1
|
Andersson J, Meik R, Pravdivtseva MS, Langguth P, Gottschalk H, Sedaghat S, Jüptner M, Koktzoglou I, Edelman RR, Kühn B, Feldkamp T, Jansen O, Both M, Salehi Ravesh M. Non-contrast preoperative MRI for determining renal perfusion and visualizing renal arteries in potential living kidney donors at 1.5 Tesla. Clin Kidney J 2024; 17:sfae101. [PMID: 38915436 PMCID: PMC11194483 DOI: 10.1093/ckj/sfae101] [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: 02/12/2024] [Indexed: 06/26/2024] Open
Abstract
Background The aim of this work was to create and evaluate a preoperative non-contrast-enhanced (CE) magnetic resonance imaging (MRI)/angiography (MRA) protocol to assess renal function and visualize renal arteries and any abnormalities in potential living kidney donors. Methods In total, 28 subjects were examined using scintigraphy to determine renal function. In addition, 3D-pseudocontinuous arterial spin labeling (pCASL), a 2D-non-CE electrocardiogram-triggered radial quiescent interval slice-selective (QISS-MRA), and 4D-CE time-resolved angiography with interleaved stochastic trajectories (CE-MRA) were performed to assess renal perfusion, visualize renal arteries and detect any abnormalities. Two glomerular filtration rates [described by Gates (GFRG) and according to the Chronic Kidney Disease Epidemiology Collaboration formula (GFRCKD-EPI)]. The renal volumes were determined using both MRA techniques. Results The mean value of regional renal blood flow (rRBF) on the right side was significantly higher than that on the left. The agreements between QISS-MRA and CE-MRA concerning the assessment of absence or presence of an aberrant artery and renal arterial stenosis were perfect. The mean renal volumes measured in the right kidney with QISS-MRA were lower than the corresponding values of CE-MRA. In contrast, the mean renal volumes measured in the left kidney with both MRA techniques were similar. The correlation between the GFRG and rRBF was compared in the same manner as that between GFRCKD-EPI and rRBF. Conclusion The combination of pCASL and QISS-MRA constitute a reliable preoperative protocol with a total measurement time of <10 min without the potential side effects of gadolinium-based contrast agents or radiation exposure.
Collapse
Affiliation(s)
- Julian Andersson
- Department of Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - Rosalie Meik
- Department of Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - Mariya S Pravdivtseva
- Department of Radiology and Neuroradiology, Section Biomedical Imaging, Molecular Imaging North Competence Center (MOIN CC), University Medical Center Schleswig-Holstein (UKSH), University of Kiel, Kiel, Germany
| | - Patrick Langguth
- Department of Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - Hannes Gottschalk
- Department of Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - Sam Sedaghat
- Department of Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Michael Jüptner
- Department of Nuclear Medicine, Molecular Imaging, Diagnostics and Therapy, University Hospital of Schleswig-Holstein, Campus Kiel, Germany
| | - Ioannis Koktzoglou
- Department of Radiology, NorthShore University HealthSystem, Evanston, IL, USA
- University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | - Robert R Edelman
- Department of Radiology, NorthShore University HealthSystem, Evanston, IL, USA
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Bernd Kühn
- Siemens Healthineers AG, Erlangen, Germany
| | - Thorsten Feldkamp
- Department of Nephrology and Hypertension, University Hospital Schleswig-Holstein, Christian-Albrechts-University, Kiel, Germany
| | - Olav Jansen
- Department of Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - Marcus Both
- Department of Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - Mona Salehi Ravesh
- Department of Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| |
Collapse
|
2
|
Jufar AH, Evans RG, May CN, Hood SG, Betrie AH, Trask‐Marino A, Bellomo R, Lankadeva YR. The effects of recruitment of renal functional reserve on renal cortical and medullary oxygenation in non-anesthetized sheep. Acta Physiol (Oxf) 2023; 237:e13919. [PMID: 36598336 PMCID: PMC10909474 DOI: 10.1111/apha.13919] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 11/18/2022] [Accepted: 01/02/2023] [Indexed: 01/05/2023]
Abstract
AIM Recruitment of renal functional reserve (RFR) with amino acid loading increases renal blood flow and glomerular filtration rate. However, its effects on renal cortical and medullary oxygenation have not been determined. Accordingly, we tested the effects of recruitment of RFR on renal cortical and medullary oxygenation in non-anesthetized sheep. METHODS Under general anesthesia, we instrumented 10 sheep to enable subsequent continuous measurements of systemic and renal hemodynamics, renal oxygen delivery and consumption, and cortical and medullary tissue oxygen tension (PO2 ). We then measured the effects of recruitment of RFR with an intravenous infusion of 500 ml of a clinically used amino acid solution (10% Synthamin® 17) in the non-anesthetized state. RESULTS Compared with baseline, Synthamin® 17 infusion significantly increased renal oxygen delivery mean ± SD maximum increase: (from 0.79 ± 0.17 to 1.06 ± 0.16 ml/kg/min, p < 0.001), renal oxygen consumption (from 0.08 ± 0.01 to 0.15 ± 0.02 ml/kg/min, p < 0.001), and glomerular filtration rate (+45.2 ± 2.7%, p < 0.001). Renal cortical tissue PO2 increased by a maximum of 26.4 ± 1.1% (p = 0.001) and medullary tissue PO2 increased by a maximum of 23.9 ± 2.8% (p = 0. 001). CONCLUSIONS In non-anesthetized healthy sheep, recruitment of RFR improved renal cortical and medullary oxygenation. These observations might have implications for the use of recruitment of RFR for diagnostic and therapeutic purposes.
Collapse
Affiliation(s)
- Alemayehu H. Jufar
- Pre‐Clinical Critical Care UnitFlorey Institute of Neuroscience and Mental Health, University of MelbourneMelbourneVictoriaAustralia
- Cardiovascular Disease Program, Department of PhysiologyBiomedicine Discovery Institute, Monash UniversityMelbourneVictoriaAustralia
| | - Roger G. Evans
- Pre‐Clinical Critical Care UnitFlorey Institute of Neuroscience and Mental Health, University of MelbourneMelbourneVictoriaAustralia
- Cardiovascular Disease Program, Department of PhysiologyBiomedicine Discovery Institute, Monash UniversityMelbourneVictoriaAustralia
| | - Clive N. May
- Pre‐Clinical Critical Care UnitFlorey Institute of Neuroscience and Mental Health, University of MelbourneMelbourneVictoriaAustralia
- Department of Critical CareMelbourne Medical School, University of MelbourneMelbourneVictoriaAustralia
| | - Sally G. Hood
- Pre‐Clinical Critical Care UnitFlorey Institute of Neuroscience and Mental Health, University of MelbourneMelbourneVictoriaAustralia
| | - Ashenafi H. Betrie
- Pre‐Clinical Critical Care UnitFlorey Institute of Neuroscience and Mental Health, University of MelbourneMelbourneVictoriaAustralia
- Melbourne Dementia Research CentreFlorey Institute of Neuroscience and Mental Health, The University of MelbourneMelbourneVictoriaAustralia
| | - Anton Trask‐Marino
- Pre‐Clinical Critical Care UnitFlorey Institute of Neuroscience and Mental Health, University of MelbourneMelbourneVictoriaAustralia
| | - Rinaldo Bellomo
- Pre‐Clinical Critical Care UnitFlorey Institute of Neuroscience and Mental Health, University of MelbourneMelbourneVictoriaAustralia
- Department of Critical CareMelbourne Medical School, University of MelbourneMelbourneVictoriaAustralia
| | - Yugeesh R. Lankadeva
- Pre‐Clinical Critical Care UnitFlorey Institute of Neuroscience and Mental Health, University of MelbourneMelbourneVictoriaAustralia
- Department of Critical CareMelbourne Medical School, University of MelbourneMelbourneVictoriaAustralia
| |
Collapse
|
3
|
Azawi N, Jensen M, Jensen BL, Goetze JP, Bistrup C, Lund L. Functional adaptation after kidney tissue removal in patients is associated with increased plasma atrial natriuretic peptide concentration. Nephrol Dial Transplant 2021; 37:2138-2149. [PMID: 34792174 DOI: 10.1093/ndt/gfab327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Following nephrectomy, the remaining kidney tissue adapts by an increase in GFR. In rats, hyperfiltration can be transferred by plasma. We examined whether natriuretic peptides (ANP, BNP) increase in plasma proportionally with kidney mass reduction and, if so, whether the increase relates to an increase in GFR. METHODS Patients (n = 54) undergoing partial or total unilateral nephrectomy at two Danish centers were followed for one year in an observational study. Glomerular filtration rate was measured before, 3, and 12 months after surgery. Natriuretic propeptides (proANP and proBNP) and aldosterone were measured in plasma before and at 24 hours, five days, 21 days, three months, and 12 months. Cyclic GMP was determined in urine. RESULTS There was no baseline difference in GFR between total- and partial nephrectomy (90.1 mL/min ±14.6 vs. 82.9±18, p = 0.16). Single-kidney GFR increased after 3 and 12 months (12.0 and 11.9 ml/min/1.73m2, +23.3%). There was no change in measured GFR 3 and 12 months after partial nephrectomy. ProANP and proBNP increased 3-fold 24h after surgery and returned to baseline after five days. The magnitude of acute proANP and proBNP increases did not relate to kidney mass removed. ProANP, not proBNP, increased 12 months after nephrectomy. Plasma aldosterone and urine cGMP did not change. Urine albumin/creatine ratio increased transiently after partial nephrectomy. Blood pressure was similar between groups. CONCLUSION ANP and BNP increase acutely in plasma with no relation to degree of kidney tissue ablation. After 1year, only unilateral nephrectomy patients display increased plasma ANP which could support adaptation.
Collapse
Affiliation(s)
- Nessn Azawi
- Department of Urology, Zealand University Hospital, Roskilde, Denmark.,Institute of clinical medicine, Copenhagen University, Denmark
| | - Mia Jensen
- Cardiovascular and renal research, Institute of Molecular Medicine, University of Southern Denmark, Denmark
| | - Boye L Jensen
- Cardiovascular and renal research, Institute of Molecular Medicine, University of Southern Denmark, Denmark.,Department of Urology, Odense University Hospital, Odense, Denmark
| | - Jens P Goetze
- Department of Clinical Biochemistry, Rigshospitalet, University of Copenhagen, Denmark
| | - Claus Bistrup
- Department of Nephrology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Denmark
| | - Lars Lund
- Department of Urology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Denmark
| |
Collapse
|
4
|
Evaluation of Vascular Structures of Living Donor Kidneys by Multislice Computed Tomography Angiography before Transplant Surgery: Is Arterial Phase Sufficient for Determination of Both Arteries and Veins? J Belg Soc Radiol 2019; 103:23. [PMID: 30972380 PMCID: PMC6450243 DOI: 10.5334/jbsr.1719] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Objectives The aim of our study was to determine the efficacy of preoperative early arterial Computed tomography angiography (CTA) in donor nephrectomy, to assess the renal arterial and venous structures of donor kidneys. Materials and Methods Seventy living donor candidates were included to this study, who had CTA for the assessment of their renal vessels in our hospital between January 2011 and January 2015. Only early arterial phase images were obtained to avoid exposing the patients from high dose of radiation. Scans were reported by two radiologists independently. The number of renal arteries, veins and their tributaries were documented. The donor kidneys were removed by two consultant surgeons, and after back-table perfusion the same details were recorded and taken as the reference findings for the operation side. Results A total of 70 potential live kidney donors underwent renal CTA, among them fifty five patients had donor nephrectomy. A total of 140 kidneys were evaluated by CTA and the vessels of 55 harvested kidneys were compared with CTA findings. There were 40 kidneys that had at least one accessory or polar artery. There were 5 early branching renal arteries, two retroaortic and two circumaortic renal veins. Three kidneys had multiple renal veins. Operation findings were totally consistent with CTA findings in patients who underwent donor nephrectomy. Conclusion Arterial phase CTA is sufficient for evaluation of both arterial and venous vessels of kidneys, and precontrast, venous or late phase imaging should be preserved only for chosen circumstances to avoid high radiation exposure.
Collapse
|
5
|
Nery F, De Vita E, Clark CA, Gordon I, Thomas DL. Robust kidney perfusion mapping in pediatric chronic kidney disease using single-shot 3D-GRASE ASL with optimized retrospective motion correction. Magn Reson Med 2018; 81:2972-2984. [PMID: 30536817 DOI: 10.1002/mrm.27614] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 10/24/2018] [Accepted: 10/25/2018] [Indexed: 12/18/2022]
Abstract
PURPOSE To develop a robust renal arterial spin labeling (ASL) acquisition and processing strategy for mapping renal blood flow (RBF) in a pediatric cohort with severe kidney disease. METHODS A single-shot background-suppressed 3D gradient and spin-echo (GRASE) flow-sensitive alternating inversion recovery (FAIR) ASL acquisition method was used to perform 2 studies. First, an evaluation of the feasibility of single-shot 3D-GRASE and retrospective noise reduction methods was performed in healthy volunteers. Second, a pediatric cohort with severe chronic kidney disease underwent single-shot 3D-GRASE FAIR ASL and RBF was quantified following several retrospective motion correction pipelines, including image registration and threshold-free weighted averaging. The effect of motion correction on the fit errors of saturation recovery (SR) images (required for RBF quantification) and on the perfusion-weighted image (PWI) temporal signal-to-noise ratio (tSNR) was evaluated, as well as the intra- and inter-session repeatability of renal longitudinal relaxation time (T1 ) and RBF. RESULTS The mean cortical and/or functional renal parenchyma RBF in healthy volunteers and CKD patients was 295 ± 97 and 95 ± 47 mL/100 g/min, respectively. Motion-correction reduced image artefacts in both T1 and RBF maps, significantly reduced SR fit errors, significantly increased the PWI tSNR and improved the improved the repeatability of T1 and RBF in the pediatric patient cohort. CONCLUSION Single-shot 3D-GRASE ASL combined with retrospective motion correction enabled repeatable non-invasive RBF mapping in the first pediatric cohort with severe kidney disease undergoing ASL scans.
Collapse
Affiliation(s)
- Fabio Nery
- Developmental Imaging and Biophysics Section, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Enrico De Vita
- Department of Biomedical Engineering, School of Biomedical Engineering & Imaging Sciences, King's College London, King's Health Partners, St Thomas' Hospital, London, United Kingdom
| | - Chris A Clark
- Developmental Imaging and Biophysics Section, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Isky Gordon
- Developmental Imaging and Biophysics Section, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - David L Thomas
- Department of Brain Repair and Rehabilitation, University College London Queen Square Institute of Neurology, Queen Square, London, United Kingdom.,Leonard Wolfson Experimental Neurology Centre, University College London Queen Square Institute of Neurology, Queen Square, London, United Kingdom
| |
Collapse
|
6
|
De Moor B, Vanwalleghem JF, Swennen Q, Stas KJ, Meijers BKI. Haemodynamic or metabolic stimulation tests to reveal the renal functional response: requiem or revival? Clin Kidney J 2018; 11:623-654. [PMID: 30288259 PMCID: PMC6165749 DOI: 10.1093/ckj/sfy022] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 02/26/2018] [Indexed: 12/24/2022] Open
Abstract
Renal stimulation tests document the dynamic response of the glomerular filtration rate (GFR) after a single or a combination of stimuli, such as an intravenous infusion of dopamine or amino acids or an oral protein meal. The increment of the GFR above the unstimulated state has formerly been called the renal functional reserve (RFR). Although the concept of a renal reserve capacity has not withstood scientific scrutiny, the literature documenting renal stimulation merits renewed interest. An absent or a blunted response of the GFR after a stimulus indicates lost or diseased nephrons. This information is valuable in preventing, diagnosing and prognosticating acute kidney injury and pregnancy-related renal events as well as chronic kidney disease. However, before renal function testing is universally practiced, some shortcomings must be addressed. First, a common nomenclature should be decided upon. The expression of RFR should be replaced by renal functional response. Second, a simple protocol must be developed and propagated. Third, we suggest designing prospective studies linking a defective stimulatory response to emergence of renal injury biomarkers, to histological or morphological renal abnormalities and to adverse renal outcomes in different renal syndromes.
Collapse
Affiliation(s)
- Bart De Moor
- Faculty of Medicine and Life Sciences, University of Hasselt, Diepenbeek, Belgium
- Department of Nephrology, Jessa Hospital of Hasselt, Hasselt, Belgium
| | | | - Quirine Swennen
- Faculty of Medicine and Life Sciences, University of Hasselt, Diepenbeek, Belgium
| | - Koen J Stas
- Department of Nephrology, Jessa Hospital of Hasselt, Hasselt, Belgium
| | - Björn K I Meijers
- Department of Nephrology, Universitair Ziekenhuis Leuven, Leuven, Belgium
- Department of Immunology and Microbiology, Faculty of Medicine, Katholieke Universiteit Leuven, Leuven, Belgium
| |
Collapse
|
7
|
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.
Collapse
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
| | | |
Collapse
|
8
|
Zhou JY, Wang YC, Zeng CH, Ju SH. Renal Functional MRI and Its Application. J Magn Reson Imaging 2018; 48:863-881. [PMID: 30102436 DOI: 10.1002/jmri.26180] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 04/10/2018] [Indexed: 12/11/2022] Open
Abstract
Renal function varies according to the nature and stage of diseases. Renal functional magnetic resonance imaging (fMRI), a technique considered superior to the most common method used to estimate the glomerular filtration rate, allows for noninvasive, accurate measurements of renal structures and functions in both animals and humans. It has become increasingly prevalent in research and clinical applications. In recent years, renal fMRI has developed rapidly with progress in MRI hardware and emerging postprocessing algorithms. Function-related imaging markers can be acquired via renal fMRI, encompassing water molecular diffusion, perfusion, and oxygenation. This review focuses on the progression and challenges of the main renal fMRI methods, including dynamic contrast-enhanced MRI, blood oxygen level-dependent MRI, diffusion-weighted imaging, diffusion tensor imaging, arterial spin labeling, fat fraction imaging, and their recent clinical applications. LEVEL OF EVIDENCE 5 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018;48:863-881.
Collapse
Affiliation(s)
- Jia-Ying Zhou
- Jiangsu Key Laboratory of Molecular and Functional Imaging, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, China
| | - Yuan-Cheng Wang
- Jiangsu Key Laboratory of Molecular and Functional Imaging, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, China
| | - Chu-Hui Zeng
- Jiangsu Key Laboratory of Molecular and Functional Imaging, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, China
| | - Sheng-Hong Ju
- Jiangsu Key Laboratory of Molecular and Functional Imaging, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, China
| |
Collapse
|
9
|
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.
Collapse
|
10
|
Romero CA, Cabral G, Knight RA, Ding G, Peterson EL, Carretero OA. Noninvasive measurement of renal blood flow by magnetic resonance imaging in rats. Am J Physiol Renal Physiol 2017; 314:F99-F106. [PMID: 28978533 DOI: 10.1152/ajprenal.00332.2017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Renal blood flow (RBF) provides important information regarding renal physiology and nephropathies. Arterial spin labeling-magnetic resonance imaging (ASL-MRI) is a noninvasive method of measuring blood flow without exogenous contrast media. However, low signal-to-noise ratio and respiratory motion artifacts are challenges for RBF measurements in small animals. Our objective was to evaluate the feasibility and reproducibility of RBF measurements by ASL-MRI using respiratory-gating and navigator correction methods to reduce motion artifacts. ASL-MRI images were obtained from the kidneys of Sprague-Dawley (SD) rats on a 7-Tesla Varian MRI system with a spin-echo imaging sequence. After 4 days, the study was repeated to evaluate its reproducibility. RBF was also measured in animals under unilateral nephrectomy and in renal artery stenosis (RST) to evaluate the sensitivity in high and low RBF models, respectively. RBF was also evaluated in Dahl salt-sensitive (SS) rats and spontaneous hypertensive rats (SHR). In SD rats, the cortical RBFs (cRBF) were 305 ± 59 and 271.8 ± 39 ml·min-1·100 g tissue-1 in the right and left kidneys, respectively. Retest analysis revealed no differences ( P = 0.2). The test-retest reliability coefficient was 92 ± 5%. The cRBFs before and after the nephrectomy were 296.8 ± 30 and 428.2 ± 45 ml·min-1·100 g tissue-1 ( P = 0.02), respectively. The kidneys with RST exhibited a cRBF decrease compared with sham animals (86 ± 17.6 vs. 198 ± 33.7 ml·min-1·100 g tissue-1; P < 0.01). The cRBFs in SD, Dahl-SS, and SHR rats were not different ( P = 0.35). We conclude that ASL-MRI performed with navigator correction and respiratory gating is a feasible and reliable noninvasive method for measuring RBF in rats.
Collapse
Affiliation(s)
- Cesar A Romero
- Hypertension and Vascular Research Division, Department of Internal Medicine, Henry Ford Hospital , Detroit, Michigan
| | - Glauber Cabral
- Department of Neurology-NMR Research, Henry Ford Hospital , Detroit, Michigan
| | - Robert A Knight
- Department of Neurology-NMR Research, Henry Ford Hospital , Detroit, Michigan
| | - Guangliang Ding
- Department of Neurology-NMR Research, Henry Ford Hospital , Detroit, Michigan
| | - Edward L Peterson
- Department of Public Health Sciences, Henry Ford Hospital , Detroit, Michigan
| | - Oscar A Carretero
- Hypertension and Vascular Research Division, Department of Internal Medicine, Henry Ford Hospital , Detroit, Michigan
| |
Collapse
|
11
|
Mora-Gutiérrez JM, Garcia-Fernandez N, Slon Roblero MF, Páramo JA, Escalada FJ, Wang DJ, Benito A, Fernández-Seara MA. Arterial spin labeling MRI is able to detect early hemodynamic changes in diabetic nephropathy. J Magn Reson Imaging 2017; 46:1810-1817. [PMID: 28383796 DOI: 10.1002/jmri.25717] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Accepted: 03/15/2017] [Indexed: 11/06/2022] Open
Abstract
PURPOSE To investigate whether arterial spin labeling (ASL) MRI could detect renal hemodynamic impairment in diabetes mellitus (DM) along different stages of chronic kidney disease (CKD). MATERIALS AND METHODS Three Tesla (3T) ASL-MRI was performed to evaluate renal blood flow (RBF) in 91 subjects (46 healthy volunteers and 45 type 2 diabetic patients). Patients were classified according to their estimated glomerular filtration rate (eGFR) as group I (eGFR > 60 mL/min/1.73 m2 ), group II (60 ≥ eGFR>30 mL/min/1.73 m2 ), or group III (eGFR ≤ 30 mL/min/1.73 m2 ), to determine differences depending on renal function. Studies were performed at 3T using a 12-channel flexible body array combined with the spine array coil as receiver. RESULTS A 28% reduction in cortical RBF was seen in diabetics in comparison with healthy controls (185.79 [54.60] versus 258.83 [37.96] mL/min/100 g, P < 3 × 10-6 ). Differences were also seen between controls and diabetic patients despite normal eGFR and absence of overt albuminuria (RBF [mL/min/100 g]: controls=258.83 [37.96], group I=208.89 [58.83], P = 0.0018; eGFR [mL/min/1.73 m2 ]: controls = 95.50 [12.60], group I = 82.00 [20.76], P > 0.05; albumin-creatinine ratio [mg/g]: controls = 3.50 [4.45], group I = 17.50 [21.20], P > 0.05). A marked decrease in RBF was noted a long with progression of diabetic nephropathy (DN) through the five stages of CKD (χ2 = 43.58; P = 1.85 × 10-9 ). Strong correlation (r = 0.62; P = 4 × 10-10 ) was obtained between RBF and GFR estimated by cystatin C. CONCLUSION ASL-MRI is able to quantify early renal perfusion impairment in DM, as well as changes according to different CKD stages of DN. In addition, we demonstrated a correlation of RBF quantified by ASL and GFR estimated by cystatin C. LEVEL OF EVIDENCE 3 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2017;46:1810-1817.
Collapse
Affiliation(s)
| | | | | | - Jose A Páramo
- Atherosclerosis Research Laboratory, CIMA, University of Navarra, Pamplona, Spain
| | | | - Danny Jj Wang
- Laboratory of Functional MRI Technology (LOFT) Stevens Neuroimaging and Informatics Institute University of Southern California, Los Angeles, California, USA
| | | | - María A Fernández-Seara
- Radiology, Clínica Universidad de Navarra, Spain.,Adjunct Associate Professor of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| |
Collapse
|
12
|
Quantification of Single-Kidney Function and Volume in Living Kidney Donors Using Dynamic Contrast-Enhanced MRI. AJR Am J Roentgenol 2016; 207:1022-1030. [DOI: 10.2214/ajr.16.16168] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
|
13
|
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.
Collapse
Affiliation(s)
- Anton S Becker
- Department of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | | |
Collapse
|
14
|
Niles DJ, Artz NS, Djamali A, Sadowski EA, Grist TM, Fain SB. Longitudinal Assessment of Renal Perfusion and Oxygenation in Transplant Donor-Recipient Pairs Using Arterial Spin Labeling and Blood Oxygen Level-Dependent Magnetic Resonance Imaging. Invest Radiol 2016; 51:113-20. [PMID: 26561047 DOI: 10.1097/rli.0000000000000210] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVES The aims of this study were to assess renal function in kidney transplant recipients and their respective donors over 2 years using arterial spin labeling (ASL) and blood oxygen level-dependent (BOLD) magnetic resonance imaging (MRI) and to prospectively evaluate the effect of losartan on functional MRI measures in recipients. MATERIALS AND METHODS The study included 15 matched pairs of renal transplant donors and recipients. Arterial spin labeling and BOLD MRI of the kidneys were performed on donors before transplant surgery (baseline) and on both donors and recipients at 3 months, 1 year, and 2 years after transplant. After 3 months, 7 of the 15 recipients were prescribed 25 to 50 mg/d losartan for the remainder of the study. A linear mixed-effects model was used to evaluate perfusion, R2*, estimated glomerular filtration rate, and fractional excretion of sodium for changes across time or associated with losartan treatment. RESULTS In donors, cortical perfusion in the remaining kidney decreased by 50 ± 19 mL/min per 100 g (11.8%) between baseline and 2 years (P < 0.05), while cortical R2* declined modestly by 0.7 ± 0.3 s-1 (5.6%; P < 0.05). In transplanted kidneys, cortical perfusion decreased markedly by 141 ± 21 mL/min per 100 g (34.2%) between baseline and 2 years (P < 0.001), while medullary R2* declined by 1.5 ± 0.8 s-1 (8.3%; P = 0.06). Single-kidney estimated glomerular filtration rate increased between baseline and 2 years by 17.7 ± 2.7 mL/min per 1.73 m (40.3%; P < 0.0001) in donors and to 14.6 ± 4.3 mL/min per 1.73 m (33.3%; P < 0.01) in recipients. Cortical perfusion at 1 and 2 years in recipients receiving 25 to 50 mg/d losartan was 62 ± 24 mL/min per 100 g higher than recipients not receiving the drug (P < 0.05). No significant effects of losartan were observed for any other markers of renal function. CONCLUSIONS The results suggest an important role for noninvasive functional monitoring with ASL and BOLD MRI in kidney transplant recipients and donors, and they indicate a potentially beneficial effect of losartan in recipients.
Collapse
Affiliation(s)
- David J Niles
- From the Departments of *Medical Physics, †Medicine, ‡Surgery, §Radiology, ∥Obstetrics and Gynecology, and ¶Biomedical Engineering, University of Wisconsin, Madison, WI
| | | | | | | | | | | |
Collapse
|
15
|
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.
Collapse
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
| |
Collapse
|
16
|
Feasibility of measuring renal blood flow by phase-contrast magnetic resonance imaging in patients with autosomal dominant polycystic kidney disease. Eur Radiol 2015; 26:683-92. [PMID: 26162576 PMCID: PMC4748006 DOI: 10.1007/s00330-015-3877-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2014] [Revised: 06/02/2015] [Accepted: 06/03/2015] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Renal blood flow (RBF) has been shown to predict disease progression in autosomal dominant polycystic kidney disease (ADPKD). We investigated the feasibility and accuracy of phase-contrast RBF by MRI (RBFMRI) in ADPKD patients with a wide range of estimated glomerular filtration rate (eGFR) values. METHODS First, we validated RBFMRI measurement using phantoms simulating renal artery hemodynamics. Thereafter, we investigated in a test-set of 21 patients intra- and inter-observer coefficient of variation of RBFMRI. After validation, we measured RBFMRI in a cohort of 91 patients and compared the variability explained by characteristics indicative for disease severity for RBFMRI and RBF measured by continuous hippuran infusion. RESULTS The correlation in flow measurement using phantoms by phase-contrast MRI was high and fluid collection was high (CCC=0.969). Technical problems that precluded RBFMRI measurement occurred predominantly in patients with a lower eGFR (34% vs. 16%). In subjects with higher eGFRs, variability in RBF explained by disease characteristics was similar for RBFMRI compared to RBFHip, whereas in subjects with lower eGFRs, this was significantly less for RBFMRI. CONCLUSIONS Our study shows that RBF can be measured accurately in ADPKD patients by phase-contrast, but this technique may be less feasible in subjects with a lower eGFR. KEY POINTS Renal blood flow (RBF) can be accurately measured by phase-contrast MRI in ADPKD patients. RBF measured by phase-contrast is associated with ADPKD disease severity. RBF measurement by phase-contrast MRI may be less feasible in patients with an impaired eGFR.
Collapse
|