerular filtration rate. Principal component analysis showed a similarity between T1 values and tissue perfusion (arterial spin labelling), and between fractional anisotropy (diffusion tensor imaging) and apparent diffusion coefficient values (diffusion-weighted imaging). In multiple regression analysis, only T2* values, derived from the blood oxygenation level-dependent (BOLD) MRI sequence, were associated with estimated glomerular filtration rate slope after adjusting for degree of proteinuria, a classic prognostic factor for CKD. In receiver operating characteristic curve analysis, T2* values were a good predictor of rapid deterioration, regardless of the degree of proteinuria. This suggests further study of the use of BOLD-derived T2* values in the workup of CKD, especially to predict the disease course.
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18
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Alhummiany BA, Shelley D, Saysell M, Olaru MA, Kühn B, Buckley DL, Bailey J, Wroe K, Coupland C, Mansfield MW, Sourbron SP, Sharma K. Bias and Precision in Magnetic Resonance Imaging-Based Estimates of Renal Blood Flow: Assessment by Triangulation. J Magn Reson Imaging 2021; 55:1241-1250. [PMID: 34397124 DOI: 10.1002/jmri.27888] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 07/31/2021] [Accepted: 08/03/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Renal blood flow (RBF) can be measured with dynamic contrast enhanced-MRI (DCE-MRI) and arterial spin labeling (ASL). Unfortunately, individual estimates from both methods vary and reference-standard methods are not available. A potential solution is to include a third, arbitrating MRI method in the comparison. PURPOSE To compare RBF estimates between ASL, DCE, and phase contrast (PC)-MRI. STUDY TYPE Prospective. POPULATION Twenty-five patients with type-2 diabetes (36% female) and five healthy volunteers (HV, 80% female). FIELD STRENGTH/SEQUENCES A 3 T; gradient-echo 2D-DCE, pseudo-continuous ASL (pCASL) and cine 2D-PC. ASSESSMENT ASL, DCE, and PC were acquired once in all patients. ASL and PC were acquired four times in each HV. RBF was estimated and split-RBF was derived as (right kidney RBF)/total RBF. Repeatability error (RE) was calculated for each HV, RE = 1.96 × SD, where SD is the standard deviation of repeat scans. STATISTICAL TESTS Paired t-tests and one-way analysis of variance (ANOVA) were used for statistical analysis. The 95% confidence interval (CI) for difference between ASL/PC and DCE/PC was assessed using two-sample F-test for variances. Statistical significance level was P < 0.05. Influential outliers were assessed with Cook's distance (Di > 1) and results with outliers removed were presented. RESULTS In patients, the mean RBF (mL/min/1.73m2 ) was 618 ± 62 (PC), 526 ± 91 (ASL), and 569 ± 110 (DCE). Differences between measurements were not significant (P = 0.28). Intrasubject agreement was poor for RBF with limits-of-agreement (mL/min/1.73m2 ) [-687, 772] DCE-ASL, [-482, 580] PC-DCE, and [-277, 460] PC-ASL. The difference PC-ASL was significantly smaller than PC-DCE, but this was driven by a single-DCE outlier (P = 0.31, after removing outlier). The difference in split-RBF was comparatively small. In HVs, mean RE (±95% CI; mL/min/1.73 m2 ) was significantly smaller for PC (79 ± 41) than for ASL (241 ± 85). CONCLUSIONS ASL, DCE, and PC RBF show poor agreement in individual subjects but agree well on average. Triangulation with PC suggests that the accuracy of ASL and DCE is comparable. EVIDENCE LEVEL 2 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
| | - David Shelley
- Department of Biomedical Imaging Sciences, University of Leeds, Leeds, UK.,Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Margaret Saysell
- Department of Biomedical Imaging Sciences, University of Leeds, Leeds, UK.,Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | - Bernd Kühn
- Siemens Healthcare GmbH, Erlangen, Germany
| | - David L Buckley
- Department of Biomedical Imaging Sciences, University of Leeds, Leeds, UK
| | | | - Kelly Wroe
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | | | - Steven P Sourbron
- Department of Imaging, Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, UK
| | - Kanishka Sharma
- Department of Imaging, Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, UK
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Lin L, Zhou X, Dekkers IA, Lamb HJ. Cardiorenal Syndrome: Emerging Role of Medical Imaging for Clinical Diagnosis and Management. J Pers Med 2021; 11:734. [PMID: 34442378 PMCID: PMC8400880 DOI: 10.3390/jpm11080734] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 07/24/2021] [Accepted: 07/24/2021] [Indexed: 12/16/2022] Open
Abstract
Cardiorenal syndrome (CRS) concerns the interconnection between heart and kidneys in which the dysfunction of one organ leads to abnormalities of the other. The main clinical challenges associated with cardiorenal syndrome are the lack of tools for early diagnosis, prognosis, and evaluation of therapeutic effects. Ultrasound, computed tomography, nuclear medicine, and magnetic resonance imaging are increasingly used for clinical management of cardiovascular and renal diseases. In the last decade, rapid development of imaging techniques provides a number of promising biomarkers for functional evaluation and tissue characterization. This review summarizes the applicability as well as the future technological potential of each imaging modality in the assessment of CRS. Furthermore, opportunities for a comprehensive imaging approach for the evaluation of CRS are defined.
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Affiliation(s)
- Ling Lin
- Cardiovascular Imaging Group (CVIG), Department of Radiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (L.L.); (I.A.D.); (H.J.L.)
| | - Xuhui Zhou
- Department of Radiology, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen 510833, China
| | - Ilona A. Dekkers
- Cardiovascular Imaging Group (CVIG), Department of Radiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (L.L.); (I.A.D.); (H.J.L.)
| | - Hildo J. Lamb
- Cardiovascular Imaging Group (CVIG), Department of Radiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (L.L.); (I.A.D.); (H.J.L.)
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20
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Vinovskis C, Li LP, Prasad P, Tommerdahl K, Pyle L, Nelson RG, Pavkov ME, van Raalte D, Rewers M, Pragnell M, Mahmud FH, Cherney DZ, Johnson RJ, Nadeau KJ, Bjornstad P. Relative Hypoxia and Early Diabetic Kidney Disease in Type 1 Diabetes. Diabetes 2020; 69:2700-2708. [PMID: 32737116 PMCID: PMC7679770 DOI: 10.2337/db20-0457] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 07/27/2020] [Indexed: 12/15/2022]
Abstract
The objective of this study was to compare the ratio of renal oxygen availability (RO2) to glomerular filtration rate (GFR), a measure of relative renal hypoxia, in adolescents with and without type 1 diabetes (T1D) and relate the ratio to albuminuria, renal plasma flow (RPF), fat mass, and insulin sensitivity (M/I). RO2 was estimated by blood oxygen level-dependent MRI; fat mass was estimated by DXA; GFR and RPF were estimated by iohexol and p-aminohippurate clearance; albuminuria was estimated by urine albumin-to-creatinine ratio (UACR); and M/I was estimated from steady-state glucose infusion rate/insulin (mg/kg/min) by hyperglycemic clamp in 50 adolescents with T1D (age 16.1 ± 3.0 years, HbA1c 8.6 ± 1.2%) and 20 control patients of similar BMI (age 16.1 ± 2.9 years, HbA1c 5.2 ± 0.2%). The RO2:GFR (ms/mL/min) was calculated as RO2 (T2*, ms) divided by GFR (mL/min). Whole-kidney RO2:GFR was 25% lower in adolescents with T1D versus control patients (P < 0.0001). In adolescents with T1D, lower whole-kidney RO2:GFR was associated with higher UACR (r = -0.31, P = 0.03), RPF (r = -0.52, P = 0.0009), and fat mass (r = -0.33, P = 0.02). Lower medullary RO2:GFR was associated with lower M/I (r = 0.31, P = 0.03). In conclusion, adolescents with T1D exhibited relative renal hypoxia that was associated with albuminuria and with increased RPF, fat mass, and insulin resistance. These data suggest a potential role of renal hypoxia in the development of diabetic kidney disease.
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Affiliation(s)
- Carissa Vinovskis
- Section of Endocrinology, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
| | - Lu-Ping Li
- Department of Radiology, NorthShore University HealthSystem, Evanston, IL
| | - Pottumarthi Prasad
- Department of Radiology, NorthShore University HealthSystem, Evanston, IL
| | - Kalie Tommerdahl
- Section of Endocrinology, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
| | - Laura Pyle
- Section of Endocrinology, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
| | - Robert G Nelson
- Chronic Kidney Disease Section, Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ
| | - Meda E Pavkov
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
| | - Daniel van Raalte
- Diabetes Center, Department of Internal Medicine, Amsterdam University Medical Centers, location VUmc, Amsterdam, the Netherlands
| | - Marian Rewers
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, CO
| | | | - Farid H Mahmud
- Division of Endocrinology, Department of Pediatrics, University of Toronto School of Medicine, Toronto, Ontario, Canada
| | - David Z Cherney
- Division of Nephrology, Department of Medicine, University of Toronto School of Medicine, Toronto, Ontario, Canada
| | - Richard J Johnson
- Division of Nephrology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO
| | - Kristen J Nadeau
- Section of Endocrinology, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
| | - Petter Bjornstad
- Section of Endocrinology, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
- Division of Nephrology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO
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21
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Early detection of subclinical pathology in patients with stable kidney graft function by arterial spin labeling. Eur Radiol 2020; 31:2687-2695. [PMID: 33151395 DOI: 10.1007/s00330-020-07369-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 08/24/2020] [Accepted: 10/02/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVES To evaluate the utility of arterial spin labeling (ASL) for the identification of kidney allografts with underlying pathologies, particularly those with stable graft function. METHODS A total of 75 patients, including 18 stable grafts with normal histology (normal group), 21 stable grafts with biopsy-proven pathology (subclinical pathology group), and 36 with unstable graft function (unstable graft group), were prospectively examined by ASL magnetic resonance imaging. Receiver operating characteristic curves were generated to calculate the area under the curve (AUC), sensitivity, and specificity. RESULTS Patient demographics among the 3 groups were comparable. Compared with the normal group, kidney allograft cortical ASL values decreased in the subclinical pathology group and the unstable graft group (204.7 ± 44.9 ml/min/100 g vs 152.5 ± 38.9 ml/min/100 g vs 92.3 ± 37.4 ml/min/100 g, p < 0.001). The AUC, sensitivity, and specificity for discriminating allografts with pathologic changes from normal allografts were 0.92 (95% CI, 0.83-0.97), 71.9%, and 100% respectively by cortical ASL and 0.82 (95% CI, 0.72-0.90), 54.4%, and 100% respectively by serum creatinine. The cortical ASL identified allografts with subclinical pathology among patients with stable graft function with an AUC of 0.80 (95% CI, 0.64-0.91), sensitivity of 57.1%, and specificity of 88.9%. Combined use of proteinuria and cortical ASL could improve the sensitivity and specificity to 76.2% and 100% respectively for distinguishing the subclinical pathology group from the normal group. CONCLUSIONS Cortical ASL is useful for the identification of allografts with underlying pathologies. More importantly, ASL showed promise as a non-invasive tool for the clinical translation of identifying kidney allografts with subclinical pathology. KEY POINTS • Cortical ASL values were decreased in kidney allografts with subclinical pathologic changes as compared with normal allografts (152.5 ± 38.9 ml/min/100 g vs 204.7 ± 44.9 ml/min/100 g, p < 0.001). • Cortical ASL differentiated allografts with pathologic changes and subclinical pathology group from normal group with an AUC of 0.92 (95% CI, 0.83-0.97) and 0.80 (95% CI, 0.64-0.91) respectively. • Cortical ASL discriminated allografts with underlying pathologic changes from normal allografts with a specificity of 100%, and combined use of proteinuria and cortical ASL values could also achieve 100% specificity for discriminating allografts with subclinical pathology from normal allografts.
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22
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de Boer A, Pieters TT, Harteveld AA, Blankestijn PJ, Bos C, Froeling M, Goldschmeding R, Hoogduin HJM, Joles JA, Petri BJ, Verhaar MC, Leiner T, Nguyen TQ, van Zuilen AD. Validation of multiparametric MRI by histopathology after nephrectomy: a case study. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2020; 34:377-387. [PMID: 32954447 PMCID: PMC8154819 DOI: 10.1007/s10334-020-00887-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 07/23/2020] [Accepted: 09/01/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Renal multiparametric MRI (mpMRI) is a promising tool to monitor renal allograft health to enable timely treatment of chronic allograft nephropathy. This study aims to validate mpMRI by whole-kidney histology following transplantectomy. MATERIALS AND METHODS A patient with kidney transplant failure underwent mpMRI prior to transplantectomy. The mpMRI included blood oxygenation level-dependent (BOLD) MRI, T1 and T2 mapping, diffusion-weighted imaging (DWI), 2D phase contrast (2DPC) and arterial spin labeling (ASL). Parenchymal mpMRI measures were compared to normative values obtained in 19 healthy controls. Differences were expressed in standard deviations (SD) of normative values. The mpMRI measures were compared qualitatively to histology. RESULTS The mpMRI showed a heterogeneous parenchyma consistent with extensive interstitial hemorrhage on histology. A global increase in T1 (+ 3.0 SD) and restricted diffusivity (- 3.6 SD) were consistent with inflammation and fibrosis. Decreased T2 (- 1.8 SD) indicated fibrosis or hemorrhage. ASL showed diminished cortical perfusion (- 2.9 SD) with patent proximal arteries. 2DPC revealed a 69% decrease in renal perfusion. Histological evaluation showed a dense inflammatory infiltrate and fibrotic changes, consistent with mpMRI results. Most interlobular arteries were obliterated while proximal arteries were patent, consistent with ASL findings. DISCUSSION mpMRI findings correlated well with histology both globally as well as locally.
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Affiliation(s)
- Anneloes de Boer
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
| | - Tobias T Pieters
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Anita A Harteveld
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Peter J Blankestijn
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Clemens Bos
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Martijn Froeling
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Roel Goldschmeding
- Department of Pathology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Hans J M Hoogduin
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Jaap A Joles
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Bart-Jeroen Petri
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Marianne C Verhaar
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Tim Leiner
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Tri Q Nguyen
- Department of Pathology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Arjan D van Zuilen
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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23
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Adams LC, Bressem KK, Scheibl S, Nunninger M, Gentsch A, Fahlenkamp UL, Eckardt KU, Hamm B, Makowski MR. Multiparametric Assessment of Changes in Renal Tissue after Kidney Transplantation with Quantitative MR Relaxometry and Diffusion-Tensor Imaging at 3 T. J Clin Med 2020; 9:jcm9051551. [PMID: 32455558 PMCID: PMC7290480 DOI: 10.3390/jcm9051551] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 05/15/2020] [Accepted: 05/18/2020] [Indexed: 12/17/2022] Open
Abstract
Background: Magnetic resonance relaxometry (MRR) offers highly reproducible pixel-wise parametric maps of T1 and T2 relaxation times, reflecting specific tissue properties, while diffusion-tensor imaging (DTI) is a promising technique for the characterization of microstructural changes, depending on the directionality of molecular motion. Both MMR and DTI may be used for non-invasive assessment of parenchymal changes caused by kidney injury or graft dysfunction. Methods: We examined 46 patients with kidney transplantation and 16 healthy controls, using T1/T2 relaxometry and DTI at 3 T. Twenty-two early transplants and 24 late transplants were included. Seven of the patients had prior renal biopsy (all of them dysfunctional allografts; 6/7 with tubular atrophy and 7/7 with interstitial fibrosis). Results: Compared to healthy controls, T1 and T2 relaxation times in the renal parenchyma were increased after transplantation, with the highest T1/T2 values in early transplants (T1: 1700 ± 53 ms/T2: 83 ± 6 ms compared to T1: 1514 ± 29 ms/T2: 78 ± 4 ms in controls). Medullary and cortical ADC/FA values were decreased in early transplants and highest in controls, with medullary FA values showing the most pronounced difference. Cortical renal T1, mean medullary FA and corticomedullary differentiation (CMD) values correlated best with renal function as measured by eGFR (cortical T1: r = −0.63, p < 0.001; medullary FA: r = 0.67, p < 0.001; FA CMD: r = 0.62, p < 0.001). Mean medullary FA proved to be a significant predictor for tubular atrophy (p < 0.001), while cortical T1 appeared as a significant predictor of interstitial fibrosis (p = 0.003). Conclusion: Cortical T1, medullary FA, and FA CMD might serve as new imaging biomarkers of renal function and histopathologic microstructure.
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Affiliation(s)
- Lisa C. Adams
- Department of Radiology, Charité, Charitéplatz 1, 10117 Berlin, Germany; (S.S.); (M.N.); (U.L.F.); (B.H.)
- Correspondence: (L.C.A.); (K.K.B.); Tel.: +49-30627376 (L.C.A.)
| | - Keno K. Bressem
- Department of Radiology, Charité, Hindenburgdamm 30, 12203 Berlin, Germany
- Correspondence: (L.C.A.); (K.K.B.); Tel.: +49-30627376 (L.C.A.)
| | - Sonja Scheibl
- Department of Radiology, Charité, Charitéplatz 1, 10117 Berlin, Germany; (S.S.); (M.N.); (U.L.F.); (B.H.)
| | - Max Nunninger
- Department of Radiology, Charité, Charitéplatz 1, 10117 Berlin, Germany; (S.S.); (M.N.); (U.L.F.); (B.H.)
| | - Andre Gentsch
- Department of Nephrology, Charité, Charitéplatz 1, 10117 Berlin, Germany; (A.G.); (K.-U.E.)
| | - Ute L. Fahlenkamp
- Department of Radiology, Charité, Charitéplatz 1, 10117 Berlin, Germany; (S.S.); (M.N.); (U.L.F.); (B.H.)
| | - Kai-Uwe Eckardt
- Department of Nephrology, Charité, Charitéplatz 1, 10117 Berlin, Germany; (A.G.); (K.-U.E.)
| | - Bernd Hamm
- Department of Radiology, Charité, Charitéplatz 1, 10117 Berlin, Germany; (S.S.); (M.N.); (U.L.F.); (B.H.)
| | - Marcus R. Makowski
- Department of Radiology, Charité, Charitéplatz 1, 10117 Berlin, Germany; (S.S.); (M.N.); (U.L.F.); (B.H.)
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, School of Medicine, 81675 Munich, Germany
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