1
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Peng J, Gao J, Hong Y, Wu Z, Chen G, Lu G. The value of functional magnetic resonance imaging in evaluating renal allograft function. Asian J Surg 2024; 47:1740-1745. [PMID: 38176978 DOI: 10.1016/j.asjsur.2023.12.121] [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: 08/30/2023] [Revised: 12/05/2023] [Accepted: 12/15/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND To explore the value of arterial spin labeled (ASL) and blood oxygen level dependent (BOLD) imaging in evaluating allogeneic kidney function after renal transplantation. METHODS One hundred and thirty-five renal transplant patients were included. Demographic and imaging data were collected. Transplanted renal function, pathology, ASL and BOLD parameters were obtained. The patients were divided into normal, mild and severe injury group. The correlation between BOLD/ASL parameters and clinical data were evaluated. The prediction models were based on ASL and BOLD parameters using multivariate logistic analysis. Cox proportional hazards regression model was used to analyze the effects of gender, age, ASL and BOLD on the survival of renal transplant patients. RESULTS ASL and BOLD parameters were independently associated with renal function injury and renal allograft positive pathology. The AUC of prediction model for renal allograft function based on ASL and BOLD parameters was 0.85, while the AUC based on BOLD parameters was 0.70. Renal transplantation time showed a positive correlation with age, BOLD parameters and SCr,while a negative correlation with ASL parameters and eGFR. ASL parameter was positively correlated with eGFR and negatively correlated with Scr. BOLD parameter was negatively correlated with eGFR, ASL and positively correlated with Scr. Cox proportional hazards regression model showed that the increase of age could reduce the risk of renal function injury and positive pathology. CONCLUSIONS ASL and BOLD were associated with renal function injury and renal allograft positive pathology. ASL and BOLD had some value in predicting renal allograft function.
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Affiliation(s)
- Jin Peng
- Department of Tumor and Vascular Intervention, Chenggong Hospital, Xiamen University, Xiamen, Fujian, 361003, China
| | - Juan Gao
- Department of Radiology, Jinling Hospital, Nanjing University, Nanjing, Jiangsu, 210006, China
| | - Yajun Hong
- Department of Medical Record Statistics, Zhongshan Hospital, Fudan University (Xiamen Branch), Fujian, 361015, China
| | - Zhengcan Wu
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, 210006, China
| | - Guozhong Chen
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, 210006, China.
| | - Guangming Lu
- Department of Radiology, Jinling Hospital, Nanjing University, Nanjing, Jiangsu, 210006, China.
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2
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Bane O, Lewis SC, Lim RP, Carney BW, Shah A, Fananapazir G. Contemporary and Emerging MRI Strategies for Assessing Kidney Allograft Complications: Arterial Stenosis and Parenchymal Injury, From the AJR Special Series on Imaging of Fibrosis. AJR Am J Roentgenol 2024; 222:e2329418. [PMID: 37315018 PMCID: PMC11006565 DOI: 10.2214/ajr.23.29418] [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] [Indexed: 06/16/2023]
Abstract
MRI plays an important role in the evaluation of kidney allografts for vascular complications as well as parenchymal insults. Transplant renal artery stenosis, the most common vascular complication of kidney transplant, can be evaluated by MRA using gadolinium and nongadolinium contrast agents as well as by unenhanced MRA techniques. Parenchymal injury occurs through a variety of pathways, including graft rejection, acute tubular injury, BK polyomavirus infection, drug-induced interstitial nephritis, and pyelonephritis. Investigational MRI techniques have sought to differentiate among these causes of dysfunction as well as to assess the degree of interstitial fibrosis or tubular atrophy (IFTA)-the common end pathway for all of these processes-which is currently evaluated by invasively obtained core biopsies. Some of these MRI sequences have shown promise in not only assessing the cause of parenchymal injury but also assessing IFTA noninvasively. This review describes current clinically used MRI techniques and previews promising investigational MRI techniques for assessing complications of kidney grafts.
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Affiliation(s)
- Octavia Bane
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Sara C Lewis
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Ruth P Lim
- Department of Radiology and Department of Surgery, University of Melbourne, Austin Health, Melbourne, Australia
| | - Benjamin W Carney
- Department of Radiology, University of California Davis Medical Center, 4860 Y St, Ste 3100, Sacramento, CA 95816
| | - Amar Shah
- Department of Radiology, Mayo Clinic Arizona, Phoenix, AZ
| | - Ghaneh Fananapazir
- Department of Radiology, University of California Davis Medical Center, 4860 Y St, Ste 3100, Sacramento, CA 95816
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3
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Brumer I, Bauer DF, Schad LR, Zöllner FG. Synthetic Arterial Spin Labeling MRI of the Kidneys for Evaluation of Data Processing Pipeline. Diagnostics (Basel) 2022; 12:diagnostics12081854. [PMID: 36010205 PMCID: PMC9406826 DOI: 10.3390/diagnostics12081854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 07/28/2022] [Accepted: 07/29/2022] [Indexed: 11/30/2022] Open
Abstract
Accurate quantification of perfusion is crucial for diagnosis and monitoring of kidney function. Arterial spin labeling (ASL), a completely non-invasive magnetic resonance imaging technique, is a promising method for this application. However, differences in acquisition (e.g., ASL parameters, readout) and processing (e.g., registration, segmentation) between studies impede the comparison of results. To alleviate challenges arising solely from differences in processing pipelines, synthetic data are of great value. In this work, synthetic renal ASL data were generated using body models from the XCAT phantom and perfusion was added using the general kinetic model. Our in-house developed processing pipeline was then evaluated in terms of registration, quantification, and segmentation using the synthetic data. Registration performance was evaluated qualitatively with line profiles and quantitatively with mean structural similarity index measures (MSSIMs). Perfusion values obtained from the pipeline were compared to the values assumed when generating the synthetic data. Segmentation masks obtained by semi-automated procedure of the processing pipeline were compared to the original XCAT organ masks using the Dice index. Overall, the pipeline evaluation yielded good results. After registration, line profiles were smoother and, on average, MSSIMs increased by 25%. Mean perfusion values for cortex and medulla were close to the assumed perfusion of 250 mL/100 g/min and 50 mL/100 g/min, respectively. Dice indices ranged 0.80–0.93, 0.78–0.89, and 0.64–0.84 for whole kidney, cortex, and medulla, respectively. The generation of synthetic ASL data allows flexible choice of parameters and the generated data are well suited for evaluation of processing pipelines.
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4
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Ahn HS, Jung Y, Park SH. Measuring glomerular blood transfer rate in kidney using diffusion-weighted arterial spin labeling. Magn Reson Med 2022; 88:2408-2418. [PMID: 35877788 DOI: 10.1002/mrm.29401] [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: 01/27/2022] [Revised: 07/05/2022] [Accepted: 07/08/2022] [Indexed: 11/07/2022]
Abstract
PURPOSE To propose a two-compartment renal perfusion model for calculating glomerular blood transfer rate ( k G $$ {k}_G $$ ) as a new measure of renal function. THEORY The renal perfusion signal was divided into preglomerular and postglomerular flows according to flow velocity. By analyzing perfusion signals acquired with and without diffusion gradients, we estimated k G $$ {k}_G $$ , the blood transfer rate from the afferent arterioles into the glomerulus. METHODS A multislice multidelay diffusion-weighted arterial spin labeling sequence was applied to subjects with no history of renal dysfunctions. In the multiple b-value experiment, images were acquired with seven b-values to validate the bi-exponential decays of the renal perfusion signal and to determine the appropriate b-value for suppressing preglomerular flow. In the caffeine challenge, six subjects were scanned twice on the caffeine day and the control day. The k G $$ {k}_G $$ values of the two dates were compared. RESULTS The perfusion signal showed a bi-exponential decay with b-values. There was no significant difference in renal blood flow and arterial transit time between caffeine and control days. In contrast, cortical k G $$ {k}_G $$ was significantly higher on the caffeine day (caffeine day: 106 . 0 ± 20 . 3 $$ 106.0\pm 20.3 $$ min - 1 $$ {}^{-1} $$ control day: 78 . 8 ± 22 . 9 $$ 78.8\pm 22.9 $$ min - 1 $$ {}^{-1} $$ ). These results were consistent with those from the literature. CONCLUSION We showed that the perfusion signal consists of two compartments of preglomerular flow and postglomerular flow. The proposed diffusion-weighted arterial spin labeling could measure the glomerular blood transfer rate ( k G $$ {k}_G $$ ), which was sensitive enough to noninvasively monitor the caffeine-induced vasodilation of afferent arterioles.
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Affiliation(s)
- Hyun-Seo Ahn
- Department of Bio and Brain Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Korea
| | - Yujin Jung
- Department of Bio and Brain Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Korea
| | - Sung-Hong Park
- Department of Bio and Brain Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Korea
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5
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Aggarwal A, Das CJ, Sharma S. Recent advances in imaging techniques of renal masses. World J Radiol 2022; 14:137-150. [PMID: 35978979 PMCID: PMC9258310 DOI: 10.4329/wjr.v14.i6.137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 03/04/2022] [Accepted: 06/17/2022] [Indexed: 02/06/2023] Open
Abstract
Multiphasic multidetector computed tomography (CT) forms the mainstay for the characterization of renal masses whereas magnetic resonance imaging (MRI) acts as a problem-solving tool in some cases. However, a few of the renal masses remain indeterminate even after evaluation by conventional imaging methods. To overcome the deficiency in current imaging techniques, advanced imaging methods have been devised and are being tested. This review will cover the role of contrast-enhanced ultrasonography, shear wave elastography, dual-energy CT, perfusion CT, MR perfusion, diffusion-weighted MRI, blood oxygen level-dependent MRI, MR spectroscopy, positron emission tomography (PET)/prostate-specific membrane antigen-PET in the characterization of renal masses.
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Affiliation(s)
- Ankita Aggarwal
- Department of Radiology, Vardhman Mahavir Medical College& Safdarjung Hospital, Delhi 110029, India
| | - Chandan J Das
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, Delhi 110029, India
| | - Sanjay Sharma
- Department of Radiology (RPC), All India Institute of Medical Sciences, New Delhi 110029, India
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6
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Chhabra J, Karwarker GV, Rajamanuri M, Maligireddy AR, Dai E, Chahal M, Mannava SM, Alfonso M. The Role of Arterial Spin Labeling Functional MRI in Assessing Perfusion Impairment of Renal Allografts: A Systematic Review. Cureus 2022; 14:e25428. [PMID: 35769679 PMCID: PMC9236280 DOI: 10.7759/cureus.25428] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 05/28/2022] [Indexed: 11/05/2022] Open
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7
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Radovic T, Jankovic MM, Stevic R, Spasojevic B, Cvetkovic M, Pavicevic P, Gojkovic I, Kostic M. Detection of impaired renal allograft function in paediatric and young adult patients using arterial spin labelling MRI (ASL-MRI). Sci Rep 2022; 12:828. [PMID: 35039571 PMCID: PMC8764097 DOI: 10.1038/s41598-022-04794-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 12/31/2021] [Indexed: 12/11/2022] Open
Abstract
The study aimed to discriminate renal allografts with impaired function by measuring cortical renal blood flow (cRBF) using magnetic resonance imaging arterial spin labelling (ASL-MRI) in paediatric and young adult patients. We included 18 subjects and performed ASL-MRI on 1.5 T MRI to calculate cRBF on parameter maps. cRBF was correlated to calculated glomerular filtration rate (GFR) and compared between patient groups with good (GFR ≥ 60 mL/min/1.73 m2) and impaired allograft function (GFR < 60 mL/min/1.73 m2). Mean cRBF in patients with good allograft function was significantly higher than in patients with impaired allograft function (219.89 ± 57.24 mL/min/100 g vs. 146.22 ± 41.84 mL/min/100 g, p < 0.008), showing a highly significant correlation with GFR in all subjects (r = 0.75, p < 0.0001). Also, the diffusion-weighted imaging (DWI-MRI) apparent diffusion coefficient (ADC) and Doppler measurements of peak-systolic and end-diastolic velocities and the resistive index (PS, ED, RI) were performed and both methods showed no significant difference between groups. ADC implied no correlation with GFR (r = 0.198, p = 0.464), while PS indicated moderate correlation to GFR (r = 0.48, p < 0.05), and PS and ED moderate correlation to cRBF (r = 0.58, p < 0.05, r = 0.56, p < 0.05, respectively). Cortical perfusion as non-invasively measured by ASL-MRI differs between patients with good and impaired allograft function and correlates significantly with its function.
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Affiliation(s)
- Tijana Radovic
- Department of Radiology, University Children's Hospital, Belgrade, Serbia.
| | - Milica M Jankovic
- Department of Signals and Systems, School of Electrical Engineering, University of Belgrade, Belgrade, Serbia
| | - Ruza Stevic
- School of Medicine, University of Belgrade, Belgrade, Serbia.,Department of Radiology, Clinical Centre of Serbia, Belgrade, Serbia
| | - Brankica Spasojevic
- School of Medicine, University of Belgrade, Belgrade, Serbia.,Department of Nephrology, Dialysis and Transplantation, University Children's Hospital, Belgrade, Serbia
| | - Mirjana Cvetkovic
- School of Medicine, University of Belgrade, Belgrade, Serbia.,Department of Nephrology, Dialysis and Transplantation, University Children's Hospital, Belgrade, Serbia
| | - Polina Pavicevic
- Department of Radiology, University Children's Hospital, Belgrade, Serbia.,School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ivana Gojkovic
- Department of Nephrology, Dialysis and Transplantation, University Children's Hospital, Belgrade, Serbia
| | - Mirjana Kostic
- School of Medicine, University of Belgrade, Belgrade, Serbia.,Department of Nephrology, Dialysis and Transplantation, University Children's Hospital, Belgrade, Serbia
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8
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Bones IK, Bos C, Moonen C, Hendrikse J, van Stralen M. Workflow for automatic renal perfusion quantification using ASL-MRI and machine learning. Magn Reson Med 2021; 87:800-809. [PMID: 34672029 PMCID: PMC9297892 DOI: 10.1002/mrm.29016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 08/31/2021] [Accepted: 09/01/2021] [Indexed: 11/07/2022]
Abstract
PURPOSE Clinical applicability of renal arterial spin labeling (ASL) MRI is hampered because of time consuming and observer dependent post-processing, including manual segmentation of the cortex to obtain cortical renal blood flow (RBF). Machine learning has proven its value in medical image segmentation, including the kidneys. This study presents a fully automatic workflow for renal cortex perfusion quantification by including machine learning-based segmentation. METHODS Fully automatic workflow was achieved by construction of a cascade of 3 U-nets to replace manual segmentation in ASL quantification. All 1.5T ASL-MRI data, including M0 , T1 , and ASL label-control images, from 10 healthy volunteers was used for training (dataset 1). Trained cascade performance was validated on 4 additional volunteers (dataset 2). Manual segmentations were generated by 2 observers, yielding reference and second observer segmentations. To validate the intended use of the automatic segmentations, manual and automatic RBF values in mL/min/100 g were compared. RESULTS Good agreement was found between automatic and manual segmentations on dataset 1 (dice score = 0.78 ± 0.04), which was in line with inter-observer variability (dice score = 0.77 ± 0.02). Good agreement was confirmed on dataset 2 (dice score = 0.75 ± 0.03). Moreover, similar cortical RBF was obtained with automatic or manual segmentations, on average and at subject level; with 211 ± 31 mL/min/100 g and 208 ± 31 mL/min/100 g (P < .05), respectively, with narrow limits of agreement at -11 and 4.6 mL/min/100 g. RBF accuracy with automated segmentations was confirmed on dataset 2. CONCLUSION Our proposed method automates ASL quantification without compromising RBF accuracy. With quick processing and without observer dependence, renal ASL-MRI is more attractive for clinical application as well as for longitudinal and multi-center studies.
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Affiliation(s)
- Isabell K Bones
- Center for Image Sciences, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Clemens Bos
- Center for Image Sciences, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Chrit Moonen
- Center for Image Sciences, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jeroen Hendrikse
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marijn van Stralen
- Center for Image Sciences, University Medical Center Utrecht, Utrecht, The Netherlands
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9
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Katagiri D, Wang F, Gore JC, Harris RC, Takahashi T. Clinical and experimental approaches for imaging of acute kidney injury. Clin Exp Nephrol 2021; 25:685-699. [PMID: 33835326 PMCID: PMC8154759 DOI: 10.1007/s10157-021-02055-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 03/17/2021] [Indexed: 12/23/2022]
Abstract
Complex molecular cell dynamics in acute kidney injury and its heterogeneous etiologies in patient populations in clinical settings have revealed the potential advantages and disadvantages of emerging novel damage biomarkers. Imaging techniques have been developed over the past decade to further our understanding about diseased organs, including the kidneys. Understanding the compositional, structural, and functional changes in damaged kidneys via several imaging modalities would enable a more comprehensive analysis of acute kidney injury, including its risks, diagnosis, and prognosis. This review summarizes recent imaging studies for acute kidney injury and discusses their potential utility in clinical settings.
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Affiliation(s)
- Daisuke Katagiri
- Division of Nephrology and Hypertension, Vanderbilt University Medical Center, S-3223 MCN, Nashville, TN, 37232, USA.
- Department of Nephrology, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan.
| | - Feng Wang
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt In Vivo Mouse Kidney Imaging Core, Vanderbilt University Medical Center, Nashville, TN, USA
| | - John C Gore
- Vanderbilt In Vivo Mouse Kidney Imaging Core, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Raymond C Harris
- Division of Nephrology and Hypertension, Vanderbilt University Medical Center, S-3223 MCN, Nashville, TN, 37232, USA
| | - Takamune Takahashi
- Division of Nephrology and Hypertension, Vanderbilt University Medical Center, S-3223 MCN, Nashville, TN, 37232, USA.
- Vanderbilt In Vivo Mouse Kidney Imaging Core, Vanderbilt University Medical Center, Nashville, TN, USA.
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10
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Boschheidgen M, Schimmöller L, Kasprowski L, Abrar D, Arsov C, Albers P, Antoch G, Wittsack HJ, Ullrich T. Arterial spin labelling as a gadolinium-free alternative in the detection of prostate cancer. Magn Reson Imaging 2021; 80:33-38. [PMID: 33905833 DOI: 10.1016/j.mri.2021.04.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 04/04/2021] [Accepted: 04/21/2021] [Indexed: 11/19/2022]
Abstract
PURPOSE To determine the capability of Gadolinium-free arterial spin labelling (ASL) sequences as novel, contrast-free, non-invasive alternative perfusion imaging method to differentiate prostate cancer (PCA) from benign prostate tissue compared to conventional DCE MRI. METHODS Thirty men with histologically confirmed PCA were included in this prospectively enrolled single center cohort study. All patients received multiparametric MRI (T2, DWI, DCE) at 3 T with additional ASL of the PCA lesion. Primary endpoint was differentiability of PCA versus benign prostate tissue by signal intensities (SI) and contrast ratios (CR) in ASL in comparison to DCE. For DCE also Signal-Enhancement-Ratio (SER) of native and early contrast enhancement SI was assessed. Secondary objectives were differences regarding PCA localisation in peripheral (PZ) or transition zone (TZ) and PCA detection. RESULTS In both, ASL and DCE, average SI of PCA differed significantly from SI in benign tissue in the TZ and PZ (p < 0,01, respectively). ASL had significantly higher CR discerning PCA and benign tissue in PZ and TZ (PZ = 5.19; TZ = 6.45) compared to DCE SI (PZ = 1.61; TZ = 1.43) and DCE SER (PZ = 1.59; TZ = 1.43) (p < 0.01, respectively). In subjective evaluation, PCA could be detected in ASL in 28 patients, compared to 29 in DCE. CONCLUSION ASL had significantly higher CR differentiating PCA from benign tissue in PZ and TZ compared to DCE. Visual detection of PCA does not differ significantly between the two sequences. As perfusion gadolinium-based contrast media is seen more critical in the last few years, ASL seems to be a promising alternative to DCE in PCA detection.
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Affiliation(s)
- M Boschheidgen
- University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225 Dusseldorf, Germany.
| | - L Schimmöller
- University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225 Dusseldorf, Germany.
| | - L Kasprowski
- University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225 Dusseldorf, Germany.
| | - D Abrar
- University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225 Dusseldorf, Germany.
| | - C Arsov
- University Dusseldorf, Medical Faculty, Department of Urology, D-40225 Dusseldorf, Germany.
| | - P Albers
- University Dusseldorf, Medical Faculty, Department of Urology, D-40225 Dusseldorf, Germany.
| | - G Antoch
- University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225 Dusseldorf, Germany.
| | - H J Wittsack
- University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225 Dusseldorf, Germany.
| | - T Ullrich
- University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225 Dusseldorf, Germany.
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11
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Zheng X, Li M, Wang P, Li X, Zhang Q, Zeng S, Jiang T, Hu X. Assessment of chronic allograft injury in renal transplantation using diffusional kurtosis imaging. BMC Med Imaging 2021; 21:63. [PMID: 33827457 PMCID: PMC8028790 DOI: 10.1186/s12880-021-00595-3] [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: 09/27/2020] [Accepted: 03/28/2021] [Indexed: 11/12/2022] Open
Abstract
Background Chronic allograft injury (CAI) is a significant reason for which many grafts were lost. The study was conducted to assess the usefulness of diffusional kurtosis imaging (DKI) technology in the non-invasive assessment of CAI. Methods Between February 2019 and October 2019, 110 renal allograft recipients were included to analyze relevant DKI parameters. According to estimated glomerular filtration rate (eGFR) (mL/min/ 1.73 m2) level, they were divided to 3 groups: group 1, eGFR ≥ 60 (n = 10); group 2, eGFR 30–60 (n = 69); group 3, eGFR < 30 (n = 31). We performed DKI on a clinical 3T magnetic resonance imaging system. We measured the area of interest to determine the mean kurtosis (MK), mean diffusivity (MD), and apparent diffusion coefficient (ADC) of the renal cortex and medulla. We performed a Pearson correlation analysis to determine the relationship between eGFR and the DKI parameters. We used the receiver operating characteristic curve to estimate the predicted values of DKI parameters in the CAI evaluation. We randomly selected five patients from group 2 for biopsy to confirm CAI. Results With the increase of creatinine, ADC, and MD of the cortex and medulla decrease, MK of the cortex and medulla gradually increase. Among the three different eGFR groups, significant differences were found in cortical and medullary MK (P = 0.039, P < 0.001, P < 0.001, respectively). Cortical and medullary ADC and MD are negatively correlated with eGFR (r = − 0.49, − 0.44, − 0.57, − 0.57, respectively; P < 0.001), while cortical and medullary MK are positively correlated with eGFR (r = 0.42, 0.38; P < 0.001). When 0.491 was set as the cutoff value, MK's CAI assessment showed 87% sensitivity and 100% specificity. All five patients randomly selected for biopsy from the second group confirmed glomerulosclerosis and tubular atrophy/interstitial fibrosis. Conclusion The DKI technique is related to eGFR as allograft injury progresses and is expected to become a potential non-invasive method for evaluating CAI. Supplementary Information The online version contains supplementary material available at 10.1186/s12880-021-00595-3.
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Affiliation(s)
- Xin Zheng
- Department of Urology, Beijing Youan Hospital, Capital Medical University, No. 8, Xi Tou Tiao, Youanmen Wai, Fengtai District, Beijing, 100069, People's Republic of China
| | - Min Li
- Department of Radiology, Beijing Chao-Yang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 200020, People's Republic of China
| | - Pan Wang
- Department of Radiology, Beijing Chao-Yang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 200020, People's Republic of China
| | - Xiangnan Li
- Department of Radiology, Beijing Chao-Yang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 200020, People's Republic of China
| | - Qiang Zhang
- Institute of Urology, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 200020, People's Republic of China.,Department of Urology, Beijing Chao-Yang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 200020, People's Republic of China
| | - Song Zeng
- Institute of Urology, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 200020, People's Republic of China.,Department of Urology, Beijing Chao-Yang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 200020, People's Republic of China
| | - Tao Jiang
- Department of Radiology, Beijing Chao-Yang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 200020, People's Republic of China.
| | - Xiaopeng Hu
- Institute of Urology, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 200020, People's Republic of China. .,Department of Urology, Beijing Chao-Yang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 200020, People's Republic of China.
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12
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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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Ahn HS, Yu HC, Kwak HS, Park SH. Assessment of Renal Perfusion in Transplanted Kidney Patients Using Pseudo-Continuous Arterial Spin Labeling with Multiple Post-Labeling Delays. Eur J Radiol 2020; 130:109200. [PMID: 32739781 DOI: 10.1016/j.ejrad.2020.109200] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 06/24/2020] [Accepted: 07/22/2020] [Indexed: 12/13/2022]
Abstract
PURPOSE To investigate technical issues for implementing pseudo-continuous arterial spin labeling (pCASL) for renal perfusion measurements in transplanted kidney patients (TK) in the early postoperative recovery phase. METHODS Eleven subjects were scanned: TK (N = 4, 42 ± 8.1Y) and normal volunteers (NV) (N = 7, 25 ± 3Y). In 3.0 T clinical MRI, pCASL with a 2D balanced steady-state free precession readout was applied with four different post-labeling delays: 0.5/1.0/1.5/2.0 s. Perfusion images were acquired with and without background suppression and processed with and without registration for comparison. Renal blood flow (RBF) and arterial transit time (ATT) values were calculated from each pixel of images. The F-test, Wilcoxon signed-rank test, and Wilcoxon rank-sum test were used for statistical analyses. RESULTS Background suppression decreased signal variations for both NV and TK. Registration suppressed effects of kidney motion for NV, which was not critical for TK. The renal cortex showed greater perfusion than the renal medulla in both NV and TK(p < 0.01). TK showed greater renal perfusion than NV(p < 0.05). Cortical and medullary RBF values were 271.8 ± 43.5, 119.1 ± 15.1 ml/100 g/min for NV and 358.3 ± 36.4, 141.0 ± 11.5 ml/100 g/min for TK. TK showed longer ATT values than NV(p < 0.01). ATT values in the cortex and medulla were 641 ± 141 and 746 ± 150 ms for NV and 919 ± 49 and 935 ± 81 ms for TK. CONCLUSIONS We demonstrated that although there is no discernible motion of the transplanted kidney, background suppression is necessary to suppress signal fluctuations in renal perfusion measurements. Also, relatively high RBF and long ATT values were observed in the transplanted kidneys in the early postoperative recovery phase, which requires further longitudinal studies.
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Affiliation(s)
- Hyun-Seo Ahn
- Department of Bio and Brain Engineering, Korea Advanced Institute of Science and Technology, Daejeon, South Korea
| | - Hee Chul Yu
- Department of Surgery, Jeonbuk National University Medical School and Hospital, Jeonju, South Korea
| | - Hyo Sung Kwak
- Department of Radiology and Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, South Korea.
| | - Sung-Hong Park
- Department of Bio and Brain Engineering, Korea Advanced Institute of Science and Technology, Daejeon, South Korea.
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Yu YM, Ni QQ, Wang ZJ, Chen ML, Zhang LJ. Multiparametric Functional Magnetic Resonance Imaging for Evaluating Renal Allograft Injury. Korean J Radiol 2020; 20:894-908. [PMID: 31132815 PMCID: PMC6536799 DOI: 10.3348/kjr.2018.0540] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 12/19/2018] [Indexed: 02/06/2023] Open
Abstract
Kidney transplantation is the treatment of choice for patients with end-stage renal disease, as it extends survival and increases quality of life in these patients. However, chronic allograft injury continues to be a major problem, and leads to eventual graft loss. Early detection of allograft injury is essential for guiding appropriate intervention to delay or prevent irreversible damage. Several advanced MRI techniques can offer some important information regarding functional changes such as perfusion, diffusion, structural complexity, as well as oxygenation and fibrosis. This review highlights the potential of multiparametric MRI for noninvasive and comprehensive assessment of renal allograft injury.
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Affiliation(s)
- Yuan Meng Yu
- Department of Medical Imaging, Jinling Hospital, Clinical School of Southern Medical University, Nanjing, China
| | - Qian Qian Ni
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Zhen Jane Wang
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Meng Lin Chen
- Medical Imaging Teaching and Research Office, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Long Jiang Zhang
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, China.
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Kennedy P, Bane O, Hectors SJ, Gordic S, Berger M, Delaney V, Salem F, Lewis S, Menon M, Taouli B. Magnetic resonance elastography vs. point shear wave ultrasound elastography for the assessment of renal allograft dysfunction. Eur J Radiol 2020; 126:108949. [PMID: 32179424 DOI: 10.1016/j.ejrad.2020.108949] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 03/02/2020] [Accepted: 03/09/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE To investigate the utility of magnetic resonance elastography (MRE) vs. ultrasound (US) point shear wave elastography (pSWE) for the assessment of chronic renal allograft dysfunction, prediction of outcome and determine the correlation with Banff pathology scores. METHODS In this IRB approved prospective study, 27 enrolled patients with functional (n = 15) and chronic dysfunctional (n = 12) renal allografts underwent same day 2D MRE and pSWE. Histogram parameters [including mean, median, standard deviation, kurtosis and skewness] of the magnitude of the complex shear modulus (MRE) and median Young's modulus (pSWE) were measured in the cortex (MRE and pSWE) and combined corticomedullary regions (MRE). Histopathology was available for 16 patients (4 functional, 12 dysfunctional). RESULTS MRE and pSWE stiffness were not significantly different between functional and dysfunctional groups (p range 0.139-0.347). The skewness of MRE corticomedullary stiffness was significantly lower (p = 0.04) in patients with chronic dysfunction and correlated significantly with Banff histopathologic scores (range r=-0.518-0.567, p = 0.035-0.040). MRE cortical and corticomedullary mean stiffness showed strong performance in predicting graft loss/relist (AUC 0.958, p = 0.011 for both). Reliable pSWE measurements were obtained in 13 patients (48 %). pSWE stiffness did not correlate with Banff scores and did not predict outcome. CONCLUSIONS The skewness of MRE corticomedullary stiffness is sensitive to changes in chronic allograft dysfunction, while mean/median MRE renal stiffness and median US stiffness did not differentiate patients with stable function vs those with chronic renal allograft dysfunction. MRE corticomedullary mean stiffness appears to be a predictor of graft loss/relist. pSWE was not found to be a useful method for assessing renal allografts.
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Affiliation(s)
- Paul Kennedy
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, United States
| | - Octavia Bane
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, United States
| | - Stefanie J Hectors
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, United States; Department of Radiology, Weill Cornell Medicine, United States
| | - Sonja Gordic
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, United States; Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Switzerland
| | - Mark Berger
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, United States
| | - Veronica Delaney
- Division of Renal Medicine, Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, United States
| | - Fadi Salem
- Department of Pathology, Icahn School of Medicine at Mount Sinai, United States
| | - Sara Lewis
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, United States; Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, United States
| | - Madhav Menon
- Division of Renal Medicine, Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, United States
| | - Bachir Taouli
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, United States; Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, United States.
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Ye J, Xu Q, Wang SA, Zheng J, Zhu QQ, Dou WQ. Differentiation between fat-poor angiomyolipoma and clear cell renal cell carcinoma: qualitative and quantitative analysis using arterial spin labeling MR imaging. Abdom Radiol (NY) 2020; 45:512-519. [PMID: 31705246 DOI: 10.1007/s00261-019-02303-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
PURPOSE To assess the diagnostic effectiveness of arterial spin labeling (ASL) MR imaging in differentiating fat-poor AML from clear cell renal cell carcinoma (ccRCC). METHODS In this prospective study, 29 ccRCC patients and 9 fat-poor AML patients underwent routine anatomical MRI and ASL at 3T before surgery after signing written informed consent form. For each tumor, tumor blood flow (TBF) was measured in a region of interest (ROI) which was positioned to outline the edge of the target lesions on ASL perfusion maps. Additionally, the mean TBF values were obtained by standardizing the TBF using a blood flow measurement in the reference ROI. Moreover, a cluster containing more than 10 voxels was chosen from the renal cortex and medulla area in normal contralateral kidney as a reference ROI to calculate tumor-to-cortex ratio and tumor-to-medulla ratio. Independent sample t test was used to examine the alteration among the groups of fat-poor AML and ccRCC. ASL images were together analyzed by two radiologists to assess the following characteristics of the renal mass: predominant SI in the tumor on ASL images was lower than, as same as, or higher than SI of the cortex. For qualitative variables, Fisher's exact test was employed to compare the proportions of these two groups. The sensitivity, specificity ,and accuracy required for discrimination of fat-poor AML from ccRCC were quantified using receiver operating characteristic (ROC) curve. The corresponding optimal cutoff value was obtained for each parameter as well. RESULTS The TBF value was significantly higher in ccRCC group than that in fat-poor AML (270.49 ± 78.88 ml/100 g/min vs. 146.68 ± 47.21 ml/100 g/min; P < 0.01). Both tumor-to-cortex and tumor-to-medulla ratios were notably higher in ccRCC group compared with those in fat-poor AML group (1.22 ± 0.26 vs. 0.74 ± 0.14, 3.13 ± 0.94 vs. 1.77 ± 0.55; P < 0.05). The values of area under the ROC curve (AUC) for TBF, tumor-to-cortex ratio, and tumor-to-medulla ratio were 0.931, 0.964, and 0.900, respectively. No significant difference in AUC values among these three measurements was observed. For qualitative variables, the SI of fat-poor AML was equal to or slightly lower than that of renal medulla and the SI of ccRCC was found to be higher than renal cortex in ASL. CONCLUSION ASL MRI performs well in differentiating fat-poor AML from ccRCC in both qualitative and quantitative analyses.
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Affiliation(s)
- Jing Ye
- Department of Medical Imaging, Clinic Medical School, Northern Jiangsu Province Hospital, Yangzhou University, Yangzhou, 225000, Jiangsu Province, China
| | - Qing Xu
- Department of Medical Imaging, Clinic Medical School, Northern Jiangsu Province Hospital, Yangzhou University, Yangzhou, 225000, Jiangsu Province, China.
| | - Shou-An Wang
- Department of Medical Imaging, Clinic Medical School, Northern Jiangsu Province Hospital, Yangzhou University, Yangzhou, 225000, Jiangsu Province, China
| | - Jin Zheng
- Department of Medical Imaging, Clinic Medical School, Northern Jiangsu Province Hospital, Yangzhou University, Yangzhou, 225000, Jiangsu Province, China
| | - Qing-Qiang Zhu
- Department of Medical Imaging, Clinic Medical School, Northern Jiangsu Province Hospital, Yangzhou University, Yangzhou, 225000, Jiangsu Province, China
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Lang ST, Guo J, Bruns A, Dürr M, Braun J, Hamm B, Sack I, Marticorena Garcia SR. Multiparametric Quantitative MRI for the Detection of IgA Nephropathy Using Tomoelastography, DWI, and BOLD Imaging. Invest Radiol 2019; 54:669-674. [DOI: 10.1097/rli.0000000000000585] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Hellms S, Gueler F, Gutberlet M, Schebb NH, Rund K, Kielstein JT, VoChieu V, Rauhut S, Greite R, Martirosian P, Haller H, Wacker F, Derlin K. Single-dose diclofenac in healthy volunteers can cause decrease in renal perfusion measured by functional magnetic resonance imaging. ACTA ACUST UNITED AC 2019; 71:1262-1270. [PMID: 31131893 DOI: 10.1111/jphp.13105] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 04/22/2019] [Indexed: 12/18/2022]
Abstract
OBJECTIVES We investigated changes of renal perfusion after topical and oral diclofenac administration in healthy volunteers using functional magnetic resonance imaging (MRI) with arterial spin labelling (ASL). METHODS Twenty-four healthy human participants (21-51 years) underwent 1.5T MRI before and 1 h after a single oral dose of diclofenac (50 mg). Twelve of 24 participants underwent an additional MRI examination following 3-day topical diclofenac administration. For renal perfusion imaging, a flow-sensitive alternating inversion-recovery TrueFISP ASL sequence was applied. Plasma concentrations of diclofenac and serum concentrations of thromboxane were determined. KEY FINDINGS After oral diclofenac application, large interindividual differences in plasma concentrations were observed (range <3-4604 nm). Topical diclofenac application did not result in relevant systemic diclofenac levels (range 5-75 nm). MRI showed a significant reduction of renal perfusion in individuals with diclofenac levels ≥225 nm (baseline: 347 ± 7 vs diclofenac: 323 ± 8 ml/min/100 g, P < 0.01); no significant differences were observed in participants with diclofenac levels <225 nm. Diclofenac levels correlated negatively with thromboxane B2 levels pointing towards target engagement. CONCLUSIONS Single-dose diclofenac caused a decrease in renal perfusion in participants with diclofenac levels ≥225 nm. We demonstrated that even a single dose of diclofenac can impair renal perfusion, which could be detrimental in patients with underlying chronic kidney disease or acute kidney injury.
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Affiliation(s)
- Susanne Hellms
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Faikah Gueler
- Nephrology Hannover Medical School, Hannover, Germany
| | - Marcel Gutberlet
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Nils Helge Schebb
- Institute for Food Toxicology and Analytical Chemistry, University of Veterinary Medicine Hannover, Hannover, Germany.,Food Chemistry, Faculty of Mathematics and Natural Sciences, University of Wuppertal, Wuppertal, Germany
| | - Katharina Rund
- Institute for Food Toxicology and Analytical Chemistry, University of Veterinary Medicine Hannover, Hannover, Germany
| | - Jan T Kielstein
- Medical Clinic V (Nephrology, Rheumatology, Blood Purification), Academic Teaching Hospital Braunschweig, Braunschweig, Germany
| | - VanDai VoChieu
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | | | - Robert Greite
- Nephrology Hannover Medical School, Hannover, Germany
| | - Petros Martirosian
- Section on Experimental Radiology, University of Tuebingen, Tübingen, Germany
| | | | - Frank Wacker
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Katja Derlin
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
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Renal Allograft Rejection: Noninvasive Ultrasound- and MRI-Based Diagnostics. CONTRAST MEDIA & MOLECULAR IMAGING 2019; 2019:3568067. [PMID: 31093027 PMCID: PMC6481101 DOI: 10.1155/2019/3568067] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 03/26/2019] [Indexed: 02/07/2023]
Abstract
To date, allogeneic kidney transplantation remains the best available therapeutic option for patients with end-stage renal disease regarding overall survival and quality of life. Despite the advancements in immunosuppressive drugs and protocols, episodes of acute allograft rejection, a sterile inflammatory process, continue to endanger allograft survival. Since effective treatment for acute rejection episodes is available, instant diagnosis of this potentially reversible graft injury is imperative. Although histological examination by invasive core needle biopsy of the graft remains the gold standard for the diagnosis of ongoing rejection, it is always associated with the risk of causing substantial graft injury as a result of the biopsy procedure itself. At the same time, biopsies are not immediately feasible for a considerable number of patients taking anticoagulants due to the high risk of complications such as bleeding and uneven distribution of pathological changes within the graft. This can result in the wrong diagnosis due to the small size of the tissue sample taken. Therefore, there is a need for a tool that overcomes these problems by being noninvasive and capable of assessing the whole organ at the same time for specific and fast detection of acute allograft rejection. In this article, we review current state-of-the-art approaches for noninvasive diagnostics of acute renal transplant inflammation, i.e., rejection. We especially focus on nonradiation-based methods using magnetic resonance imaging (MRI) and ultrasound.
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20
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Sjekavica I, Novosel L, Rupčić M, Smiljanić R, Muršić M, Duspara V, Lušić M, Perkov D, Hrabak-Paar M, Zidanić M, Skender M. RADIOLOGICAL IMAGING IN RENAL TRANSPLANTATION. Acta Clin Croat 2018; 57:694-712. [PMID: 31168207 PMCID: PMC6544089 DOI: 10.20471/acc.2018.57.04.12] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
SUMMARY – Radiological diagnostic methods have a significant role in the preoperative and postoperative care of patients after kidney transplantation. Improvement and innovations in technology, but also the growing experience of the radiologists who deal with kidney transplant patients as part of the transplant team lead to earlier detection of complications in the postoperative period, which are the leading cause of transplant failure. In this article, we describe, through diagnostic imaging examples, detailed evaluation of all possible complications that can occur after kidney transplantation, with evaluation of different possible diagnostic methods that can be used in the preoperative assessment and postoperative follow up and care of the transplanted patient. The goal of this article is to demonstrate and summarize in detail the possible complications of renal transplantation and how to best diagnostically approach them, with special reference to ultrasound which is the main imaging method for this group of conditions.
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Affiliation(s)
| | - Luka Novosel
- 1Department of Diagnostic and Interventional Radiology, Zagreb University Hospital Center, Zagreb, Croatia; 2School of Medicine, University of Zagreb, Zagreb, Croatia; 3Department of Diagnostic and Interventional Radiology, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | - Melita Rupčić
- 1Department of Diagnostic and Interventional Radiology, Zagreb University Hospital Center, Zagreb, Croatia; 2School of Medicine, University of Zagreb, Zagreb, Croatia; 3Department of Diagnostic and Interventional Radiology, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | - Ranko Smiljanić
- 1Department of Diagnostic and Interventional Radiology, Zagreb University Hospital Center, Zagreb, Croatia; 2School of Medicine, University of Zagreb, Zagreb, Croatia; 3Department of Diagnostic and Interventional Radiology, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | - Miroslav Muršić
- 1Department of Diagnostic and Interventional Radiology, Zagreb University Hospital Center, Zagreb, Croatia; 2School of Medicine, University of Zagreb, Zagreb, Croatia; 3Department of Diagnostic and Interventional Radiology, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | - Vlatko Duspara
- 1Department of Diagnostic and Interventional Radiology, Zagreb University Hospital Center, Zagreb, Croatia; 2School of Medicine, University of Zagreb, Zagreb, Croatia; 3Department of Diagnostic and Interventional Radiology, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | - Mario Lušić
- 1Department of Diagnostic and Interventional Radiology, Zagreb University Hospital Center, Zagreb, Croatia; 2School of Medicine, University of Zagreb, Zagreb, Croatia; 3Department of Diagnostic and Interventional Radiology, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | - Dražen Perkov
- 1Department of Diagnostic and Interventional Radiology, Zagreb University Hospital Center, Zagreb, Croatia; 2School of Medicine, University of Zagreb, Zagreb, Croatia; 3Department of Diagnostic and Interventional Radiology, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | - Maja Hrabak-Paar
- 1Department of Diagnostic and Interventional Radiology, Zagreb University Hospital Center, Zagreb, Croatia; 2School of Medicine, University of Zagreb, Zagreb, Croatia; 3Department of Diagnostic and Interventional Radiology, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | - Martina Zidanić
- 1Department of Diagnostic and Interventional Radiology, Zagreb University Hospital Center, Zagreb, Croatia; 2School of Medicine, University of Zagreb, Zagreb, Croatia; 3Department of Diagnostic and Interventional Radiology, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | - Mateja Skender
- 1Department of Diagnostic and Interventional Radiology, Zagreb University Hospital Center, Zagreb, Croatia; 2School of Medicine, University of Zagreb, Zagreb, Croatia; 3Department of Diagnostic and Interventional Radiology, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
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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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Odudu A, Nery F, Harteveld AA, Evans RG, Pendse D, Buchanan CE, Francis ST, Fernández-Seara MA. Arterial spin labelling MRI to measure renal perfusion: a systematic review and statement paper. Nephrol Dial Transplant 2018; 33:ii15-ii21. [PMID: 30137581 PMCID: PMC6106644 DOI: 10.1093/ndt/gfy180] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 05/15/2018] [Indexed: 01/03/2023] Open
Abstract
Renal perfusion provides the driving pressure for glomerular filtration and delivers the oxygen and nutrients to fuel solute reabsorption. Renal ischaemia is a major mechanism in acute kidney injury and may promote the progression of chronic kidney disease. Thus, quantifying renal tissue perfusion is critically important for both clinicians and physiologists. Current reference techniques for assessing renal tissue perfusion have significant limitations. Arterial spin labelling (ASL) is a magnetic resonance imaging (MRI) technique that uses magnetic labelling of water in arterial blood as an endogenous tracer to generate maps of absolute regional perfusion without requiring exogenous contrast. The technique holds enormous potential for clinical use but remains restricted to research settings. This statement paper from the PARENCHIMA network briefly outlines the ASL technique and reviews renal perfusion data in 53 studies published in English through January 2018. Renal perfusion by ASL has been validated against reference methods and has good reproducibility. Renal perfusion by ASL reduces with age and excretory function. Technical advancements mean that a renal ASL study can acquire a whole kidney perfusion measurement in less than 5-10 min. The short acquisition time permits combination with other MRI techniques that might inform drug mechanisms and renal physiology. The flexibility of renal ASL has yielded several variants of the technique, but there are limited data comparing these approaches. We make recommendations for acquiring and reporting renal ASL data and outline the knowledge gaps that future research should address.
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Affiliation(s)
- Aghogho Odudu
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Fabio Nery
- Developmental Imaging & Biophysics Section, University College London, Great Ormond Street Institute of Child Health, London, UK
| | - Anita A Harteveld
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Roger G Evans
- Department of Physiology, Cardiovascular Disease Program, Biomedicine Discovery Institute, Monash University, Melbourne, Victoria, Australia
| | - Douglas Pendse
- Centre for Medical Imaging, University College London, London, UK
| | - Charlotte E Buchanan
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, UK
| | - Susan T Francis
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, UK
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Organ-specific responses during brain death: increased aerobic metabolism in the liver and anaerobic metabolism with decreased perfusion in the kidneys. Sci Rep 2018. [PMID: 29535334 PMCID: PMC5849719 DOI: 10.1038/s41598-018-22689-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Hepatic and renal energy status prior to transplantation correlates with graft survival. However, effects of brain death (BD) on organ-specific energy status are largely unknown. We studied metabolism, perfusion, oxygen consumption, and mitochondrial function in the liver and kidneys following BD. BD was induced in mechanically-ventilated rats, inflating an epidurally-placed Fogarty-catheter, with sham-operated rats as controls. A 9.4T-preclinical MRI system measured hourly oxygen availability (BOLD-related R2*) and perfusion (T1-weighted). After 4 hrs, tissue was collected, mitochondria isolated and assessed with high-resolution respirometry. Quantitative proteomics, qPCR, and biochemistry was performed on stored tissue/plasma. Following BD, the liver increased glycolytic gene expression (Pfk-1) with decreased glycogen stores, while the kidneys increased anaerobic- (Ldha) and decreased gluconeogenic-related gene expression (Pck-1). Hepatic oxygen consumption increased, while renal perfusion decreased. ATP levels dropped in both organs while mitochondrial respiration and complex I/ATP synthase activity were unaffected. In conclusion, the liver responds to increased metabolic demands during BD, enhancing aerobic metabolism with functional mitochondria. The kidneys shift towards anaerobic energy production while renal perfusion decreases. Our findings highlight the need for an organ-specific approach to assess and optimise graft quality prior to transplantation, to optimise hepatic metabolic conditions and improve renal perfusion while supporting cellular detoxification.
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Non-Invasive Renal Perfusion Imaging Using Arterial Spin Labeling MRI: Challenges and Opportunities. Diagnostics (Basel) 2018; 8:diagnostics8010002. [PMID: 29303965 PMCID: PMC5871985 DOI: 10.3390/diagnostics8010002] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 12/25/2017] [Accepted: 01/02/2018] [Indexed: 12/28/2022] Open
Abstract
Tissue perfusion allows for delivery of oxygen and nutrients to tissues, and in the kidneys is also a key determinant of glomerular filtration. Quantification of regional renal perfusion provides a potential window into renal (patho) physiology. However, non-invasive, practical, and robust methods to measure renal perfusion remain elusive, particularly in the clinic. Arterial spin labeling (ASL), a magnetic resonance imaging (MRI) technique, is arguably the only available method with potential to meet all these needs. Recent developments suggest its viability for clinical application. This review addresses several of these developments and discusses remaining challenges with the emphasis on renal imaging in human subjects.
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Getzin T, May M, Schmidbauer M, Gutberlet M, Martirosian P, Oertel R, Wacker F, Schindler C, Hueper K. Usability of Functional MRI in Clinical Studies for Fast and Reliable Assessment of Renal Perfusion and Quantification of Hemodynamic Effects on the Kidney. J Clin Pharmacol 2017; 58:466-473. [DOI: 10.1002/jcph.1034] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 09/18/2017] [Indexed: 02/06/2023]
Affiliation(s)
- Tobias Getzin
- Department of Diagnostic and Interventional Radiology; Hannover Medical School; Hannover Germany
| | - Marcus May
- Center for Pharmacology and Toxicology; Clinical Research Center, Hannover Medical School; Hannover Germany
| | - Martina Schmidbauer
- Department of Diagnostic and Interventional Radiology; Hannover Medical School; Hannover Germany
| | - Marcel Gutberlet
- Department of Diagnostic and Interventional Radiology; Hannover Medical School; Hannover Germany
| | - Petros Martirosian
- Department of Diagnostic and Interventional Radiology, Section Experimental Radiology, Medical Faculty; University of Tübingen; Tübingen Germany
| | - Reinhard Oertel
- Institute for Clinical Pharmacology, Medical Faculty; Technical University Dresden; Dresden Germany
| | - Frank Wacker
- Department of Diagnostic and Interventional Radiology; Hannover Medical School; Hannover Germany
| | - Christoph Schindler
- Center for Pharmacology and Toxicology; Clinical Research Center, Hannover Medical School; Hannover Germany
| | - Katja Hueper
- Department of Diagnostic and Interventional Radiology; Hannover Medical School; Hannover Germany
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Zhang H, Wu Y, Xue W, Zuo P, Oesingmann N, Gan Q, Huang Z, Wu M, Hu F, Kuang M, Song B. Arterial spin labelling MRI for detecting pseudocapsule defects and predicting renal capsule invasion in renal cell carcinoma. Clin Radiol 2017; 72:936-943. [PMID: 28673449 DOI: 10.1016/j.crad.2017.06.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 04/06/2017] [Accepted: 06/06/2017] [Indexed: 02/08/2023]
Abstract
AIM To evaluate prospectively the performance of combining morphological and arterial spin labelling (ASL) magnetic resonance imaging (MRI) for detecting pseudocapsule defects in renal cell carcinoma (RCC), and to predict renal capsule invasion confirmed histopathologically. MATERIALS AND METHODS Twenty consecutive patients with suspicious renal tumours underwent MRI. Renal ASL imaging was performed and renal blood flow was measured quantitatively. The diagnostic performance of T2-weighted images alone, and a combination of T2-weighted and ASL images for predicting renal capsule invasion were assessed. RESULTS Twenty renal lesions were evaluated in 20 patients. All lesions were clear cell RCCs (ccRCCs) confirmed at post-surgical histopathology. Fifteen ccRCCs showed pseudocapsule defects on T2-weighted images, of which 12 cases showed existing blood flow in defect areas on perfusion images. To predict renal capsule invasion, the sensitivity, specificity, positive predictive value, and negative predictive value were 100%, 71.4%, 86.7%, 100%, respectively, for T2-weighted images alone, and 92.3%, 100%, 100%, 87.5%, respectively, for the combination of T2-weighted and ASL images. CONCLUSION ASL images can reflect the perfusion of pseudocapsule defects and as such, the combination of T2-weighted and ASL images produces promising diagnostic accuracy for predicting renal capsule invasion.
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Affiliation(s)
- H Zhang
- Department of Radiology, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, Sichuan 610041, China
| | - Y Wu
- School of Nursing, Chengdu University of Traditional Chinese Medicine, No. 1166, Liutai Avenue, Wenjiang District, Chengdu 611137, China
| | - W Xue
- Department of Urology, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, Sichuan 610041, China
| | - P Zuo
- Siemens Healthcare, MR Collaborations NE Asia, No. 7, Wangjing Zhonghuan Nanlu, Chaoyang District, Beijing 100102, China
| | - N Oesingmann
- Siemens HC, No. 511, Benedict Avenue, Tarrytown, NY 10591-5097, USA
| | - Q Gan
- Department of Neurosurgery, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, Sichuan 610041, China
| | - Z Huang
- Department of Radiology, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, Sichuan 610041, China
| | - M Wu
- Department of Radiology, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, Sichuan 610041, China
| | - F Hu
- Department of Radiology, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, Sichuan 610041, China
| | - M Kuang
- Department of Radiology, The Second Clinical Medicine School, Chengdu University of Traditional Chinese Medicine, No. 15, Section 4, Renmin South Road, Chengdu, Sichuan 610041, China
| | - B Song
- Department of Radiology, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, Sichuan 610041, China.
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Sade R, Kantarci M, Karaca L, Okur A, Ogul H, Keles M, Çankaya E, Ayan AK. Value of dynamic MRI using the Ktrans technique for assessment of native kidneys in pre-emptive renal transplantation. Acta Radiol 2017; 58:1005-1011. [PMID: 27864568 DOI: 10.1177/0284185116678272] [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: 01/04/2023]
Abstract
Background Different non-invasive imaging techniques such as Doppler ultrasonography and renal scintigraphy are commonly employed to assess allograft function and associated complications. However, all such methods lack sufficient specificity to discriminate between residual renal function of native kidneys. Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) evaluates signal dynamics during the passage of contrast material through the renal cortex, medulla, and collecting system. Purpose To investigate the value of DCE 3T MRI using a quantitative pharmacokinetic parameter (Ktrans) for the assessment of native kidneys before and after pre-emptive renal transplantation. Material and Methods Twenty-five consecutive patients with end-stage renal disease underwent DCE MRI before and 6 months after kidney transplantation. MRI was performed using a 3T scanner. Regions of interests were drawn over each kidney, encompassing the cortex and medulla but excluding the collecting system and any coexisting cysts. Parametric Ktrans values were automatically generated. Results In the pre-transplantation group, mean Ktrans values for the right and left kidneys were 0.55 ± 0.09 min-1 and 0.44 ± 0.15 min-1, respectively. In the post-transplantation group, mean Ktrans values of the right and left kidneys were 0.27 ± 0.07 min-1 and 0.25 ± 0.10 min-1, respectively. There were statistically significant differences between right and left kidneys in terms of mean Ktrans values in the pre- and post-transplantation groups ( P < 0.001). Conclusion Our preliminary results show that native kidneys were still functioning 6 months after transplantation. MR perfusion using Ktrans may constitute a non-invasive means of determination of the viability of native kidneys after renal transplantation.
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Affiliation(s)
- Recep Sade
- AtaturkUniversity, School of Medicine, Department of Radiology, Erzurum, Turkey
| | - Mecit Kantarci
- AtaturkUniversity, School of Medicine, Department of Radiology, Erzurum, Turkey
| | - Leyla Karaca
- AtaturkUniversity, School of Medicine, Department of Radiology, Erzurum, Turkey
| | - Aylin Okur
- Bozok University, School of Medicine, Department of Radiology, Yozgat, Turkey
| | - Hayri Ogul
- AtaturkUniversity, School of Medicine, Department of Radiology, Erzurum, Turkey
| | - Mustafa Keles
- AtaturkUniversity, School of Medicine, Department of Internal Medicine, Division of Nephrology, Erzurum, Turkey
| | - Erdem Çankaya
- AtaturkUniversity, School of Medicine, Department of Internal Medicine, Division of Nephrology, Erzurum, Turkey
| | - Arif Kursad Ayan
- AtaturkUniversity, School of Medicine, Department of Nuclear Medicine, Erzurum, Turkey
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Galia M, Albano D, Bruno A, Agrusa A, Romano G, Di Buono G, Agnello F, Salvaggio G, La Grutta L, Midiri M, Lagalla R. Imaging features of solid renal masses. Br J Radiol 2017; 90:20170077. [PMID: 28590813 DOI: 10.1259/bjr.20170077] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The widespread use of abdominal imaging techniques has increased the detection of solid renal masses over the past years. Imaging plays a crucial role in the management and surveillance and in determining which lesions need treatment. The "classical angiomyolipoma" is the only benign solid renal mass that can be characterized with confidence by imaging through the detection of a fat-containing lesion without calcifications. There is a large overlap of imaging features between benign and malignant renal masses that often makes difficult a correct characterization of these lesions. In this review, we discuss the imaging features of the main solid renal masses that may suggest a likely benign diagnosis.
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Affiliation(s)
- Massimo Galia
- 1 Department of Radiology, DIBIMED, University of Palermo, Palermo, Italy
| | - Domenico Albano
- 1 Department of Radiology, DIBIMED, University of Palermo, Palermo, Italy
| | - Alberto Bruno
- 1 Department of Radiology, DIBIMED, University of Palermo, Palermo, Italy
| | - Antonino Agrusa
- 2 Department of General Surgery and Emergency, University of Palermo, Palermo, Italy
| | - Giorgio Romano
- 2 Department of General Surgery and Emergency, University of Palermo, Palermo, Italy
| | - Giuseppe Di Buono
- 2 Department of General Surgery and Emergency, University of Palermo, Palermo, Italy
| | - Francesco Agnello
- 1 Department of Radiology, DIBIMED, University of Palermo, Palermo, Italy
| | - Giuseppe Salvaggio
- 1 Department of Radiology, DIBIMED, University of Palermo, Palermo, Italy
| | - Ludovico La Grutta
- 1 Department of Radiology, DIBIMED, University of Palermo, Palermo, Italy
| | - Massimo Midiri
- 1 Department of Radiology, DIBIMED, University of Palermo, Palermo, Italy
| | - Roberto Lagalla
- 1 Department of Radiology, DIBIMED, University of Palermo, Palermo, Italy
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van Eijs MJM, van Zuilen AD, de Boer A, Froeling M, Nguyen TQ, Joles JA, Leiner T, Verhaar MC. Innovative Perspective: Gadolinium-Free Magnetic Resonance Imaging in Long-Term Follow-Up after Kidney Transplantation. Front Physiol 2017; 8:296. [PMID: 28559850 PMCID: PMC5432553 DOI: 10.3389/fphys.2017.00296] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 04/24/2017] [Indexed: 12/23/2022] Open
Abstract
Since the mid-1980s magnetic resonance imaging (MRI) has been investigated as a non- or minimally invasive tool to probe kidney allograft function. Despite this long-standing interest, MRI still plays a subordinate role in daily practice of transplantation nephrology. With the introduction of new functional MRI techniques, administration of exogenous gadolinium-based contrast agents has often become unnecessary and true non-invasive assessment of allograft function has become possible. This raises the question why application of MRI in the follow-up of kidney transplantation remains restricted, despite promising results. Current literature on kidney allograft MRI is mainly focused on assessment of (sub) acute kidney injury after transplantation. The aim of this review is to survey whether MRI can provide valuable diagnostic information beyond 1 year after kidney transplantation from a mechanistic point of view. The driving force behind chronic allograft nephropathy is believed to be chronic hypoxia. Based on this, techniques that visualize kidney perfusion and oxygenation, scarring, and parenchymal inflammation deserve special interest. We propose that functional MRI mechanistically provides tools for diagnostic work-up in long-term follow-up of kidney allografts.
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Affiliation(s)
- Mick J M van Eijs
- Department of Nephrology and Hypertension, University Medical Center UtrechtUtrecht, Netherlands
| | - Arjan D van Zuilen
- Department of Nephrology and Hypertension, University Medical Center UtrechtUtrecht, Netherlands
| | - Anneloes de Boer
- Department of Radiology, University Medical Center UtrechtUtrecht, Netherlands
| | - Martijn Froeling
- Department of Radiology, University Medical Center UtrechtUtrecht, Netherlands
| | - Tri Q Nguyen
- Department of Pathology, University Medical Center UtrechtUtrecht, Netherlands
| | - Jaap A Joles
- Department of Nephrology and Hypertension, University Medical Center UtrechtUtrecht, Netherlands
| | - Tim Leiner
- Department of Radiology, University Medical Center UtrechtUtrecht, Netherlands
| | - Marianne C Verhaar
- Department of Nephrology and Hypertension, University Medical Center UtrechtUtrecht, Netherlands
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Selection for biopsy of kidney transplant patients by diffusion-weighted MRI. Eur Radiol 2017; 27:4336-4344. [PMID: 28374076 DOI: 10.1007/s00330-017-4814-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Revised: 02/26/2017] [Accepted: 03/14/2017] [Indexed: 10/19/2022]
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Hueper K, Schmidbauer M, Thorenz A, Bräsen JH, Gutberlet M, Mengel M, Hartung D, Chen R, Meier M, Haller H, Wacker F, Rong S, Gueler F. Longitudinal evaluation of perfusion changes in acute and chronic renal allograft rejection using arterial spin labeling in translational mouse models. J Magn Reson Imaging 2017; 46:1664-1672. [DOI: 10.1002/jmri.25713] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 03/02/2017] [Indexed: 12/17/2022] Open
Affiliation(s)
| | | | | | | | | | - Michael Mengel
- Laboratory Medicine and Pathology; University of Alberta; Edmonton Canada
| | | | | | - Martin Meier
- Institute of Laboratory Animal Science, Imaging Center, Hannover Medical School; Germany
| | | | | | - Song Rong
- Nephrology, Hannover Medical School; Germany
- The Transplantation Center of the affiliated hospital, Zunyi Medical College; Zunyi China
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Zimmer F, Klotz S, Hoeger S, Yard BA, Krämer BK, Schad LR, Zöllner FG. Quantitative arterial spin labelling perfusion measurements in rat models of renal transplantation and acute kidney injury at 3T. Z Med Phys 2017; 27:39-48. [DOI: 10.1016/j.zemedi.2016.02.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 02/11/2016] [Accepted: 02/22/2016] [Indexed: 10/22/2022]
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Cai YZ, Li ZC, Zuo PL, Pfeuffer J, Li YM, Liu F, Liu RB. Diagnostic value of renal perfusion in patients with chronic kidney disease using 3D arterial spin labeling. J Magn Reson Imaging 2017; 46:589-594. [PMID: 28181335 DOI: 10.1002/jmri.25601] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 12/05/2016] [Indexed: 02/05/2023] Open
Abstract
PURPOSE To evaluate the diagnostic value of 3D arterial spin labeling (ASL) for noninvasive quantification of renal blood flow (RBF) in patients with chronic kidney disease (CKD). MATERIALS AND METHODS CKD patients (n = 27) and healthy volunteers (n = 36) underwent renal 3T ASL magnetic resonance imaging, with inversion times from 1200 to 2000 msec for volunteers in the preliminary test, and 1800 to 2000 msec for volunteers and CKD patients in the formal experiments. The cortical RBFs were compared, and a correlation between RBF and estimated glomerular filtration rate (eGFR) was evaluated. RESULTS For healthy volunteers, RBF values increased with TIs from 1200 to 1600 msec, but were almost constant at TIs from 1600 to 2000 msec. The cortical RBF values of CKD patients were lower than that of healthy volunteers at TIs from 1800 to 2000 msec. In addition, the CKD patients had lower cortical RBF values than the healthy volunteers (P < 0.01 for both), and their RBF values positively correlated with eGFR. CONCLUSION 3D ASL is a potential noninvasive method for measuring renal perfusion that can provide valuable information for clinical CKD diagnosis. LEVEL OF EVIDENCE 1 Technical Efficacy: Stage 3 J. MAGN. RESON. IMAGING 2017;46:589-594.
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Affiliation(s)
- Yu-Zhe Cai
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan, PR China
| | - Zhi-Cheng Li
- Department of Nephrology, West China Hospital of Sichuan University, Chengdu, Sichuan, PR China
| | - Pan-Li Zuo
- Siemens Healthcare, MR Collaboration NE Asia, Beijing, PR China
| | - Josef Pfeuffer
- Application Development, Siemens Healthcare, Erlangen, Germany
| | - Yu-Ming Li
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan, PR China
| | - Fang Liu
- Department of Nephrology, West China Hospital of Sichuan University, Chengdu, Sichuan, PR China
| | - Rong-Bo Liu
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan, PR China
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Notohamiprodjo M, Kalnins A, Andrassy M, Kolb M, Ehle B, Mueller S, Thomas MN, Werner J, Guba M, Nikolaou K, Andrassy J. Multiparametric Functional MRI: A Tool to Uncover Subtle Changes following Allogeneic Renal Transplantation. PLoS One 2016; 11:e0165532. [PMID: 27820833 PMCID: PMC5098737 DOI: 10.1371/journal.pone.0165532] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 10/13/2016] [Indexed: 12/30/2022] Open
Abstract
PURPOSE To investigate multiparametric functional MRI to characterize acute rejection in a murine allogeneic renal transplant model and evaluate the effect of novel therapeutics. MATERIAL AND METHODS We performed allogeneic and syngeneic orthotopic transplantations (Balb/c to C57Bl/6 and C57Bl/6 to C57Bl/6). Allogeneic Groups (n = 5) were either treated with the anti-CCL2-Spiegelmer (mNOX-E36) in monotherapy or in combination with low doses of Ciclosporin-A (10mg/kgBW/d) for 10 days. Controls received equivalent doses of a non-functional spiegelmer (revmNOX-E36) or low dose Ciclosporin-A. Diffusion-weighted (DWI) and Dynamic-contrast-enhanced (DCE-) MRI-scans were performed using a clinical 3T-scanner. DWI analysis (b-values from 0-800 s/mm2) was performed mono- and biexponentially, while DCE-MRI was assessed with deconvolution analysis. Therapy effects were assessed ex vivo with histopathology, immunohistochemistry and RT-PCR. Statistical analysis was performed with unpaired t-tests and Spearman´s correlation coefficient. RESULTS DWI showed a significant diffusion restriction in allogeneic compared to syngeneic transplants (ADC: 0.63±0.08 vs. 1.29±0.12 mm2/s*103) with decreasing diffusion restriction under therapy. DCE-MRI showed restored organ perfusion under Ciclosporin A alone and combination therapy (Plasma Flow: 43.43±12.49; 38.75±7.53ml/100ml/min) compared to syngeneic controls (51.03±12.49ml/100ml/min). Ex vivo analysis showed reduced monocytic infiltrates, attenuated levels of inflammatory cytokines under mNOX-E36 monotherapy with an additive effect of low dose Ciclosporin A. There was a significant (p<0.05) negative correlation between ADC and interstitial inflammation (r = -0.73) or macrophage infiltration (r = -0.81) and between organ perfusion and intimal arteritis (r = -0.63). CONCLUSION Multiparametric functional MRI is suited to detect renal allograft rejection in an experimental murine model and allows to characterize effects of immunosuppressive therapy alleviating acute rejection processes in allogeneic transplantation.
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Affiliation(s)
- Mike Notohamiprodjo
- Department of Radiology, University Hospital Tuebingen, Tuebingen, Germany
- Department of Clinical Radiology, University Hospitals Munich, Munich, Germany
| | - Aivars Kalnins
- Department of Surgery, University Hospital Munich, Munich, Germany
| | - Martin Andrassy
- Department of Medicine, Rupprecht-Karl’s University, Heidelberg, Germany
| | - Manuel Kolb
- Department of Radiology, University Hospital Tuebingen, Tuebingen, Germany
- Department of Clinical Radiology, University Hospitals Munich, Munich, Germany
| | - Benjamin Ehle
- Department of Surgery, University Hospital Munich, Munich, Germany
| | - Susanna Mueller
- Department of Pathology, Ludwig-Maximilian’s University, Munich, Germany
| | | | - Jens Werner
- Department of Surgery, University Hospital Munich, Munich, Germany
| | - Markus Guba
- Department of Surgery, University Hospital Munich, Munich, Germany
| | | | - Joachim Andrassy
- Department of Surgery, University Hospital Munich, Munich, Germany
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Becker AS, Rossi C. Renal Arterial Spin Labeling Magnetic Resonance Imaging. Nephron Clin Pract 2016; 135:1-5. [PMID: 27760424 DOI: 10.1159/000450797] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 09/06/2016] [Indexed: 12/13/2022] Open
Abstract
Arterial spin labeling (ASL) MRI allows the quantification of tissue perfusion without administration of exogenous contrast agents. Patients with reduced renal function or other contraindications to Gadolinium-based contrast media may benefit from the non-invasive monitoring of tissue microcirculation. So far, only few studies have investigated the sensitivity, the specificity and the reliability of the ASL techniques for the assessment of renal perfusion. Moreover, only little is known about the interplay between ASL markers of perfusion and functional renal filtration parameters. In this editorial, we discuss the main technical issues related to the quantification of renal perfusion by ASL and, in particular, the latest results in patients with kidney disorders.
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Affiliation(s)
- Anton S Becker
- Department of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
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Kidney Transplantation: Multiparametric Functional Magnetic Resonance Imaging for Assessment of Renal Allograft Pathophysiology in Mice. Invest Radiol 2016; 51:58-65. [PMID: 26371534 DOI: 10.1097/rli.0000000000000205] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aims of this experimental study were to investigate renal allograft pathophysiology by multiparametric functional magnetic resonance imaging (MRI) and to directly correlate MRI parameters with renal histopathology in mouse models of allogenic and isogenic kidney transplantation (ktx). MATERIALS AND METHODS Allograft rejection was induced by transplantation of C57BL/6 (B6) donor kidneys into BALB/c recipients (allogenic ktx). B6 mice that received B6 kidneys served as controls (isogenic ktx). Three weeks after ktx, MRI was performed using a 7-T small-animal scanner. Flow sensitive alternating inversion recovery echoplanar imaging arterial spin labeling, multiecho turbo spin echo, and diffusion-weighted imaging sequences were acquired. Maps of renal perfusion, T2 and T1 relaxation times, and apparent diffusion coefficients were calculated. Histological changes in the kidney were evaluated according to Banff criteria. Renal cell infiltrates and fibrosis were quantified by immunohistochemistry. Differences between groups were assessed using the Mann-Whitney U test, and the correlation of MRI parameters with renal histopathology was determined by Spearman correlation analysis. RESULTS After allogenic, but not isogenic, ktx, animals developed acute allograft rejection. Allogenic grafts were infiltrated by macrophages and T-lymphocytes and exhibited marked renal fibrosis. Magnetic resonance imaging revealed stronger impairment of renal perfusion (56 ± 7 vs 293 ± 44 mL/[min × 100 g]; P < 0.01) and more pronounced increases in T2 (60.1 ± 2.0 vs 45.7 ± 1.2 milliseconds, P < 0.01) and T1 relaxation times (1938 ± 53 vs 1350 ± 27 milliseconds, P < 0.01) in allogenic than in isogenic kidneys. Apparent diffusion coefficient was reduced to 1.39 ± 0.14 × 10(-3) mm2/s in kidneys with an acute rejection and was 1.83 ± 0.05 × 10(-3) mm2/s in isogenic kidneys without rejection (P < 0.05). Magnetic resonance imaging parameters significantly correlated with the amount of cellular infiltration and renal fibrosis observed histologically. CONCLUSIONS Functional MRI allows detection of acute renal allograft rejection after allogenic ktx in mice. Functional MRI parameters correlate with cell infiltrates and fibrosis. Thus, MRI may be used noninvasively and longitudinally to investigate mechanisms of renal allograft rejection and evaluate novel therapeutic strategies in experimental studies.
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Abstract
Multiparametric MR imaging (mpMRI) combine different sequences that, properly tailored, can provide qualitative and quantitative information about the tumor microenvironment beyond traditional tumor size measures and/or morphologic assessments. This article focuses on mpMRI in the evaluation of urogenital tract malignancies by first reviewing technical aspects and then discussing its potential clinical role. This includes insight into histologic subtyping and grading of renal cell carcinoma and assessment of tumor response to targeted therapies. The clinical utility of mpMRI in the staging and grading of ureteral and bladder tumors is presented. Finally, the evolving role of mpMRI in prostate cancer is discussed.
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Gillis KA, McComb C, Patel RK, Stevens KK, Schneider MP, Radjenovic A, Morris STW, Roditi GH, Delles C, Mark PB. Non-Contrast Renal Magnetic Resonance Imaging to Assess Perfusion and Corticomedullary Differentiation in Health and Chronic Kidney Disease. Nephron Clin Pract 2016; 133:183-92. [PMID: 27362585 DOI: 10.1159/000447601] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 06/10/2016] [Indexed: 11/19/2022] Open
Abstract
AIMS Arterial spin labelling (ASL) MRI measures perfusion without administration of contrast agent. While ASL has been validated in animals and healthy volunteers (HVs), application to chronic kidney disease (CKD) has been limited. We investigated the utility of ASL MRI in patients with CKD. METHODS We studied renal perfusion in 24 HVs and 17 patients with CKD (age 22-77 years, 40% male) using ASL MRI at 3.0T. Kidney function was determined using estimated glomerular filtration rate (eGFR). T1 relaxation time was measured using modified look-locker inversion and xFB02;ow-sensitive alternating inversion recovery true-fast imaging and steady precession was performed to measure cortical and whole kidney perfusion. RESULTS T1 was higher in CKD within cortex and whole kidney, and there was association between T1 time and eGFR. No association was seen between kidney size and volume and either T1, or ASL perfusion. Perfusion was lower in CKD in cortex (136 ± 37 vs. 279 ± 69 ml/min/100 g; p < 0.001) and whole kidney (146 ± 24 vs. 221 ± 38 ml/min/100 g; p < 0.001). There was significant, negative, association between T1 longitudinal relaxation time and ASL perfusion in both the cortex (r = -0.75, p < 0.001) and whole kidney (r = -0.50, p < 0.001). There was correlation between eGFR and both cortical (r = 0.73, p < 0.01) and whole kidney (r = 0.69, p < 0.01) perfusion. CONCLUSIONS Significant differences in renal structure and function were demonstrated using ASL MRI. T1 may be representative of structural changes associated with CKD; however, further investigation is required into the pathological correlates of reduced ASL perfusion and increased T1 time in CKD.
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Affiliation(s)
- Keith A Gillis
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
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Ren T, Wen CL, Chen LH, Xie SS, Cheng Y, Fu YX, Oesingmann N, de Oliveira A, Zuo PL, Yin JZ, Xia S, Shen W. Evaluation of renal allografts function early after transplantation using intravoxel incoherent motion and arterial spin labeling MRI. Magn Reson Imaging 2016; 34:908-14. [PMID: 27114341 DOI: 10.1016/j.mri.2016.04.022] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Revised: 03/25/2016] [Accepted: 04/17/2016] [Indexed: 12/30/2022]
Abstract
PURPOSE To evaluate renal allografts function early after transplantation using intravoxel incoherent motion (IVIM) and arterial spin labeling (ASL) MRI. METHODS This prospective study was approved by the local ethics committee, and written informed consent was obtained from all participants. A total of 82 participants with 62 renal allograft recipients (2-4weeks after kidney transplantation) and 20 volunteers were enrolled to be scanned using IVIM and ASL MRI on a 3.0T MR scanner. Recipients were divided into two groups with either normal or impaired function according to the estimated glomerular filtration rate (eGFR) with a threshold of 60ml/min/1.73m(2). The apparent diffusion coefficient (ADC) of pure diffusion (ADCslow), the ADC of pseudodiffusion (ADCfast), perfusion fraction (PF), and renal blood flow (RBF) of cortex were compared among three groups. The correlation of ADCslow, ADCfast, PF and RBF with eGFR was evaluated. The receiver operating characteristic (ROC) curve and binary logistic regression analyses were performed to assess the diagnostic efficiency of using IVIM and ASL parameters to discriminate allografts with impaired function from normal function. P<0.05 was considered statistically significant. RESULTS In allografts with normal function, no significant difference of mean cortical ADCslow, ADCfast, and PF was found compared with healthy controls (P>0.05). Cortical RBF in allografts with normal function was statistically lower than that of healthy controls (P<0.001). Mean cortical ADCslow, ADCfast, PF and RBF were lower for allografts with impaired function than that with normal function (P<0.05). Mean cortical ADCslow, ADCfast, PF and RBF showed a positive correlation with eGFR (all P<0.01) for recipients. The combination of IVIM and ASL MRI showed a higher area under the ROC curve (AUC) (0.865) than that of ASL MRI alone (P=0.02). CONCLUSION Combined IVIM and ASL MRI can better evaluate the diffusion and perfusion properties for allografts early after kidney transplantation.
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Affiliation(s)
- Tao Ren
- Department of Radiology, Tianjin Medical University First Center Hospital, 300192, Tianjin, China.
| | - Cheng-Long Wen
- Department of Radiology, Tianjin Medical University First Center Hospital, 300192, Tianjin, China.
| | - Li-Hua Chen
- Department of Radiology, Tianjin Medical University First Center Hospital, 300192, Tianjin, China.
| | - Shuang-Shuang Xie
- Department of Radiology, Tianjin Medical University First Center Hospital, 300192, Tianjin, China.
| | - Yue Cheng
- Department of Radiology, Tianjin Medical University First Center Hospital, 300192, Tianjin, China.
| | - Ying-Xin Fu
- Department of Transplantation Surgery, Tianjin First Center Hospital, 300192, Tianjin, China.
| | | | | | - Pan-Li Zuo
- Siemens Healthcare, MR Collaborations NE Asia, 100010,Beijing, China.
| | - Jian-Zhong Yin
- Department of Radiology, Tianjin Medical University First Center Hospital, 300192, Tianjin, China.
| | - Shuang Xia
- Department of Radiology, Tianjin Medical University First Center Hospital, 300192, Tianjin, China.
| | - Wen Shen
- Department of Radiology, Tianjin Medical University First Center Hospital, 300192, Tianjin, China.
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Ye Q, Chen Z, Zhao Y, Zhang Z, Miao H, Xiao Q, Wang M, Li J. Initial experience of generalized intravoxel incoherent motion imaging and diffusion tensor imaging (GIVIM-DTI) in healthy subjects. J Magn Reson Imaging 2016; 44:732-8. [PMID: 27079733 DOI: 10.1002/jmri.25262] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Accepted: 03/18/2016] [Indexed: 11/06/2022] Open
Affiliation(s)
- Qiong Ye
- Department of Radiology; The First Affiliated Hospital of Wenzhou Medical University; ZheJiang P.R. China
| | - Zhongwei Chen
- Department of Radiology; The First Affiliated Hospital of Wenzhou Medical University; ZheJiang P.R. China
| | - Youfan Zhao
- Department of Radiology; The First Affiliated Hospital of Wenzhou Medical University; ZheJiang P.R. China
| | - Zhenhua Zhang
- Department of Radiology; The First Affiliated Hospital of Wenzhou Medical University; ZheJiang P.R. China
| | - Haiwei Miao
- Department of Radiology; The First Affiliated Hospital of Wenzhou Medical University; ZheJiang P.R. China
| | - Qinqin Xiao
- Department of Radiology; The First Affiliated Hospital of Wenzhou Medical University; ZheJiang P.R. China
| | - Meihao Wang
- Department of Radiology; The First Affiliated Hospital of Wenzhou Medical University; ZheJiang P.R. China
| | - Jiance Li
- Department of Radiology; The First Affiliated Hospital of Wenzhou Medical University; ZheJiang P.R. China
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Thölking G, Schuette-Nuetgen K, Kentrup D, Pawelski H, Reuter S. Imaging-based diagnosis of acute renal allograft rejection. World J Transplant 2016; 6:174-182. [PMID: 27011915 PMCID: PMC4801793 DOI: 10.5500/wjt.v6.i1.174] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2015] [Revised: 08/28/2015] [Accepted: 12/02/2015] [Indexed: 02/05/2023] Open
Abstract
Kidney transplantation is the best available treatment for patients with end stage renal disease. Despite the introduction of effective immunosuppressant drugs, episodes of acute allograft rejection still endanger graft survival. Since efficient treatment of acute rejection is available, rapid diagnosis of this reversible graft injury is essential. For diagnosis of rejection, invasive core needle biopsy of the graft is the “gold-standard”. However, biopsy carries the risk of significant graft injury and is not immediately feasible in patients taking anticoagulants. Therefore, a non-invasive tool assessing the whole organ for specific and fast detection of acute allograft rejection is desirable. We herein review current imaging-based state of the art approaches for non-invasive diagnostics of acute renal transplant rejection. We especially focus on new positron emission tomography-based as well as targeted ultrasound-based methods.
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Hammon M, Janka R, Siegl C, Seuss H, Grosso R, Martirosian P, Schmieder RE, Uder M, Kistner I. Reproducibility of Kidney Perfusion Measurements With Arterial Spin Labeling at 1.5 Tesla MRI Combined With Semiautomatic Segmentation for Differential Cortical and Medullary Assessment. Medicine (Baltimore) 2016; 95:e3083. [PMID: 26986143 PMCID: PMC4839924 DOI: 10.1097/md.0000000000003083] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Magnetic resonance imaging with arterial spin labeling (ASL) is a noninvasive approach to measure organ perfusion. The purpose of this study was to evaluate the reproducibility of ASL kidney perfusion measurements with semiautomatic segmentation, which allows separate quantification of cortical and medullary perfusion. The right kidneys of 14 healthy volunteers were examined 6 times on 2 occasions (3 times at each occasion). There was a 10-minute pause between each examination and a 14-day interval between the 2 occasions. Cortical, medullary, and whole kidney parenchymal perfusion was determined with customized semiautomatic segmentation software. Coefficient of variances (CVs) and intraclass correlations (ICCs) were calculated. Mean whole, cortical, and medullary kidney perfusion was 307.26 ± 25.65, 337.10 ± 34.83, and 279.61 ± 26.73 mL/min/100 g, respectively. On session 1, mean perfusion for the whole kidney, cortex, and medulla was 307.08 ± 26.91, 336.79 ± 36.54, and 279.60 ± 27.81 mL/min/100 g, respectively, and on session 2, 307.45 ± 24.65, 337.41 ± 33.48, and 279.61 ± 25.94 mL/min/100 g, respectively (P > 0.05; R² = 0.60/0.59/0.54). For whole, cortical, and medullary kidney perfusion, the total ICC/CV were 0.97/3.43 ± 0.86%, 0.97/4.19 ± 1.33%, and 0.96/4.12 ± 1.36%, respectively. Measurements did not differ significantly and showed a very good correlation (P > 0.05; R² = 0.75/0.76/0.65). ASL kidney measurements combined with operator-independent semiautomatic segmentation revealed high correlation and low variance of cortical, medullary, and whole kidney perfusion.
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Affiliation(s)
- Matthias Hammon
- From the Department of Radiology (MH, RJ, HS, MU), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Maximiliansplatz, Erlangen, Germany; Department of Computer Graphics (CS, RG), Friedrich-Alexander-Universität Erlangen-Nürnberg, Cauerstraße, Erlangen, Germany; Experimental Radiology, Department of Diagnostic and Interventional Radiology (PM), University Hospital Tübingen, Otfried-Müller-Straße, Tübingen, Germany; and Department of Nephrology and Hypertension (RES, IK), University Hospital Erlangen, Ulmenweg, Erlangen, Germany
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Robson PM, Madhuranthakam AJ, Smith MP, Sun MRM, Dai W, Rofsky NM, Pedrosa I, Alsop DC. Volumetric Arterial Spin-labeled Perfusion Imaging of the Kidneys with a Three-dimensional Fast Spin Echo Acquisition. Acad Radiol 2016; 23:144-54. [PMID: 26521186 DOI: 10.1016/j.acra.2015.09.013] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 07/06/2015] [Accepted: 09/27/2015] [Indexed: 11/16/2022]
Abstract
RATIONALE AND OBJECTIVES Renal perfusion measurements using noninvasive arterial spin-labeled (ASL) magnetic resonance imaging techniques are gaining interest. Currently, focus has been on perfusion in the context of renal transplant. Our objectives were to explore the use of ASL in patients with renal cancer, and to evaluate three-dimensional (3D) fast spin echo (FSE) acquisition, a robust volumetric imaging method for abdominal applications. We evaluate 3D ASL perfusion magnetic resonance imaging in the kidneys compared to two-dimensional (2D) ASL in patients and healthy subjects. MATERIALS AND METHODS Isotropic resolution (2.6 × 2.6 × 2.8 mm(3)) 3D ASL using segmented FSE was compared to 2D single-shot FSE. ASL used pseudo-continuous labeling, suppression of background signal, and synchronized breathing. Quantitative perfusion values and signal-to-noise ratio (SNR) were compared between 3D and 2D ASL in four healthy volunteers and semiquantitative assessments were made by four radiologists in four patients with known renal masses (primary renal cell carcinoma). RESULTS Renal cortex perfusion in healthy subjects was 284 ± 21 mL/100 g/min, with test-retest repeatability of 8.8%. No significant differences were found between the quantitative perfusion value and SNR in volunteers between 3D ASL and 2D ASL, or in 3D ASL with synchronized or free breathing. In patients, semiquantitative assessment by radiologists showed no significant difference in image quality between 2D ASL and 3D ASL. In one case, 2D ASL missed a high perfusion focus in a mass that was seen by 3D ASL. CONCLUSIONS 3D ASL renal perfusion imaging provides isotropic-resolution images, with comparable quantitative perfusion values and image SNR in similar imaging time to single-slice 2D ASL.
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Affiliation(s)
- Philip M Robson
- Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave, AN-226, Boston, MA 02215.
| | | | - Martin P Smith
- Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave, AN-226, Boston, MA 02215
| | - Maryellen R M Sun
- Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave, AN-226, Boston, MA 02215
| | - Weiying Dai
- Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave, AN-226, Boston, MA 02215
| | - Neil M Rofsky
- University of Texas Southwestern Medical Center, Dallas, Texas
| | - Ivan Pedrosa
- University of Texas Southwestern Medical Center, Dallas, Texas
| | - David C Alsop
- Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave, AN-226, Boston, MA 02215
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Zhang Y, Kapur P, Yuan Q, Xi Y, Carvo I, Signoretti S, Dimitrov I, Cadeddu JA, Margulis V, Muradyan N, Brugarolas J, Madhuranthakam AJ, Pedrosa I. Tumor Vascularity in Renal Masses: Correlation of Arterial Spin-Labeled and Dynamic Contrast-Enhanced Magnetic Resonance Imaging Assessments. Clin Genitourin Cancer 2016; 14:e25-36. [PMID: 26422014 PMCID: PMC4698181 DOI: 10.1016/j.clgc.2015.08.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 08/12/2015] [Accepted: 08/24/2015] [Indexed: 01/18/2023]
Abstract
UNLABELLED Arterial spin-labeled (ASL) and dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) have been proposed to quantitatively assess vascularity in renal cell carcinoma (RCC). However, there are intrinsic differences between these 2 imaging methods, such as the relative contribution of vascular permeability and blood flow to signal intensity for DCE MRI. We found a correlation between ASL perfusion and the DCE-derived volume transfer constant and rate constant parameters in renal masses > 2 cm in size and these measures correlated with microvessel density in clear cell RCC. BACKGROUND The objective of this study was to investigate potential correlations between perfusion using arterial spin-labeled (ASL) magnetic resonance imaging (MRI) and dynamic contrast-enhanced (DCE) MRI-derived quantitative measures of vascularity in renal masses > 2 cm and to correlate these with microvessel density (MVD) in clear cell renal cell carcinoma (ccRCC). PATIENTS AND METHODS Informed written consent was obtained from all patients before imaging in this Health Insurance Portability and Accountability Act-compliant, institutional review board-approved, prospective study. Thirty-six consecutive patients scheduled for surgery of a known renal mass > 2 cm underwent 3T ASL and DCE MRI. ASL perfusion measures (PASL) of mean, peak, and low perfusion areas within the mass were correlated to DCE-derived volume transfer constant (K(trans)), rate constant (Kep), and fractional volume of the extravascular extracellular space (Ve) in the same locations using a region of interest analysis. MRI data were correlated to MVD measures in the same tumor regions in ccRCC. Spearman correlation was used to evaluate the correlation between PASL and DCE-derived measurements, and MVD. P < .05 was considered statistically significant. RESULTS Histopathologic diagnosis was obtained in 36 patients (25 men; mean age 58 ± 12 years). PASL correlated with K(trans) (ρ = 0.48 and P = .0091 for the entire tumor and ρ = 0.43 and P = .03 for the high flow area, respectively) and Kep (ρ = 0.46 and P = .01 for the entire tumor and ρ = 0.52 and P = .008 for the high flow area, respectively). PASL (ρ = 0.66; P = .0002), K(trans) (ρ = 0.61; P = .001), and Kep (ρ = 0.64; P = .0006) also correlated with MVD in high and low perfusion areas in ccRCC. CONCLUSION PASL correlated with the DCE-derived measures of vascular permeability and flow, K(trans) and Kep, in renal masses > 2 cm in size. Both measures correlated to MVD in clear cell histology.
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Affiliation(s)
- Yue Zhang
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX
| | - Payal Kapur
- Department of Urology, UT Southwestern Medical Center, Dallas, TX; Department of Pathology, UT Southwestern Medical Center, Dallas, TX
| | - Qing Yuan
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX
| | - Yin Xi
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX
| | - Ingrid Carvo
- Department of Pathology, Brigham and Women's Hospital, Boston, MA
| | | | - Ivan Dimitrov
- Advanced Imaging Research Center, UT Southwestern Medical Center, Dallas, TX; Philips Medical Systems, Cleveland, OH
| | - Jeffrey A Cadeddu
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX; Department of Urology, UT Southwestern Medical Center, Dallas, TX
| | - Vitaly Margulis
- Department of Urology, UT Southwestern Medical Center, Dallas, TX
| | | | - James Brugarolas
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX; Developmental Biology, UT Southwestern Medical Center, Dallas, TX
| | - Ananth J Madhuranthakam
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX; Advanced Imaging Research Center, UT Southwestern Medical Center, Dallas, TX
| | - Ivan Pedrosa
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX; Advanced Imaging Research Center, UT Southwestern Medical Center, Dallas, TX.
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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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Wang YT, Li YC, Yin LL, Pu H, Chen JY. Functional assessment of transplanted kidneys with magnetic resonance imaging. World J Radiol 2015; 7:343-349. [PMID: 26516431 PMCID: PMC4620115 DOI: 10.4329/wjr.v7.i10.343] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Revised: 08/17/2015] [Accepted: 09/08/2015] [Indexed: 02/06/2023] Open
Abstract
Kidney transplantation has emerged as the treatment of choice for many patients with end-stage renal disease, which is a significant cause of morbidity and mortality. Given the shortage of clinically available donor kidneys and the significant incidence of allograft dysfunction, a noninvasive and accurate assessment of the allograft renal function is critical for postoperative management. Prompt diagnosis of graft dysfunction facilitates clinical intervention of kidneys with salvageable function. New advances in magnetic resonance imaging (MRI) technology have enabled the calculation of various renal parameters that were previously not feasible to measure noninvasively. Diffusion-weighted imaging provides information on renal diffusion and perfusion simultaneously, with quantification by the apparent diffusion coefficient, the decrease of which reflects renal function impairment. Diffusion-tensor imaging accounts for the directionality of molecular motion and measures fractional anisotropy of the kidneys. Blood oxygen level-dependent MR evaluates intrarenal oxygen bioavailability, generating the parameter of R2* (reflecting the concentration of deoxyhemoglobin). A decrease in R2* could happen during acute rejection. MR nephro-urography/renography demonstrates structural data depicting urinary tract obstructions and functional data regarding the glomerular filtration and blood flow. MR angiography details the transplant vasculature and is particularly suitable for detecting vascular complications, with good correlation with digital subtraction angiography. Other functional MRI technologies, such as arterial spin labeling and MR spectroscopy, are showing additional promise. This review highlights MRI as a comprehensive modality to diagnose a variety of etiologies of graft dysfunction, including prerenal (e.g., renal vasculature), renal (intrinsic causes) and postrenal (e.g., obstruction of the collecting system) etiologies.
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Hueper K, Gueler F, Bräsen JH, Gutberlet M, Jang MS, Lehner F, Richter N, Hanke N, Peperhove M, Martirosian P, Tewes S, Vo Chieu VD, Großhennig A, Haller H, Wacker F, Gwinner W, Hartung D. Functional MRI detects perfusion impairment in renal allografts with delayed graft function. Am J Physiol Renal Physiol 2015; 308:F1444-51. [DOI: 10.1152/ajprenal.00064.2015] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 04/28/2015] [Indexed: 11/22/2022] Open
Abstract
Delayed graft function (DGF) after kidney transplantation is not uncommon, and it is associated with long-term allograft impairment. Our aim was to compare renal perfusion changes measured with noninvasive functional MRI in patients early after kidney transplantation to renal function and allograft histology in biopsy samples. Forty-six patients underwent MRI 4–11 days after transplantation. Contrast-free MRI renal perfusion images were acquired using an arterial spin labeling technique. Renal function was assessed by estimated glomerular filtration rate (eGFR), and renal biopsies were performed when indicated within 5 days of MRI. Twenty-six of 46 patients had DGF. Of these, nine patients had acute rejection (including borderline), and eight had other changes (e.g., tubular injury or glomerulosclerosis). Renal perfusion was significantly lower in the DGF group compared with the group with good allograft function (231 ± 15 vs. 331 ± 15 ml·min−1·100 g−1, P < 0.001). Living donor allografts exhibited significantly higher perfusion values compared with deceased donor allografts ( P < 0.001). Renal perfusion significantly correlated with eGFR ( r = 0.64, P < 0.001), resistance index ( r = −0.57, P < 0.001), and cold ischemia time ( r = −0.48, P < 0.01). Furthermore, renal perfusion impairment early after transplantation predicted inferior renal outcome and graft loss. In conclusion, noninvasive functional MRI detects renal perfusion impairment early after kidney transplantation in patients with DGF.
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Affiliation(s)
- Katja Hueper
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Faikah Gueler
- Department of Nephrology, Hannover Medical School, Hannover, Germany
| | | | - Marcel Gutberlet
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Mi-Sun Jang
- Department of Nephrology, Hannover Medical School, Hannover, Germany
| | - Frank Lehner
- Department of General, Abdominal and Transplant Surgery, Hannover Medical School, Hannover, Germany
| | - Nicolas Richter
- Department of General, Abdominal and Transplant Surgery, Hannover Medical School, Hannover, Germany
| | - Nils Hanke
- Department of Nephrology, Hannover Medical School, Hannover, Germany
| | - Matti Peperhove
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Petros Martirosian
- Section on Experimental Radiology, University of Tübingen, Tübingen, Germany; and
| | - Susanne Tewes
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Van Dai Vo Chieu
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Anika Großhennig
- Institute for Biostatistics, Hannover Medical School, Hannover, Germany
| | - Hermann Haller
- Department of Nephrology, Hannover Medical School, Hannover, Germany
| | - Frank Wacker
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Wilfried Gwinner
- Department of Nephrology, Hannover Medical School, Hannover, Germany
| | - Dagmar Hartung
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
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Cutajar M, Hilton R, Olsburgh J, Marks SD, Thomas DL, Banks T, Clark CA, Gordon I. Renal blood flow using arterial spin labelling MRI and calculated filtration fraction in healthy adult kidney donors Pre-nephrectomy and post-nephrectomy. Eur Radiol 2015; 25:2390-6. [PMID: 25666379 DOI: 10.1007/s00330-015-3594-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Revised: 12/21/2014] [Accepted: 01/12/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Renal plasma flow (RPF) (derived from renal blood flow, RBF) and glomerular filtration rate (GFR) allow the determination of the filtration fraction (FF), which may have a role as a non-invasive renal biomarker. This is a hypothesis-generating pilot study assessing the effect of nephrectomy on renal function in healthy kidney donors. METHODS Eight living kidney donors underwent arterial spin labelling (ASL) magnetic resonance imaging (MRI) and GFR measurement prior to and 1 year after nephrectomy. Chromium-51 labelled ethylenediamine tetraacetic acid ((51)Cr-EDTA) with multi-blood sampling was undertaken and GFR calculated. The RBF and GFR obtained were used to calculate FF. RESULTS All donors showed an increase in single kidney GFR of 24 - 75 %, and all but two showed an increase in FF (-7 to +52 %) after nephrectomy. The increase in RBF, and hence RPF, post-nephrectomy was not as great as the increase in GFR in seven out of eight donors. As with any pilot study, the small number of donors and their relatively narrow age range are potential limiting factors. CONCLUSIONS The ability to measure RBF, and hence RPF, non-invasively, coupled with GFR measurement, allows calculation of FF, a biomarker that might provide a sensitive indicator of loss of renal reserve in potential donors. KEY POINTS • Non-invasive MRI measured renal blood flow and calculated renal plasma flow. • Effect of nephrectomy on blood flow and filtration in donors is presented. • Calculated filtration fraction may be a useful new kidney biomarker.
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Affiliation(s)
- Marica Cutajar
- Imaging and Biophysics Unit, Institute of Child Health, University College London, 30 Guilford Street, London, WC1N1EH, UK
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Hueper K, Peperhove M, Rong S, Gerstenberg J, Mengel M, Meier M, Gutberlet M, Tewes S, Barrmeyer A, Chen R, Haller H, Wacker F, Hartung D, Gueler F. T1-mapping for assessment of ischemia-induced acute kidney injury and prediction of chronic kidney disease in mice. Eur Radiol 2014; 24:2252-60. [DOI: 10.1007/s00330-014-3250-6] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Revised: 04/02/2014] [Accepted: 05/15/2014] [Indexed: 12/27/2022]
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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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