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Hillaert A, Sanmiguel Serpa LC, Xu Y, Hesta M, Bogaert S, Vanderperren K, Pullens P. Optimization of Fair Arterial Spin Labeling Magnetic Resonance Imaging (ASL-MRI) for Renal Perfusion Quantification in Dogs: Pilot Study. Animals (Basel) 2024; 14:1810. [PMID: 38929429 PMCID: PMC11201026 DOI: 10.3390/ani14121810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2024] [Revised: 06/11/2024] [Accepted: 06/12/2024] [Indexed: 06/28/2024] Open
Abstract
Arterial spin labeling (ASL) MRI allows non-invasive quantification of renal blood flow (RBF) and shows great potential for renal assessment. To our knowledge, renal ASL-MRI has not previously been performed in dogs. The aim of this pilot study was to determine parameters essential for ALS-MRI-based quantification of RBF in dogs: T1, blood (longitudinal relaxation time), λ (blood tissue partition coefficient) and TI (inversion time). A Beagle was scanned at 3T with a multi-TI ASL sequence, with TIs ranging from 250 to 2500 ms, to determine the optimal TI value. The T1 of blood for dogs was determined by scanning a blood sample with a 2D IR TSE sequence. The water content of the dog's kidney was determined by analyzing kidney samples from four dogs with a moisture analyzer and was subsequently used to calculate λ. The optimal TI and the measured values for T1,blood, and λ were 2000 ms, 1463 ms and 0.91 mL/g, respectively. These optimized parameters for dogs resulted in lower RBF values than those obtained from inline generated RBF maps. In conclusion, this study determined preliminary parameters essential for ALS-MRI-based RBF quantification in dogs. Further research is needed to confirm these values, but it may help guide future research.
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Affiliation(s)
- Amber Hillaert
- Department of Morphology, Imaging, Orthopedics, Rehabilitation and Nutrition, Faculty of Veterinary Medicine, Ghent University, 9820 Merelbeke, Belgium; (A.H.)
| | - Luis Carlos Sanmiguel Serpa
- Department of Medical Imaging, Ghent University Hospital, 9000 Ghent, Belgium
- Ghent Institute for Functional and Metabolic Imaging, Ghent University, 9000 Ghent, Belgium
- Department of Diagnostic Sciences, Faculty of Medicine and Health Sciences, Ghent University, 9000 Ghent, Belgium
| | - Yangfeng Xu
- Department of Morphology, Imaging, Orthopedics, Rehabilitation and Nutrition, Faculty of Veterinary Medicine, Ghent University, 9820 Merelbeke, Belgium; (A.H.)
| | - Myriam Hesta
- Department of Morphology, Imaging, Orthopedics, Rehabilitation and Nutrition, Faculty of Veterinary Medicine, Ghent University, 9820 Merelbeke, Belgium; (A.H.)
| | - Stephanie Bogaert
- Department of Medical Imaging, Ghent University Hospital, 9000 Ghent, Belgium
- Ghent Institute for Functional and Metabolic Imaging, Ghent University, 9000 Ghent, Belgium
| | - Katrien Vanderperren
- Department of Morphology, Imaging, Orthopedics, Rehabilitation and Nutrition, Faculty of Veterinary Medicine, Ghent University, 9820 Merelbeke, Belgium; (A.H.)
| | - Pim Pullens
- Department of Medical Imaging, Ghent University Hospital, 9000 Ghent, Belgium
- Ghent Institute for Functional and Metabolic Imaging, Ghent University, 9000 Ghent, Belgium
- Institute of Biomedical Engineering and Technology (IBiTech)—MEDISP, Faculty of Engineering and Architecture, Ghent University, 9000 Ghent, Belgium
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2
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Ni C, Mu X, Wu M, Li Y, Zhang Y, Qi H, Zhang JL. Accurate exclusion of kidney regions affected by susceptibility artifact in blood oxygenation level-dependent (BOLD) images using deep-learning-based segmentation. Sci Rep 2023; 13:19191. [PMID: 37932431 PMCID: PMC10628125 DOI: 10.1038/s41598-023-46760-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 11/04/2023] [Indexed: 11/08/2023] Open
Abstract
Susceptibility artifact (SA) is common in renal blood oxygenation level-dependent (BOLD) images, and including the SA-affected region could induce much error in renal oxygenation quantification. In this paper, we propose to exclude kidney regions affected by SA in gradient echo images with different echo times (TE), based on a deep-learning segmentation approach. For kidney segmentation, a ResUNet was trained with 4000 CT images and then tuned with 60 BOLD images. Verified by a Monte Carlo simulation, the presence of SA leads to a bilinear pattern for the segmented area of kidney as function of TE, and the segmented kidney in the image of turning point's TE would exclude SA-affected regions. To evaluate the accuracy of excluding SA-affected regions, we compared the SA-free segmentations by the proposed method against manual segmentation by an experienced user for BOLD images of 35 subjects, and found DICE of 93.9% ± 3.4%. For 10 kidneys with severe SA, the DICE was 94.5% ± 1.7%, for 14 with moderate SA, 92.8% ± 4.7%, and for 46 with mild or no SA, 94.3% ± 3.8%. For the three sub-groups of kidneys, correction of SA led to a decrease of R2* of 8.5 ± 2.8, 4.7 ± 1.8, and 1.6 ± 0.9 s-1, respectively. In conclusion, the proposed method is capable of segmenting kidneys in BOLD images and at the same time excluding SA-affected region in a fully automatic way, therefore can potentially improve both speed and accuracy of the quantification procedure of renal BOLD data.
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Affiliation(s)
- Chang Ni
- School of Biomedical Engineering, ShanghaiTech University, Room 416, BME Building, 393 Middle Huaxia Road, Pudong, Shanghai, China
| | - Xin Mu
- School of Biomedical Engineering, ShanghaiTech University, Room 416, BME Building, 393 Middle Huaxia Road, Pudong, Shanghai, China
| | - Mingyan Wu
- Central Research Institute, United Imaging Healthcare Group, Shanghai, China
| | - Yanbin Li
- Central Research Institute, United Imaging Healthcare Group, Shanghai, China
| | - Yuyao Zhang
- School of Information Science and Technology, ShanghaiTech University, Shanghai, China
| | - Haikun Qi
- School of Biomedical Engineering, ShanghaiTech University, Room 416, BME Building, 393 Middle Huaxia Road, Pudong, Shanghai, China
| | - Jeff L Zhang
- School of Biomedical Engineering, ShanghaiTech University, Room 416, BME Building, 393 Middle Huaxia Road, Pudong, Shanghai, China.
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3
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Francis ST, Selby NM, Taal MW. Magnetic Resonance Imaging to Evaluate Kidney Structure, Function, and Pathology: Moving Toward Clinical Application. Am J Kidney Dis 2023; 82:491-504. [PMID: 37187282 DOI: 10.1053/j.ajkd.2023.02.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 02/20/2023] [Indexed: 05/17/2023]
Abstract
Recent advances in multiparametric magnetic resonance imaging (MRI) allow multiple quantitative measures to assess kidney morphology, tissue microstructure, oxygenation, kidney blood flow, and perfusion to be collected in a single scan session. Animal and clinical studies have investigated the relationship between the different MRI measures and biological processes, although their interpretation can be complex due to variations in study design and generally small participant numbers. However, emerging themes include the apparent diffusion coefficient derived from diffusion-weighted imaging, T1 and T2 mapping parameters, and cortical perfusion being consistently associated with kidney damage and predicting kidney function decline. Blood oxygen level-dependent (BOLD) MRI has shown inconsistent associations with kidney damage markers but has been predictive of kidney function decline in several studies. Therefore, multiparametric MRI of the kidneys has the potential to address the limitations of existing diagnostic methods to provide a noninvasive, noncontrast, and radiation-free method to assess whole kidney structure and function. Barriers to be overcome to facilitate widespread clinical application include improved understanding of biological factors that impact MRI measures, development of a larger evidence base for clinical utility, standardization of MRI protocols, automation of data analysis, determining optimal combination of MRI measures, and health economic evaluation.
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Affiliation(s)
- Susan T Francis
- Sir Peter Mansfield Imaging Centre, School of Physics & Astronomy, University of Nottingham, Nottingham; NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, University of Nottingham, Nottingham
| | - Nicholas M Selby
- Centre for Kidney Research and Innovation, Academic Unit for Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham; Department of Renal Medicine, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, United Kingdom
| | - Maarten W Taal
- Centre for Kidney Research and Innovation, Academic Unit for Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham; Department of Renal Medicine, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, United Kingdom.
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4
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Friedli I, Baid-Agrawal S, Unwin R, Morell A, Johansson L, Hockings PD. Magnetic Resonance Imaging in Clinical Trials of Diabetic Kidney Disease. J Clin Med 2023; 12:4625. [PMID: 37510740 PMCID: PMC10380287 DOI: 10.3390/jcm12144625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 06/28/2023] [Accepted: 07/04/2023] [Indexed: 07/30/2023] Open
Abstract
Chronic kidney disease (CKD) associated with diabetes mellitus (DM) (known as diabetic kidney disease, DKD) is a serious and growing healthcare problem worldwide. In DM patients, DKD is generally diagnosed based on the presence of albuminuria and a reduced glomerular filtration rate. Diagnosis rarely includes an invasive kidney biopsy, although DKD has some characteristic histological features, and kidney fibrosis and nephron loss cause disease progression that eventually ends in kidney failure. Alternative sensitive and reliable non-invasive biomarkers are needed for DKD (and CKD in general) to improve timely diagnosis and aid disease monitoring without the need for a kidney biopsy. Such biomarkers may also serve as endpoints in clinical trials of new treatments. Non-invasive magnetic resonance imaging (MRI), particularly multiparametric MRI, may achieve these goals. In this article, we review emerging data on MRI techniques and their scientific, clinical, and economic value in DKD/CKD for diagnosis, assessment of disease pathogenesis and progression, and as potential biomarkers for clinical trial use that may also increase our understanding of the efficacy and mode(s) of action of potential DKD therapeutic interventions. We also consider how multi-site MRI studies are conducted and the challenges that should be addressed to increase wider application of MRI in DKD.
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Affiliation(s)
- Iris Friedli
- Antaros Medical, BioVenture Hub, 43183 Mölndal, Sweden
| | - Seema Baid-Agrawal
- Transplant Center, Sahlgrenska University Hospital, University of Gothenburg, 41345 Gothenburg, Sweden
| | - Robert Unwin
- AstraZeneca R&D BioPharmaceuticals, Translational Science and Experimental Medicine, Early Cardiovascular, Renal & Metabolic Diseases (CVRM), Granta Park, Cambridge CB21 6GH, UK
| | - Arvid Morell
- Antaros Medical, BioVenture Hub, 43183 Mölndal, Sweden
| | | | - Paul D Hockings
- Antaros Medical, BioVenture Hub, 43183 Mölndal, Sweden
- MedTech West, Chalmers University of Technology, 41345 Gothenburg, Sweden
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5
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Zhang K, Triphan SMF, Kurz FT, Ziener CH, Kauczor HU, Schlemmer HP, Sedlaczek O. Navigator-based slice tracking for prospective motion correction in kidney vessel architecture imaging. Magn Reson Imaging 2023; 98:26-35. [PMID: 36603781 DOI: 10.1016/j.mri.2023.01.001] [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: 10/14/2022] [Accepted: 01/01/2023] [Indexed: 01/04/2023]
Abstract
OBJECTIVES To apply a navigator-based slice tracking method to prospectively compensate the respiratory motion for kidney vessel architecture imaging (VAI). MATERIALS AND METHODS A dual gradient echo spin echo 2D EPI sequence was developed for kidney VAI. A single gradient-echo slice selection and projection readout at the location of the diaphragm along the inferior-superior direction was applied as a navigator. Navigator acquisition and fat suppression were inserted before each transverse imaging slice. Motion information was calculated after exclusion of the signal saturation in the navigator signal caused by imaging slices. The motion information was then directly sent back to the sequence and slice positioning was adjusted in real-time. The whole sequence was applied during a contrast agent pass-through. RESULTS VAI parametric maps show the structural heterogeneity of the renal vasculature. The respiratory motion from the navigator signal was precisely calculated and slice positioning was changed in real-time based on the motion information. The vibration amplitude of the signal intensity of the liver tissue at the liver-lung interface in the case of prospective motion correction (PMC) on is about 28% of the PMC off case. Compared to the case of PMC off, the coefficient of variation was reduced 30% of the case of PMC on. CONCLUSIONS This study demonstrates the feasibility of the motion-compensating technique in kidney VAI. The sequence may improve the evaluation of microvasculature in kidney diseases.
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Affiliation(s)
- Ke Zhang
- Department of Diagnostic & Interventional Radiology, Heidelberg University Hospital, Heidelberg, Germany; Department of Radiology, German Cancer Research Center, Heidelberg, Germany
| | - Simon M F Triphan
- Department of Diagnostic & Interventional Radiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Felix T Kurz
- Department of Radiology, German Cancer Research Center, Heidelberg, Germany
| | - Christian H Ziener
- Department of Radiology, German Cancer Research Center, Heidelberg, Germany
| | - Hans-Ulrich Kauczor
- Department of Diagnostic & Interventional Radiology, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Oliver Sedlaczek
- Department of Diagnostic & Interventional Radiology, Heidelberg University Hospital, Heidelberg, Germany; Department of Radiology, German Cancer Research Center, Heidelberg, Germany.
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6
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Laothamatas I, Al Mubarak H, Reddy A, Wax R, Badani K, Taouli B, Bane O, Lewis S. Multiparametric MRI of Solid Renal Masses: Principles and Applications of Advanced Quantitative and Functional Methods for Tumor Diagnosis and Characterization. J Magn Reson Imaging 2023. [PMID: 37052601 DOI: 10.1002/jmri.28718] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/23/2023] [Accepted: 03/23/2023] [Indexed: 04/14/2023] Open
Abstract
Solid renal masses (SRMs) are increasingly detected and encompass both benign and malignant masses, with renal cell carcinoma (RCC) being the most common malignant SRM. Most patients with SRMs will undergo management without a priori pathologic confirmation. There is an unmet need to noninvasively diagnose and characterize RCCs, as significant variability in clinical behavior is observed and a wide range of differing management options exist. Cross-sectional imaging modalities, including magnetic resonance imaging (MRI), are increasingly used for SRM characterization. Multiparametric (mp) MRI techniques can provide insight into tumor biology by probing different physiologic/pathophysiologic processes noninvasively. These include sequences that probe tissue microstructure, including intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) and T1 relaxometry; oxygen metabolism (blood oxygen level dependent [BOLD-MRI]); as well as vascular flow and perfusion (dynamic contrast-enhanced MRI [DCE-MRI] and arterial spin labeling [ASL]). In this review, we will discuss each mpMRI method in terms of its principles, roles, and discuss the results of human studies for SRM assessment. Future validation of these methods may help to enable a personalized management approach for patients with SRM in the emerging era of precision medicine. EVIDENCE LEVEL: 5. TECHNICAL EFFICACY: 2.
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Affiliation(s)
- Indira Laothamatas
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Haitham Al Mubarak
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Arthi Reddy
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Rebecca Wax
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ketan Badani
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Bachir Taouli
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Octavia Bane
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Sara Lewis
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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7
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Mei Y, Yang G, Guo Y, Zhao K, Wu S, Xu Z, Zhou S, Yan C, Seeliger E, Niendorf T, Xu Y, Feng Y. Parametric MRI Detects Aristolochic Acid Induced Acute Kidney Injury. Tomography 2022; 8:2902-2914. [PMID: 36548535 PMCID: PMC9786286 DOI: 10.3390/tomography8060243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 11/30/2022] [Accepted: 12/05/2022] [Indexed: 12/14/2022] Open
Abstract
Exposure to aristolochic acid (AA) is of increased concern due to carcinogenic and nephrotoxic effects, and incidence of aristolochic acid nephropathy (AAN) is increasing. This study characterizes renal alterations during the acute phase of AAN using parametric magnetic resonance imaging (MRI). An AAN and a control group of male Wistar rats received administration of aristolochic acid I (AAI) and polyethylene glycol (PEG), respectively, for six days. Both groups underwent MRI before and 2, 4 and 6 days after AAI or PEG administration. T2 relaxation times and apparent diffusion coefficients (ADCs) were determined for four renal layers. Serum creatinine levels (sCr) and blood urea nitrogen (BUN) were measured. Tubular injury scores (TIS) were evaluated based on histologic findings. Increased T2 values were detected since day 2 in the AAN group, but decreased ADCs and increased sCr levels and BUN were not detected until day 4. Significant linear correlations were observed between T2 of the cortex and the outer stripe of outer medulla and TIS. Our results demonstrate that parametric MRI facilitates early detection of renal injury induced by AAI in a rat model. T2 mapping may be a valuable tool for assessing kidney injury during the acute phase of AAN.
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Affiliation(s)
- Yingjie Mei
- School of Biomedical Engineering, Southern Medical University, Guangzhou 510515, China
| | - Guixiang Yang
- School of Biomedical Engineering, Southern Medical University, Guangzhou 510515, China
- Department of Medical Imaging Center, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Yihao Guo
- Department of Radiology, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou 570311, China
| | - Kaixuan Zhao
- School of Biomedical Engineering, Southern Medical University, Guangzhou 510515, China
| | - Shuyu Wu
- Radiotherapy Center, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou 510095, China
| | - Zhongbiao Xu
- Radiotherapy Center, Guangdong General Hospital, Guangzhou 510080, China
| | - Shan Zhou
- State Key Laboratory of Organ Failure Research, National Clinical Research Center of Kidney Disease, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Chenggong Yan
- Department of Medical Imaging Center, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Erdmann Seeliger
- Institute of Translational Physiology, Charité–Universitätsmedizin Berlin, 10117 Berlin, Germany
| | - Thoralf Niendorf
- Berlin Ultrahigh Field Facility (B.U.F.F.), Max Delbrück Center for Molecular Medicine in the Helmholtz Association, 13125 Berlin, Germany
| | - Yikai Xu
- Department of Medical Imaging Center, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Yanqiu Feng
- School of Biomedical Engineering, Southern Medical University, Guangzhou 510515, China
- Guangdong Provincial Key Laboratory of Medical Image Processing & Guangdong Province Engineering Laboratory for Medical Imaging and Diagnostic Technology, Southern Medical University, Guangzhou 510515, China
- Guangdong-Hong Kong-Macao Greater Bay Area Center for Brain Science and Brain-Inspired Intelligence & Key Laboratory of Mental Health of the Ministry of Education, Southern Medical University, Guangzhou 510515, China
- Department of Radiology, Shunde Hospital, Southern Medical University (The First People’s Hospital of Shunde, Foshan), Foshan 528399, China
- Correspondence:
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8
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Jiang K, Ferguson CM, Grimm RC, Zhu X, Glockner JF, Lerman LO. Reliable Assessment of Swine Renal Fibrosis Using Quantitative Magnetization Transfer Imaging. Invest Radiol 2022; 57:334-342. [PMID: 34935650 PMCID: PMC8986560 DOI: 10.1097/rli.0000000000000843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVES Quantitative magnetization transfer (qMT) is useful for measurement of murine renal fibrosis at high and ultrahigh field strengths. However, its utility at clinical field strengths and in human-like kidneys remains unknown. We tested the hypothesis that qMT would successfully detect fibrosis in swine kidneys with unilateral renal artery stenosis (RAS) at 3.0 T. METHODS The qMT protocol is composed of MT scans with variable flip angles and offset frequencies, and of B0, B1, and T1 mapping. Pigs were scanned 10 weeks after RAS or control. A 2-pool model was used to fit the bound pool fraction f of the renal cortex (CO) and outer medulla (OM). Then qMT-derived f in 5 normal and 10 RAS pigs was compared with histological fibrosis determined using Masson's trichrome staining and to renal perfusion assessed with computed tomography. RESULTS The qMT 2-pool model provided accurate fittings of data collected on swine kidneys. Stenotic kidneys showed significantly elevated f in both the CO (9.8% ± 2.7% vs 6.4% ± 0.9%, P = 0.002) and OM (7.6% ± 2.2% vs 4.7% ± 1.1%, P = 0.002), as compared with normal kidneys. Histology-measured renal fibrosis and qMT-derived f correlated directly in both the cortex (Pearson correlation coefficient r = 0.93, P < 0.001) and OM (r = 0.84, P = 0.002), and inversely with stenotic kidney perfusion (r = 0.85, P = 0.002). CONCLUSIONS This study demonstrates the feasibility of qMT for measuring fibrosis in human-like swine kidneys, and the association between tissue macromolecule content and renal perfusion. Therefore, qMT may be useful as a tool for noninvasive assessment of renal fibrosis in subjects with RAS at clinical field strengths.
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Affiliation(s)
- Kai Jiang
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Roger C. Grimm
- Department of Diagnostic Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Xiangyang Zhu
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
| | - James F. Glockner
- Department of Diagnostic Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Lilach O. Lerman
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
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9
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Canaud B, Stephens MP, Nikam M, Etter M, Collins A. Multitargeted interventions to reduce dialysis-induced systemic stress. Clin Kidney J 2021; 14:i72-i84. [PMID: 34987787 PMCID: PMC8711765 DOI: 10.1093/ckj/sfab192] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Indexed: 11/13/2022] Open
Abstract
Hemodialysis (HD) is a life-sustaining therapy as well as an intermittent and repetitive stress condition for the patient. In ridding the blood of unwanted substances and excess fluid from the blood, the extracorporeal procedure simultaneously induces persistent physiological changes that adversely affect several organs. Dialysis patients experience this systemic stress condition usually thrice weekly and sometimes more frequently depending on the treatment schedule. Dialysis-induced systemic stress results from multifactorial components that include treatment schedule (i.e. modality, treatment time), hemodynamic management (i.e. ultrafiltration, weight loss), intensity of solute fluxes, osmotic and electrolytic shifts and interaction of blood with components of the extracorporeal circuit. Intradialytic morbidity (i.e. hypovolemia, intradialytic hypotension, hypoxia) is the clinical expression of this systemic stress that may act as a disease modifier, resulting in multiorgan injury and long-term morbidity. Thus, while lifesaving, HD exposes the patient to several systemic stressors, both hemodynamic and non-hemodynamic in origin. In addition, a combination of cardiocirculatory stress, greatly conditioned by the switch from hypervolemia to hypovolemia, hypoxemia and electrolyte changes may create pro-arrhythmogenic conditions. Moreover, contact of blood with components of the extracorporeal circuit directly activate circulating cells (i.e. macrophages-monocytes or platelets) and protein systems (i.e. coagulation, complement, contact phase kallikrein-kinin system), leading to induction of pro-inflammatory cytokines and resulting in chronic low-grade inflammation, further contributing to poor outcomes. The multifactorial, repetitive HD-induced stress that globally reduces tissue perfusion and oxygenation could have deleterious long-term consequences on the functionality of vital organs such as heart, brain, liver and kidney. In this article, we summarize the multisystemic pathophysiological consequences of the main circulatory stress factors. Strategies to mitigate their effects to provide more cardioprotective and personalized dialytic therapies are proposed to reduce the systemic burden of HD.
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Affiliation(s)
- Bernard Canaud
- Montpellier University, Montpellier, France
- Global Medical Office, FMC Deutschland, Bad Homburg, Germany
| | - Melanie P Stephens
- MSL & Medical Strategies for Innovative Therapies, Fresenius Medical Care, Waltham, MA, USA
| | - Milind Nikam
- Global Medical Office, Fresenius Medical Care, Hong Kong
| | - Michael Etter
- Global Medical Office, Fresenius Medical Care, Hong Kong
| | - Allan Collins
- Global Medical Office, Fresenius Medical Care, Waltham, MA, USA
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10
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Charlton JR, Xu Y, Parvin N, Wu T, Gao F, Baldelomar EJ, Morozov D, Beeman SC, Derakhshan J, Bennett KM. Image analysis techniques to map pyramids, pyramid structure, glomerular distribution, and pathology in the intact human kidney from 3-D MRI. Am J Physiol Renal Physiol 2021; 321:F293-F304. [PMID: 34282957 PMCID: PMC8530750 DOI: 10.1152/ajprenal.00130.2021] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 06/28/2021] [Accepted: 07/15/2021] [Indexed: 11/22/2022] Open
Abstract
Kidney pathologies are often highly heterogeneous. To comprehensively understand kidney structure and pathology, it is critical to develop tools to map tissue microstructure in the context of the whole, intact organ. Magnetic resonance imaging (MRI) can provide a unique, three-dimensional view of the kidney and allows for measurements of multiple pathological features. Here, we developed a platform to systematically render and map gross and microstructural features of the human kidney based on three-dimensional MRI. These features include pyramid number and morphology as well as the associated medulla and cortex. In a subset of these kidneys, we also mapped individual glomeruli and glomerular volumes using cationic ferritin-enhanced MRI to report intrarenal heterogeneity in glomerular density and size. Finally, we rendered and measured regions of nephron loss due to pathology and individual glomerular volumes in each pyramidal unit. This work provides new tools to comprehensively evaluate the kidney across scales, with potential applications in anatomic and physiological research, transplant allograft evaluation, biomarker development, biopsy guidance, and therapeutic monitoring. These image rendering and analysis tools could eventually impact the field of transplantation medicine to improve longevity matching of donor allografts and recipients and reduce discard rates through the direct assessment of donor kidneys.NEW & NOTEWORTHY We report the application of cutting-edge image analysis approaches to characterize the pyramidal geometry, glomerular microstructure, and heterogeneity of the whole human kidney imaged using MRI. This work establishes a framework to improve the detection of microstructural pathology to potentially facilitate disease monitoring or transplant evaluation in the individual kidney.
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Affiliation(s)
- Jennifer R Charlton
- Department of Pediatrics, University of Virginia Children's Hospital, Charlottesville, Virginia
| | - Yanzhe Xu
- School of Computing, Informatics, Decision Systems Engineering, Arizona State University, Tempe, Arizona
- Mayo Center for Innovative Imaging, Arizona State University, Tempe, Arizona
| | - Neda Parvin
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, Missouri
| | - Teresa Wu
- School of Computing, Informatics, Decision Systems Engineering, Arizona State University, Tempe, Arizona
- Mayo Center for Innovative Imaging, Arizona State University, Tempe, Arizona
| | - Fei Gao
- School of Computing, Informatics, Decision Systems Engineering, Arizona State University, Tempe, Arizona
- Mayo Center for Innovative Imaging, Arizona State University, Tempe, Arizona
| | - Edwin J Baldelomar
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, Missouri
| | - Darya Morozov
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, Missouri
| | - Scott C Beeman
- School of Biological and Health Systems Engineering, Arizona State University, Tempe, Arizona
| | - Jamal Derakhshan
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, Missouri
| | - Kevin M Bennett
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, Missouri
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11
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Kannenkeril D, Janka R, Bosch A, Jung S, Kolwelter J, Striepe K, Ott C, Martirosian P, Schiffer M, Uder M, Schmieder RE. Detection of Changes in Renal Blood Flow Using Arterial Spin Labeling MRI. Am J Nephrol 2021; 52:69-75. [PMID: 33677438 DOI: 10.1159/000513665] [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: 10/28/2020] [Accepted: 12/07/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Alteration in kidney perfusion is an early marker of renal damage. The purpose of this study was to evaluate if changes in renal blood flow (RBF) could be detected using MRI with arterial spin labeling (ASL) technique. METHODS RBF as assessed by cortical (CRBF), medullary, and total renal blood flow (TRBF) were measured by MRI with arterial spin labeling (ASL-MRI) using flow-sensitive alternating inversion recovery true fast imaging with steady-state precession sequence. In 11 normotensive healthy individuals (NT) and 11 hypertensive patients (HT), RBF was measured at baseline and after both feet were covered with cold ice packs (cold pressor test) that activates the sympathetic nervous system. In another experiment, RBF was measured in 10 patients with CKD before and after a pharmacological intervention. We compared RBF measurements between the 3 study populations. RESULTS A significant reduction in CRBF (p = 0.042) and a trend in TRBF (p = 0.053) were observed in response to the activation of the sympathetic nervous system. A trend toward reduction of CRBF (p = 0.051) and TRBF (p = 0.059) has been detected after pharmacological intervention. TRBF was significantly lower in patients with HT and CKD patients compared to NT individuals (NT vs. HT, p = 0.014; NT vs. CKD, p = 0.004). TRBF was lower in patients with CKD compared to HT (p = 0.047). CONCLUSION Our data indicate that both acute and short-term changes in RBF could be detected using ASL-MRI. We were able to detect differences in RBF between healthy and diseased individuals by needing only small sample size per group. Thus, ASL-MRI offers an advantage in conducting clinical trials compared to other technologies.
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Affiliation(s)
- Dennis Kannenkeril
- Department of Nephrology and Hypertension, University Hospital Erlangen, Erlangen, Germany
| | - Rolf Janka
- Institute of Radiology, University Hospital Erlangen, Erlangen, Germany
| | - Agnes Bosch
- Department of Nephrology and Hypertension, University Hospital Erlangen, Erlangen, Germany
| | - Susanne Jung
- Department of Nephrology and Hypertension, University Hospital Erlangen, Erlangen, Germany
- Department of Cardiology, University Hospital Erlangen, Erlangen, Germany
| | - Julie Kolwelter
- Department of Nephrology and Hypertension, University Hospital Erlangen, Erlangen, Germany
- Department of Cardiology, University Hospital Erlangen, Erlangen, Germany
| | - Kristina Striepe
- Department of Nephrology and Hypertension, University Hospital Erlangen, Erlangen, Germany
| | - Christian Ott
- Department of Nephrology and Hypertension, University Hospital Erlangen, Erlangen, Germany
| | - Petros Martirosian
- Section on Experimental Radiology, University Hospital of Tübingen, Tübingen, Germany
| | - Mario Schiffer
- Department of Nephrology and Hypertension, University Hospital Erlangen, Erlangen, Germany
| | - Michael Uder
- Institute of Radiology, University Hospital Erlangen, Erlangen, Germany
| | - Roland E Schmieder
- Department of Nephrology and Hypertension, University Hospital Erlangen, Erlangen, Germany,
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12
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Bo S, Sedaghat F, Pavuluri K, Rowe SP, Cohen A, Kates M, McMahon MT. Dynamic Contrast Enhanced-MR CEST Urography: An Emerging Tool in the Diagnosis and Management of Upper Urinary Tract Obstruction. Tomography 2021; 7:80-94. [PMID: 33801533 PMCID: PMC8103243 DOI: 10.3390/tomography7010008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 02/16/2021] [Indexed: 02/04/2023] Open
Abstract
Upper urinary tract obstructions (UTOs) are blockages that inhibit the flow of urine through its normal course, leading to impaired kidney function. Imaging plays a significant role in the initial diagnosis of UTO, with anatomic imaging (primarily ultrasound (US) and non-contrast computed tomography (CT)) serving as screening tools for the detection of the dilation of the urinary collecting systems (i.e., hydronephrosis). Whether hydronephrosis represents UTO or a non-obstructive process is determined by functional imaging (typically nuclear medicine renal scintigraphy). If these exams reveal evidence of UTO but no discernable source, multiphase contrast enhanced CT urography and/or dynamic contrast enhanced MR urography (DCE-MRU) may be performed to delineate a cause. These are often performed in conjunction with direct ureteroscopic evaluation. While contrast-enhanced CT currently predominates, it can induce renal injury due to contrast induced nephropathy (CIN), subject patients to ionizing radiation and is limited in quantifying renal function (traditionally assessed by renal scintigraphy) and establishing the extent to which hydronephrosis is due to functional obstruction. Traditional MRI is similarly limited in its ability to quantify function. DCE-MRU presents concerns regarding nephrogenic systemic fibrosis (NSF), although decreased with newer gadolinium-based contrast agents, and regarding cumulative gadolinium deposition in the basal ganglia. DCE-MR CEST urography is a promising alternative, employing new MRI contrast agents and imaging schemes and allowing for concurrent assessment of renal anatomy and functional parameters. In this review we highlight clinical challenges in the diagnosis and management of UTO, identify key advances in imaging agents and techniques for DCE-MR CEST urography and provide perspective on how this technique may evolve in clinical importance.
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Affiliation(s)
- Shaowei Bo
- The Russell H. Morgan Department of Radiology and Radiological Science, School of Medicine, The Johns Hopkins University, Baltimore, MD 21205, USA; (S.B.); (F.S.); (K.P.); (S.P.R.)
| | - Farzad Sedaghat
- The Russell H. Morgan Department of Radiology and Radiological Science, School of Medicine, The Johns Hopkins University, Baltimore, MD 21205, USA; (S.B.); (F.S.); (K.P.); (S.P.R.)
| | - KowsalyaDevi Pavuluri
- The Russell H. Morgan Department of Radiology and Radiological Science, School of Medicine, The Johns Hopkins University, Baltimore, MD 21205, USA; (S.B.); (F.S.); (K.P.); (S.P.R.)
| | - Steven P. Rowe
- The Russell H. Morgan Department of Radiology and Radiological Science, School of Medicine, The Johns Hopkins University, Baltimore, MD 21205, USA; (S.B.); (F.S.); (K.P.); (S.P.R.)
- The James Buchanan Brady Urological Institute, Department of Urology, School of Medicine, Johns Hopkins University, Baltimore, MD 21205, USA; (A.C.); (M.K.)
| | - Andrew Cohen
- The James Buchanan Brady Urological Institute, Department of Urology, School of Medicine, Johns Hopkins University, Baltimore, MD 21205, USA; (A.C.); (M.K.)
| | - Max Kates
- The James Buchanan Brady Urological Institute, Department of Urology, School of Medicine, Johns Hopkins University, Baltimore, MD 21205, USA; (A.C.); (M.K.)
| | - Michael T. McMahon
- The Russell H. Morgan Department of Radiology and Radiological Science, School of Medicine, The Johns Hopkins University, Baltimore, MD 21205, USA; (S.B.); (F.S.); (K.P.); (S.P.R.)
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD 21205, USA
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13
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Longo DL, Irrera P, Consolino L, Sun PZ, McMahon MT. Renal pH Imaging Using Chemical Exchange Saturation Transfer (CEST) MRI: Basic Concept. Methods Mol Biol 2021; 2216:241-256. [PMID: 33476004 DOI: 10.1007/978-1-0716-0978-1_14] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Abstract
Magnetic Resonance Imaging (MRI) has been actively explored in the last several decades for assessing renal function by providing several physiological information, including glomerular filtration rate, renal plasma flow, tissue oxygenation and water diffusion. Within MRI, the developing field of chemical exchange saturation transfer (CEST) has potential to provide further functional information for diagnosing kidney diseases. Both endogenous produced molecules as well as exogenously administered CEST agents have been exploited for providing functional information related to kidney diseases in preclinical studies. In particular, CEST MRI has been exploited for assessing the acid-base homeostasis in the kidney and for monitoring pH changes in several disease models. This review summarizes several CEST MRI procedures for assessing kidney functionality and pH, for monitoring renal pH changes in different kidney injury models and for evaluating renal allograft rejection.This chapter is based upon work from the COST Action PARENCHIMA, a community-driven network funded by the European Cooperation in Science and Technology (COST) program of the European Union, which aims to improve the reproducibility and standardization of renal MRI biomarkers. This introduction chapter is complemented by two separate chapters describing the experimental procedure and data analysis.
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Affiliation(s)
- Dario Livio Longo
- Institute of Biostructures and Bioimaging (IBB), Italian National Research Council (CNR), Torino, Italy.
| | - Pietro Irrera
- University of Campania "Luigi Vanvitelli", Napoli, Italy
| | - Lorena Consolino
- Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy
| | - Phillip Zhe Sun
- Yerkes Imaging Center, Yerkes National Primate Research Center, Emory University, Atlanta, GA, USA
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, USA
| | - Michael T McMahon
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, USA
- Division of MR Research, The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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14
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MacAskill CJ, Erokwu BO, Markley M, Parsons A, Farr S, Zhang Y, Tran U, Chen Y, Anderson CE, Serai S, Hartung EA, Wessely O, Ma D, Dell KM, Flask CA. Multi-parametric MRI of kidney disease progression for autosomal recessive polycystic kidney disease: mouse model and initial patient results. Pediatr Res 2021; 89:157-162. [PMID: 32283547 PMCID: PMC7554096 DOI: 10.1038/s41390-020-0883-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 02/20/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND Autosomal recessive polycystic kidney disease (ARPKD) is a rare but potentially lethal genetic disorder typically characterized by diffuse renal microcysts. Clinical trials for patients with ARPKD are not currently possible due to the absence of sensitive measures of ARPKD kidney disease progression and/or therapeutic efficacy. METHODS In this study, animal and human magnetic resonance imaging (MRI) scanners were used to obtain quantitative kidney T1 and T2 relaxation time maps for both excised kidneys from bpk and wild-type (WT) mice as well as for a pediatric patient with ARPKD and a healthy adult volunteer. RESULTS Mean kidney T1 and T2 relaxation times showed significant increases with age (p < 0.05) as well as significant increases in comparison to WT mice (p < 2 × 10-10). Significant or nearly significant linear correlations were observed for mean kidney T1 (p = 0.030) and T2 (p = 0.054) as a function of total kidney volume, respectively. Initial magnetic resonance fingerprinting assessments in a patient with ARPKD showed visible increases in both kidney T1 and T2 in comparison to the healthy volunteer. CONCLUSIONS These preclinical and initial clinical MRI studies suggest that renal T1 and T2 relaxometry may provide an additional outcome measure to assess cystic kidney disease progression in patients with ARPKD. IMPACT A major roadblock for implementing clinical trials in patients with ARPKD is the absence of sensitive measures of ARPKD kidney disease progression and/or therapeutic efficacy. A clinical need exists to develop a safe and sensitive measure for kidney disease progression, and eventually therapeutic efficacy, for patients with ARPKD. Mean kidney T1 and T2 MRI relaxation times showed significant increases with age (p < 0.05) as well as significant increases in comparison to WT mice (p < 2 ×10-10), indicating that T1 and T2 may provide sensitive assessments of cystic changes associated with progressive ARPKD kidney disease. This preclinical and initial clinical study suggests that MRI-based kidney T1 and T2 mapping could be used as a non-invasive assessment of ARPKD kidney disease progression. These non-invasive, quantitative MRI techniques could eventually be used as an outcome measure for clinical trials evaluating novel therapeutics aimed at limiting or preventing ARPKD kidney disease progression.
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Affiliation(s)
| | - Bernadette O Erokwu
- Department of Radiology, Case Western Reserve University, Cleveland, OH, USA
| | - Michael Markley
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Ashlee Parsons
- Center for Pediatric Nephrology, Cleveland Clinic Children's, Cleveland, OH, USA
| | - Susan Farr
- Department of Radiology, Case Western Reserve University, Cleveland, OH, USA
| | - Yifan Zhang
- Department of Radiology, Case Western Reserve University, Cleveland, OH, USA
| | - Uyen Tran
- Department of Cellular and Molecular Medicine, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Yong Chen
- Department of Radiology, Case Western Reserve University, Cleveland, OH, USA
| | - Christian E Anderson
- Department of Radiology, Case Western Reserve University, Cleveland, OH, USA
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - Suraj Serai
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Erum A Hartung
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Oliver Wessely
- Department of Cellular and Molecular Medicine, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Dan Ma
- Department of Radiology, Case Western Reserve University, Cleveland, OH, USA
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - Katherine M Dell
- Center for Pediatric Nephrology, Cleveland Clinic Children's, Cleveland, OH, USA
- Department of Pediatrics, Case Western Reserve University, Cleveland, OH, USA
| | - Chris A Flask
- Department of Radiology, Case Western Reserve University, Cleveland, OH, USA.
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA.
- Department of Pediatrics, Case Western Reserve University, Cleveland, OH, USA.
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15
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Derlin K, Hellms S, Gutberlet M, Peperhove M, Jang MS, Greite R, Hartung D, Derlin T, Fegbeutel C, Tudorache I, Jüttner B, Wiese B, Lichtinghagen R, Haller H, Haverich A, Wacker F, Warnecke G, Gueler F. Application of MR diffusion imaging for non-invasive assessment of acute kidney injury after lung transplantation. Medicine (Baltimore) 2020; 99:e22445. [PMID: 33285670 PMCID: PMC7717793 DOI: 10.1097/md.0000000000022445] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 06/06/2020] [Accepted: 08/16/2020] [Indexed: 01/07/2023] Open
Abstract
To assess whether MR diffusion imaging may be applied for non-invasive detection of renal changes correlating with clinical diagnosis of acute kidney injury (AKI) in patients after lung transplantation (lutx).Fifty-four patients (mean age 49.6, range 26-64 years) after lutx were enrolled in a prospective clinical study and underwent functional MR imaging of the kidneys in the early postoperative period. Baseline s-creatinine ranged from 39 to 112 μmol/L. For comparison, 14 healthy volunteers (mean age 42.1, range 24-59 years) underwent magnetic resonance imaging (MRI) using the same protocol. Renal tissue injury was evaluated using quantification of diffusion and diffusion anisotropy with diffusion-weighted (DWI) and diffusion-tensor imaging (DTI). Renal function was monitored and AKI was defined according to Acute-Kidney-Injury-Network criteria. Statistical analysis comprised one-way ANOVA and Pearson correlation.67% of lutx patients (36/54) developed AKI, 47% (17/36) had AKI stage 1, 42% (15/36) AKI stage 2, and 8% (3/36) severe AKI stage 3. Renal apparent diffusion coefficients (ADCs) were reduced in patients with AKI, but preserved in transplant patients without AKI and healthy volunteers (2.07 ± 0.02 vs 2.18 ± 0.05 vs 2.21 ± 0.03 × 10 mm/s, P < .05). Diffusion anisotropy was reduced in all lutx recipients compared with healthy volunteers (AKI: 0.27 ± 0.01 vs no AKI: 0.28 ± 0.01 vs healthy: 0.33 ± 0.02; P < .01). Reduction of renal ADC correlated significantly with acute loss of renal function after lutx (decrease of renal function in the postoperative period and glomerular filtration rate on the day of MRI).MR diffusion imaging enables non-invasive assessment of renal changes correlating with AKI early after lutx. Reduction of diffusion anisotropy was present in all patients after lutx, whereas marked reduction of renal ADC was observed only in the group of lutx recipients with AKI and correlated with renal function impairment.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Ralf Lichtinghagen
- Department of Clinical Chemistry, Hannover Medical School, Hannover, Germany
| | | | - Axel Haverich
- Department of Cardiothoracic, Transplantation and Vascular Surgery
| | | | - Gregor Warnecke
- Department of Cardiothoracic, Transplantation and Vascular Surgery
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16
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Jiang K, Fang Y, Ferguson CM, Tang H, Mishra PK, Macura SI, Lerman LO. Quantitative Magnetization Transfer Detects Renal Fibrosis in Murine Kidneys With Renal Artery Stenosis. J Magn Reson Imaging 2020; 53:10.1002/jmri.27370. [PMID: 32964585 PMCID: PMC7965778 DOI: 10.1002/jmri.27370] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 09/02/2020] [Accepted: 09/03/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Renal fibrosis is a common pathway in tubulointerstitial injury and a major determinant of renal insufficiency. Collagen deposition, a key feature of renal fibrosis, may serve as an imaging biomarker to differentiate scarred from healthy kidneys. PURPOSE To test the feasibility of using quantitative magnetization transfer (qMT), which assesses tissue macromolecule content, to measure renal fibrosis. STUDY TYPE Prospective. ANIMAL MODEL Fifteen 129S1 mice were studied 4 weeks after either sham (n = 7) or unilateral renal artery stenosis (RAS, n = 8) surgeries. FIELD STRENGTH/SEQUENCE Magnetization transfer (MT)-weighted images were acquired at 16.4T using an MT-prepared fast-low-angle-shot sequence. Renal B0, B1, and T1 maps were also acquired, using a dual-echo gradient echo, an actual flip angle, and inversion recovery method, respectively. ASSESSMENT A two-pool model was used to estimate the bound water fraction (f) and other tissue imaging biomarkers. Masson's trichrome staining was subsequently performed ex vivo to evaluate renal fibrosis. STATISTICAL TESTS Comparisons of renal parameters between sham and RAS were performed using independent samples t-tests. Pearson's correlation was conducted to investigate the relationship between renal fibrosis by histology and the qMT-derived bound pool fraction f. RESULTS The two-pool model provided accurate fittings of measured MT signal. The qMT-derived f of RAS kidneys was significantly increased compared to sham in all kidney zones (renal cortex [CO], 7.6 ± 2.4% vs. 4.6 ± 0.6%; outer medulla [OM], 8.2 ± 4.2% vs. 4.2 ± 0.9%; inner medulla [IM] + P, 5.8 ± 1.6% vs. 2.9 ± 0.6%, all P < 0.05). Measured f correlated well with histological fibrosis in all kidney zones (CO, Pearson's correlation coefficient r = 0.95; OM, r = 0.93; IM + P, r = 0.94, all P < 0.05). DATA CONCLUSION The bound pool fraction f can be quantified using qMT at 16.4T in murine kidneys, increases significantly in fibrotic RAS kidneys, and correlates well with fibrosis by histology. Therefore, qMT may constitute a valuable tool for measuring renal fibrosis in RAS. LEVEL OF EVIDENCE 1 TECHNICAL EFFICACY STAGE: 3.
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Affiliation(s)
- Kai Jiang
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
| | - Yiyuan Fang
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Hui Tang
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
| | - Prasanna K. Mishra
- Biochemistry and Molecular Biology, Mayo Clinic, Rochester, Minnesota, USA
| | - Slobodan I. Macura
- Biochemistry and Molecular Biology, Mayo Clinic, Rochester, Minnesota, USA
| | - Lilach O. Lerman
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
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17
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Bădulescu MR, Socaciu MA, Moisoiu T, Andries A, Iacob G, Badea R. Current status of imaging diagnosis in the transplanted kidney. A review of the literature with a special focus on contrast-enhanced ultrasonography. Med Pharm Rep 2020; 93:133-144. [PMID: 32478319 PMCID: PMC7243885 DOI: 10.15386/mpr-1536] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 01/27/2020] [Accepted: 02/17/2020] [Indexed: 12/15/2022] Open
Abstract
Objectives Ultrasonographic scanning is currently the most widespread imaging diagnostic procedure. The method provides real-time morphological, vascular and elastographic information in a non-invasive manner. In recent years, harmonic vascular examination has become accessible using intravenous contrast agents. In urological pathology, this procedure is used in the detection and evaluation of vascular and ischemic complications, in the classification of complex cysts according to the Bosniak system, also in the renal lesions with uncertain etiology and in acute pyelonephritis for the detection of abscesses. The contrast agent (SonoVue) is angiospecific and can be used in patients transplanted immediately after surgery without adverse effects or impaired renal function. Thus, it is desirable to be used in the nephrological pathology of the renal graft and to develop diagnostic models based on the evaluation of renal microvascularization, as well as the quantitative data resulting from the graphical representation of the specific parameters. The purpose of this review is to evaluate the current state of the literature regarding the place and role of contrast substance ultrasound in the early diagnosis of acute renal graft dysfunction and to make a differential diagnosis of this pathological entity. Method This review quantifies the role of contrast ultrasound in the diagnosis of acute complications of the renal graft. The research was conducted based on the databases PubMed, MedScape, Cochrane, according to the search criteria such as contrast-enhanced ultrasound + kidney transplant, “time intensity curves” + “kidney transplant”, filtered for the period 2004–2018. Results In the nephrological pathology of the renal graft, contrast-enhanced ultrasound is a valuable tool, superior to Doppler ultrasound in predicting the evolution of the renal graft, identifying very small early defects in renal microvascularization. A number of studies succeeded in identifying acute graft dysfunction, some of which establish its etiology - humoral rejection versus acute tubular necrosis. On the other hand, the contrast-enhanced ultrasound parameters do not have the ability to distinguish between cellular and humoral rejection. Conclusions If, at present, the histopathological examination is the only one that can differentiate with certainty the cause of acute renal graft dysfunction, we consider that contrast-enhanced ultrasound, as a non-invasive imaging technique, opens a favorable perspective for increasing the survival of the renal graft and decreasing the complications in the renal transplant. The combination of other ultrasound techniques, together with contrast-enhanced ultrasound, could lead to the development of new diagnostic models.
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Affiliation(s)
- Maria Ramona Bădulescu
- Hemodialysis Department, 5 Medical Clinic and Urology Department. Clinical Institute of Urology and Renal Transplantation, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Mihai Adrian Socaciu
- Medical Imaging Department, "Octavian Fodor" Institute of Gastroenterology and Hepatology and Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Tudor Moisoiu
- Urology Department, Clinical Institute of Urology and Renal Transplantation, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Alexandra Andries
- Medical Imaging Department, "Octavian Fodor" Institute of Gastroenterology and Hepatology and Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Medical Imaging Department, "Prof dr. Ion Chiricuta" Institute of Oncology, Cluj-Napoca, Romania
| | - Gheorghiţă Iacob
- Morphology Department, Clinical Institute of Urology and Renal Transplantation, Cluj-Napoca. Romania
| | - Radu Badea
- Medical Imaging Department, "Octavian Fodor" Institute of Gastroenterology and Hepatology and Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
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18
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Chalouhi GE, Millischer AÉ, Mahallati H, Siauve N, Melbourne A, Grevent D, Vinit N, Heidet L, Aigrain Y, Ville Y, Blanc T, Salomon LJ. The use of fetal MRI for renal and urogenital tract anomalies. Prenat Diagn 2019; 40:100-109. [PMID: 31736096 DOI: 10.1002/pd.5610] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 10/29/2019] [Accepted: 10/30/2019] [Indexed: 12/20/2022]
Abstract
Fetal anomalies are detected in approximately 2% of all fetuses and, among these, genitourinary tract abnormalities account for 30% to 50% of all structural anomalies present at birth. Although ultrasound remains the first line diagnostic modality, fetal MRI provides important additional structural and functional information, especially with the development of faster sequences and the use of functional sequences. The added value of MRI-based imaging is three-fold: (a) improvement of diagnostic accuracy by adequate morphological examination, (b) detection of additional anomalies, and (c) in addition, MRI has the potential to provide information regarding renal function. In this review, we describe the role of fetal MRI in the anatomical evaluation of renal and urogenital tract anomalies, and we also touch upon the contribution of functional MRI to the diagnostic workup of these conditions.
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Affiliation(s)
- Gihad E Chalouhi
- Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes and Fetus & LUMIERE team, Paris, France.,Division of Fetal Medicine, Department of Obstetrics and Gynecology, American University of Beirut Medical Center, American University of Beirut, Beirut, Lebanon.,Université de Paris, Paris, France
| | - Anne-Élodie Millischer
- Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes and Fetus & LUMIERE team, Paris, France
| | - Houman Mahallati
- Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes and Fetus & LUMIERE team, Paris, France.,Department of Radiology, University of Calgary, Calgary, Canada
| | - Nathalie Siauve
- Imagerie Médicale, Hôpital Louis Mourier APHP, Colombes, France
| | - Andrew Melbourne
- Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes and Fetus & LUMIERE team, Paris, France.,School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom.,Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - David Grevent
- Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes and Fetus & LUMIERE team, Paris, France
| | - Nicolas Vinit
- Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Department of Pediatric Surgery and Urology, Paris, France
| | - Laurence Heidet
- Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes and Fetus & LUMIERE team, Paris, France.,Centre de référence des Maladies Rénales Héréditaires de l'Enfant et de l'Adulte (MARHEA), Paris, France.,Pediatric Nephrology Department, Hôpital Universitaire Necker-Enfants Malades, Sorbonne Paris Cité University, Paris, France
| | - Yves Aigrain
- Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes and Fetus & LUMIERE team, Paris, France.,Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Department of Pediatric Surgery and Urology, Paris, France
| | - Yves Ville
- Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes and Fetus & LUMIERE team, Paris, France
| | - Thomas Blanc
- Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes and Fetus & LUMIERE team, Paris, France.,Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Department of Pediatric Surgery and Urology, Paris, France.,INSERM U1151-CNRS UMR 8253, Université de Paris, Institut Necker-Enfants Malades, Paris, France.,Université de Paris, Paris, France
| | - Laurent J Salomon
- Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes and Fetus & LUMIERE team, Paris, France.,Université de Paris, Paris, France
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Technical recommendations for clinical translation of renal MRI: a consensus project of the Cooperation in Science and Technology Action PARENCHIMA. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2019; 33:131-140. [PMID: 31628564 PMCID: PMC7021737 DOI: 10.1007/s10334-019-00784-w] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Revised: 09/23/2019] [Accepted: 10/01/2019] [Indexed: 12/14/2022]
Abstract
Purpose The potential of renal MRI biomarkers has been increasingly recognised, but clinical translation requires more standardisation. The PARENCHIMA consensus project aims to develop and apply a process for generating technical recommendations on renal MRI. Methods A task force was formed in July 2018 focused on five methods. A draft process for attaining consensus was distributed publicly for consultation and finalised at an open meeting (Prague, October 2018). Four expert panels completed surveys between October 2018 and March 2019, discussed results and refined the surveys at a face-to-face meeting (Aarhus, March 2019) and completed a second round (May 2019). Results A seven-stage process was defined: (1) formation of expert panels; (2) definition of the context of use; (3) literature review; (4) collection and comparison of MRI protocols; (5) consensus generation by an approximate Delphi method; (6) reporting of results in vendor-neutral and vendor-specific terms; (7) ongoing review and updating. Application of the process resulted in 166 consensus statements. Conclusion The process generated meaningful technical recommendations across very different MRI methods, while allowing for improvement and refinement as open issues are resolved. The results are likely to be widely supported by the renal MRI community and thereby promote more harmonisation.
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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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21
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CPT1a downregulation protects against cholesterol-induced fibrosis in tubular epithelial cells by downregulating TGFβ-1 and inflammasome. Biochem Biophys Res Commun 2019; 517:715-721. [DOI: 10.1016/j.bbrc.2019.07.121] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 07/30/2019] [Indexed: 01/10/2023]
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22
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Zhang JL, Lee VS. Renal perfusion imaging by MRI. J Magn Reson Imaging 2019; 52:369-379. [PMID: 31452303 DOI: 10.1002/jmri.26911] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 08/14/2019] [Indexed: 12/13/2022] Open
Abstract
Renal perfusion can be quantitatively assessed by multiple magnetic resonance imaging (MRI) methods, including dynamic contrast enhanced (DCE), arterial spin labeling (ASL), and diffusion-weighted imaging with intravoxel incoherent motion (IVIM) analysis. In this review we summarize the advances in the field of renal-perfusion MRI over the past 5 years. The review starts with a brief introduction of relevant MRI methods, followed by a discussion of recent technical developments. In the main section of the review, we examine the clinical and preclinical applications for three disease populations: chronic kidney disease, renal transplant, and renal tumors. The DCE method has been routinely used for assessing renal tumors but not other renal diseases. As a noncontrast alternative, ASL was extensively explored in both preclinical and clinical applications and showed much promise. Protocol standardization for the methods is desperately needed, and then large-scale clinical trials for the methods can be initiated prior to their broad clinical use. Level of Evidence: 5 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019. J. Magn. Reson. Imaging 2020;52:369-379.
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Affiliation(s)
- Jeff L Zhang
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Vivian S Lee
- Verily Life Sciences, Cambridge, Massachusetts, USA
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Pavuluri K, Manoli I, Pass A, Li Y, Vernon HJ, Venditti CP, McMahon MT. Noninvasive monitoring of chronic kidney disease using pH and perfusion imaging. SCIENCE ADVANCES 2019; 5:eaaw8357. [PMID: 31453331 PMCID: PMC6693904 DOI: 10.1126/sciadv.aaw8357] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 07/08/2019] [Indexed: 05/18/2023]
Abstract
Chronic Kidney Disease (CKD) is a cardinal feature of methylmalonic acidemia (MMA), a prototypic organic acidemia. Impaired growth, low activity, and protein restriction affect muscle mass and lower serum creatinine, which can delay diagnosis and management of renal disease. We have designed an alternative strategy for monitoring renal function based on administration of a pH sensitive MRI agent and assessed this in a mouse model. This protocol produced three metrics: kidney contrast, ~4% for severe renal disease mice compared to ~13% and ~25% for moderate renal disease and healthy controls, filtration fraction (FF), ~15% for severe renal disease mice compared to ~79% and 100% for moderate renal disease and healthy controls, and variation in pH, ~0.45 units for severe disease mice compared to 0.06 and 0.01 for moderate disease and healthy controls. Our results demonstrate that MRI can be used for early detection and monitoring of CKD.
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Affiliation(s)
- KowsalyaDevi Pavuluri
- Division of MR Research, The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Irini Manoli
- Medical Genomics and Metabolic Genetics Branch, National Human Genome Research Institute, National Institutes of Health (NIH), Bethesda, MD, USA
| | - Alexandra Pass
- Medical Genomics and Metabolic Genetics Branch, National Human Genome Research Institute, National Institutes of Health (NIH), Bethesda, MD, USA
| | - Yuguo Li
- Division of MR Research, The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Hilary J. Vernon
- McKusick-Nathans Institute of Genetic Medicine, Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Charles P. Venditti
- Medical Genomics and Metabolic Genetics Branch, National Human Genome Research Institute, National Institutes of Health (NIH), Bethesda, MD, USA
| | - Michael T. McMahon
- Division of MR Research, The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, USA
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24
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Serai SD, Otero HJ, Calle-Toro JS, Berman JI, Darge K, Hartung EA. Diffusion tensor imaging of the kidney in healthy controls and in children and young adults with autosomal recessive polycystic kidney disease. Abdom Radiol (NY) 2019; 44:1867-1872. [PMID: 30783727 DOI: 10.1007/s00261-019-01933-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To compare diffusion tensor imaging (DTI) of the kidneys and its derived parameters in children with autosomal recessive polycystic kidney disease (ARPKD) versus healthy controls. METHODS In a prospective IRB-approved study, we evaluated the use of DTI to compare kidney parenchyma FA values in healthy controls (age-matched children with no history of renal disease) versus patients with ARPKD. A 20-direction DTI with b-values of b = 0 s/mm2 and b = 400 s/mm2 was used to acquire data in coronal direction using a fat-suppressed spin-echo echo-planar sequence. Diffusion Toolkit and TrackVis were used for analysis and segmentation. TrackVis was used to draw regions of interest (ROIs) covering the entire volume of the renal parenchyma, excluding the collecting system. Fibers were reconstructed using a deterministic fiber tracking algorithm. The FA values based on the ROI data, mean length, and volume of the tracks based on the fiber tracking data were recorded. RESULTS Eight healthy controls (mean age = 12.9 years ± 4.0; 1/8 males) and six ARPKD participants (mean age = 13.8 years ± 8.5; 5/6 males) were included in the study. Compared to healthy controls, patients with ARPKD had significantly lower FA values (0.33 ± 0.03 vs. 0.25 ± 0.02, p = 0.002) and mean track length (16.73 ± 3.43 vs. 11.61 ± 1.29 mm, p = 0.005). CONCLUSION DTI of the kidneys shows significantly lower FA values and mean track length in children and young adults with ARPKD compared to normal subjects. DTI of the kidney offers a novel approach for characterizing renal disease based on changes in diffusion anisotropy and kidney structure.
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Affiliation(s)
- Suraj D Serai
- Division of Body Imaging, Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA.
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Hansel J Otero
- Division of Body Imaging, Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Juan S Calle-Toro
- Division of Body Imaging, Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Jeffrey I Berman
- Division of Body Imaging, Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Kassa Darge
- Division of Body Imaging, Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Erum A Hartung
- Division of Nephrology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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25
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Köhnke R, Kentrup D, Schütte-Nütgen K, Schäfers M, Schnöckel U, Hoerr V, Reuter S. Update on imaging-based diagnosis of acute renal allograft rejection. AMERICAN JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING 2019; 9:110-126. [PMID: 31139495 PMCID: PMC6526365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Accepted: 04/12/2019] [Indexed: 06/09/2023]
Abstract
Kidney transplantation is the preferred treatment for patients with end-stage renal disease. Despite effective immunosuppressants, acute allograft rejections pose a major threat to graft survival. In early stages, acute rejections are still potentially reversible, and early detection is crucial to initiate the necessary treatment options and to prevent further graft dysfunction or even loss of the complete graft. Currently, invasive core needle biopsy is the reference standard to diagnose acute rejection. However, biopsies carry the risk of graft injuries and cannot be immediately performed on patients receiving anticoagulation drugs. Therefore, non-invasive assessment of the whole organ for specific and rapid detection of acute allograft rejection is desirable. We herein provide a review summarizing current imaging-based approaches for non-invasive diagnosis of acute renal allograft rejection.
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Affiliation(s)
- Richard Köhnke
- Department of Medicine, Division of General Internal Medicine, Nephrology and Rheumatology, University Hospital of Muenster48149 Muenster, Germany
| | - Dominik Kentrup
- Department of Medicine, Division of General Internal Medicine, Nephrology and Rheumatology, University Hospital of Muenster48149 Muenster, Germany
- Department of Medicine, Division of Nephrology, The University of Alabama at Birmingham (UAB)35294 Birmingham Alabama, US
| | - Katharina Schütte-Nütgen
- Department of Medicine, Division of General Internal Medicine, Nephrology and Rheumatology, University Hospital of Muenster48149 Muenster, Germany
| | - Michael Schäfers
- Department of Nuclear Medicine, University Hospital of Muenster48149 Muenster, Germany
- European Institute for Molecular Imaging, University of Muenster48140 Muenster, Germany
| | - Uta Schnöckel
- Department of Nuclear Medicine, University Hospital of Muenster48149 Muenster, Germany
| | - Verena Hoerr
- Department of Clinical Radiology, University Hospital of Muenster48149 Muenster, Germany
- Institute of Medical Microbiology, Jena University HospitalAm Klinikum 1, 07747 Jena, Germany
| | - Stefan Reuter
- Department of Medicine, Division of General Internal Medicine, Nephrology and Rheumatology, University Hospital of Muenster48149 Muenster, 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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Abassi Z, Rosen S, Lamothe S, Heyman SN. Why Have Detection, Understanding and Management of Kidney Hypoxic Injury Lagged Behind those for the Heart? J Clin Med 2019; 8:E267. [PMID: 30795640 PMCID: PMC6406359 DOI: 10.3390/jcm8020267] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 02/17/2019] [Accepted: 02/19/2019] [Indexed: 12/27/2022] Open
Abstract
The outcome of patients with acute myocardial infarction (AMI) has dramatically improved over recent decades, thanks to early detection and prompt interventions to restore coronary blood flow. In contrast, the prognosis of patients with hypoxic acute kidney injury (AKI) remained unchanged over the years. Delayed diagnosis of AKI is a major reason for this discrepancy, reflecting the lack of symptoms and diagnostic tools indicating at real time altered renal microcirculation, oxygenation, functional derangement and tissue injury. New tools addressing these deficiencies, such as biomarkers of tissue damage are yet far less distinctive than myocardial biomarkers and advanced functional renal imaging technologies are non-available in the clinical practice. Moreover, our understanding of pathogenic mechanisms likely suffers from conceptual errors, generated by the extensive use of the wrong animal model, namely warm ischemia and reperfusion. This model parallels mechanistically type I AMI, which properly represents the rare conditions leading to renal infarcts, whereas common scenarios leading to hypoxic AKI parallel physiologically type II AMI, with tissue hypoxic damage generated by altered oxygen supply/demand equilibrium. Better understanding the pathogenesis of hypoxic AKI and its management requires a more extensive use of models of type II-rather than type I hypoxic AKI.
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Affiliation(s)
- Zaid Abassi
- Department of Physiology, Ruth & Bruce Rappaport Faculty of Medicine, Technion-IIT, Haifa, 31096, Israel.
- Department of Laboratory Medicine, Rambam Health Care campus, Haifa, 31096, Israel.
| | - Seymour Rosen
- Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA 02215, USA.
| | - Simon Lamothe
- Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA 02215, USA.
| | - Samuel N Heyman
- Department of Medicine, Hadassah Hebrew University Hospital, Mt. Scopus, Jerusalem, 91240, Israel.
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Tomoelastography Paired With T2* Magnetic Resonance Imaging Detects Lupus Nephritis With Normal Renal Function. Invest Radiol 2019; 54:89-97. [DOI: 10.1097/rli.0000000000000511] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Yang J, Zhang LJ, Wang F, Hong T, Liu Z. Molecular imaging of diabetes and diabetic complications: Beyond pancreatic β-cell targeting. Adv Drug Deliv Rev 2019; 139:32-50. [PMID: 30529307 DOI: 10.1016/j.addr.2018.11.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 09/28/2018] [Accepted: 11/27/2018] [Indexed: 12/13/2022]
Abstract
Diabetes is a chronic non-communicable disease affecting over 400 million people worldwide. Diabetic patients are at a high risk of various complications, such as cardiovascular, renal, and other diseases. The pathogenesis of diabetes (both type 1 and type 2 diabetes) is associated with a functional impairment of pancreatic β-cells. Consequently, most efforts to manage and prevent diabetes have focused on preserving β-cells and their function. Advances in imaging techniques, such as magnetic resonance imaging, magnetic resonance spectroscopy, positron emission tomography, and single-photon-emission computed tomography, have enabled noninvasive and quantitative detection and characterization of the population and function of β-cells in vivo. These advantages aid in defining and monitoring the progress of diabetes and determining the efficacy of anti-diabetic therapies. Beyond β-cell targeting, molecular imaging of biomarkers associated with the development of diabetes, e.g., lymphocyte infiltration, insulitis, and metabolic changes, may also be a promising strategy for early detection of diabetes, monitoring its progression, and occurrence of complications, as well as facilitating exploration of new therapeutic interventions. Moreover, molecular imaging of glucose uptake, production and excretion in specified tissues is critical for understanding the pathogenesis of diabetes. In the current review, we summarize and discuss recent advances in noninvasive imaging technologies for imaging of biomarkers beyond β-cells for early diagnosis of diabetes, investigation of glucose metabolism, and precise diagnosis and monitoring of diabetic complications for better management of diabetic patients.
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Affiliation(s)
- Jichun Yang
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences Peking University Health Science Center, Key Laboratory of Cardiovascular Science of the Ministry of Education, Center for Non-coding RNA Medicine, Beijing 100191, China.
| | - Long Jiang Zhang
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China
| | - Fan Wang
- Medical Isotopes Research Center and Department of Radiation Medicine, School of Basic Medical Sciences, Peking University Health Science Center, Beijing 100191, China
| | - Tianpei Hong
- Department of Endocrinology and Metabolism, Peking University Third Hospital, Beijing 100191, China.
| | - Zhaofei Liu
- Medical Isotopes Research Center and Department of Radiation Medicine, School of Basic Medical Sciences, Peking University Health Science Center, Beijing 100191, China.
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Abstract
Kidney diseases can be caused by a wide range of genetic, hemodynamic, toxic, infectious, and autoimmune factors. The diagnosis of kidney disease usually involves the biochemical analysis of serum and blood, but these tests are often insufficiently sensitive or specific to make a definitive diagnosis. Although radiologic imaging currently has a limited role in the evaluation of most kidney diseases, several new imaging methods hold great promise for improving our ability to non-invasively detect structural, functional, and molecular changes within the kidney. New methods, such as dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and blood oxygen level-dependent (BOLD) MRI, allow functional imaging of the kidney. The use of novel contrast agents, such as microbubbles and nanoparticles, allows the detection of specific molecules in the kidney. These methods could greatly advance our ability to diagnose disease and also to safely monitor patients over time. This could improve the care of individual patients, and it could also facilitate the evaluation of new treatment strategies.
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Affiliation(s)
- Joshua Thurman
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Faikah Gueler
- Department of Nephrology, Hannover Medical School, Hannover, Germany
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Lanzman RS, Ljimani A, Müller-Lutz A, Weller J, Stabinska J, Antoch G, Wittsack HJ. Assessment of time-resolved renal diffusion parameters over the entire cardiac cycle. Magn Reson Imaging 2018; 55:1-6. [PMID: 30213753 DOI: 10.1016/j.mri.2018.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 08/24/2018] [Accepted: 09/08/2018] [Indexed: 12/11/2022]
Abstract
OBJECT To assess changes diffusion properties of renal cortex over the entire cardiac cycle using electrocardiogram-gated respiratory-triggered dynamic diffusion-weighted imaging (DWI). MATERIALS AND METHODS 20 healthy volunteers were investigated on a 1.5 T MR scanner. Blood flow velocity within the renal arteries was determined by electrocardiogram-gated phase-contrast measurements. For dynamic renal DWI, an electrocardiogram-gated respiratory-triggered coronal single-slice EPI sequence was acquired at 14 times at 20, 70, 120, 170, …, 570, 620, 720 ms after the R-wave over the cardiac cycle. ROI measurements were performed by two authors in the renal cortex on apparent diffusion coefficient (ADC) maps. A pulsatility index was calculated for ADC as maximal percentage change. Five subjects were measured twice to assess scan-rescan reproducibility. RESULTS Flow measurements exhibited a minimum velocity of 15.7 ± 4.3 cm/s during the R-wave and a maximum of 43.2 ± 10.4 cm/s at 182.5 ± 48.3 ms after the R-wave. A minimal mean ADC of 2.19 ± 0.09 × 10-3 mm2/s was observed during the R-wave. A maximum mean ADC of 2.85 ± 0.20 × 10-3 mm2/s was measured 193 ± 57 ms after the R-wave. The mean ADC pulsatility index in the renal cortex was 29.9 ± 5.8%. ADC variation exhibited a significant correlation with pulsatile blood flow velocity. The scan-rescan reproducibility in this study had a low deviation of 0.3 ± 0.1%. The inter-reader reproducibility was 2.9 ± 0.6%. CONCLUSION Renal ADCs exhibit pulsatile characteristics. Due to the significant difference of systolic and diastolic ADCs, the pulsatility index can be calculated.
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Affiliation(s)
- Rotem Shlomo Lanzman
- University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225 Dusseldorf, Germany.
| | - Alexandra Ljimani
- University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225 Dusseldorf, Germany.
| | - Anja Müller-Lutz
- University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225 Dusseldorf, Germany.
| | - Julia Weller
- University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225 Dusseldorf, Germany
| | - Julia Stabinska
- University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225 Dusseldorf, Germany.
| | - Gerald Antoch
- University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225 Dusseldorf, Germany.
| | - Hans-Jörg Wittsack
- University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225 Dusseldorf, Germany.
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Honzumi S, Takeuchi M, Kurihara M, Fujiyoshi M, Uchida M, Watanabe K, Suzuki T, Ishii I. The effect of cholesterol overload on mouse kidney and kidney-derived cells. Ren Fail 2018; 40:43-50. [PMID: 29304720 PMCID: PMC6014466 DOI: 10.1080/0886022x.2017.1419974] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Introduction: Dyslipidemia is one of the onset and risk factors of chronic kidney disease and renal function drop is seen in lipoprotein abnormal animal models. However, the detailed molecular mechanism of renal lipotoxicity has not been clarified. Therefore, the present study aimed to investigate the influence of cholesterol overload using mouse kidney tissue and kidney-derived cultured cells. Methods: C57BL/6 mice were fed normal diet (ND) or 1.25% cholesterol-containing high-cholesterol diet (HCD) for 11 weeks, and we used megalin as a proximal tubule marker for immunohistology. We added beta-very low density lipoprotein (βVLDL) to kidney-derived cells and examined the effect of cholesterol overload on megalin protein and mRNA expression level, cell proliferation and cholesterol content in cells. Results: In the kidney of HCD mice, the gap between glomerulus and the surrounding Bowman’s capsule decreased and the expression level of megalin decreased. After βVLDL treatment to the cells, the protein expression and mRNA expression level of megalin decreased and cell proliferation was restrained. We also observed an increase in cholesterol accumulation in the cell and free cholesterol/phospholipid ratios increased. Conclusions: These findings suggest that the increased cholesterol load on kidney contribute to the decrease of megalin and the overloaded cholesterol is taken into the renal tubule epithelial cells, causing suppression on cell proliferation, which may be the cause of kidney damage.
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Affiliation(s)
- Shoko Honzumi
- a Department of Clinical Pharmacy, Graduate School of Pharmaceutical Sciences , Chiba University , Chiba , Japan
| | - Miho Takeuchi
- a Department of Clinical Pharmacy, Graduate School of Pharmaceutical Sciences , Chiba University , Chiba , Japan
| | - Mizuki Kurihara
- a Department of Clinical Pharmacy, Graduate School of Pharmaceutical Sciences , Chiba University , Chiba , Japan
| | - Masachika Fujiyoshi
- a Department of Clinical Pharmacy, Graduate School of Pharmaceutical Sciences , Chiba University , Chiba , Japan
| | - Masashi Uchida
- b Division of Pharmacy , Chiba University Hospital , Chiba , Japan
| | - Kenta Watanabe
- b Division of Pharmacy , Chiba University Hospital , Chiba , Japan
| | - Takaaki Suzuki
- b Division of Pharmacy , Chiba University Hospital , Chiba , Japan
| | - Itsuko Ishii
- a Department of Clinical Pharmacy, Graduate School of Pharmaceutical Sciences , Chiba University , Chiba , Japan.,b Division of Pharmacy , Chiba University Hospital , Chiba , Japan
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Schley G, Jordan J, Ellmann S, Rosen S, Eckardt KU, Uder M, Willam C, Bäuerle T. Multiparametric magnetic resonance imaging of experimental chronic kidney disease: A quantitative correlation study with histology. PLoS One 2018; 13:e0200259. [PMID: 30011301 PMCID: PMC6047786 DOI: 10.1371/journal.pone.0200259] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 06/24/2018] [Indexed: 12/27/2022] Open
Abstract
Objectives In human chronic kidney disease (CKD) the extent of renal tubulointerstitial fibrosis correlates with progressive loss of renal function. However, fibrosis can so far only be assessed by histology of kidney biopsies. Magnetic resonance imaging (MRI) can provide information about tissue architecture, but its potential to assess fibrosis and inflammation in diseased kidneys remains poorly defined. Materials and methods We evaluated excised kidneys in a murine adenine-induced nephropathy model for CKD by MRI and correlated quantitative MRI parameters (T1, T2, and T2* relaxation times, apparent diffusion coefficient and fractional anisotropy) with histological hallmarks of progressive CKD, including renal fibrosis, inflammation, and microvascular rarefaction. Furthermore, we analyzed the effects of paraformaldehyde fixation on MRI parameters by comparing kidney samples before and after fixation with paraformaldehyde. Results In diseased kidneys T2 and T2* relaxation times, apparent diffusion coefficient and fractional anisotropy in the renal cortex and/or outer medulla were significantly different from those in control kidneys. In particular, T2 relaxation time was the best parameter to distinguish control and CKD groups and correlated very well with the extent of fibrosis, inflammatory infiltrates, tubular dilation, crystal deposition, and loss of peritubular capillaries and normal tubules in the renal cortex and outer medulla. Fixation with paraformaldehyde had no impact on T2 relaxation time and fractional anisotropy, whereas T1 times significantly decreased and T2* times and apparent diffusion coefficients increased in fixed kidney tissue. Conclusions MRI parameters provide a promising approach to quantitatively assess renal fibrosis and inflammation in CKD. Especially T2 relaxation time correlates well with histological features of CKD and is not influenced by paraformaldehyde fixation of kidney samples. Thus, T2 relaxation time might be a candidate parameter for non-invasive assessment of renal fibrosis in human patients.
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Affiliation(s)
- Gunnar Schley
- Department of Nephrology and Hypertension, Friedrich-Alexander University Erlangen-Nürnberg (FAU) and University Hospital Erlangen, Erlangen, Germany
- * E-mail:
| | - Jutta Jordan
- Department of Radiology, Friedrich-Alexander University Erlangen-Nürnberg (FAU) and University Hospital Erlangen, Erlangen, Germany
| | - Stephan Ellmann
- Department of Radiology, Friedrich-Alexander University Erlangen-Nürnberg (FAU) and University Hospital Erlangen, Erlangen, Germany
| | - Seymour Rosen
- Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
| | - Kai-Uwe Eckardt
- Department of Nephrology and Hypertension, Friedrich-Alexander University Erlangen-Nürnberg (FAU) and University Hospital Erlangen, Erlangen, Germany
- Department of Nephrology and Medical Intensive Care, Charité –Universitätsmedizin Berlin, Berlin, Germany
| | - Michael Uder
- Department of Radiology, Friedrich-Alexander University Erlangen-Nürnberg (FAU) and University Hospital Erlangen, Erlangen, Germany
| | - Carsten Willam
- Department of Nephrology and Hypertension, Friedrich-Alexander University Erlangen-Nürnberg (FAU) and University Hospital Erlangen, Erlangen, Germany
| | - Tobias Bäuerle
- Department of Radiology, Friedrich-Alexander University Erlangen-Nürnberg (FAU) and University Hospital Erlangen, Erlangen, Germany
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Shehata M, Khalifa F, Soliman A, Ghazal M, Taher F, El-Ghar MA, Dwyer AC, Gimel'farb G, Keynton RS, El-Baz A. Computer-Aided Diagnostic System for Early Detection of Acute Renal Transplant Rejection Using Diffusion-Weighted MRI. IEEE Trans Biomed Eng 2018; 66:539-552. [PMID: 29993503 DOI: 10.1109/tbme.2018.2849987] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Early diagnosis of acute renal transplant rejection (ARTR) is critical for accurate treatment. Although the current gold standard, diagnostic technique is renal biopsy, it is not preferred due to its invasiveness, long recovery time (1-2 weeks), and potential for complications, e.g., bleeding and/or infection. METHODS This paper presents a computer-aided diagnostic (CAD) system for early ARTR detection using (3D + b-value) diffusion-weighted (DW) magnetic resonance imaging (MRI) data. The CAD process starts from kidney tissue segmentation with an evolving geometric (level-set-based) deformable model. The evolution is guided by a voxel-wise stochastic speed function, which follows from a joint kidney-background Markov-Gibbs random field model accounting for an adaptive kidney shape prior and on-going kidney-background visual appearances. A B-spline-based three-dimensional data alignment is employed to handle local deviations due to breathing and heart beating. Then, empirical cumulative distribution functions of apparent diffusion coefficients of the segmented DW-MRI at different b-values are collected as discriminatory transplant status features. Finally, a deep-learning-based classifier with stacked nonnegative constrained autoencoders is employed to distinguish between rejected and nonrejected renal transplants. RESULTS In our initial "leave-one-subject-out" experiment on 100 subjects, [Formula: see text] of the subjects were correctly classified. The subsequent four-fold and ten-fold cross-validations gave the average accuracy of [Formula: see text] and [Formula: see text], respectively. CONCLUSION These results demonstrate the promise of this new CAD system to reliably diagnose renal transplant rejection. SIGNIFICANCE The technology presented here can significantly impact the quality of care of renal transplant patients since it has the potential to replace the gold standard in kidney diagnosis, biopsy.
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Liu Y, Zhang GMY, Peng X, Wen Y, Ye W, Zheng K, Li X, Sun H, Chen L. Diffusional kurtosis imaging in assessing renal function and pathology of IgA nephropathy: a preliminary clinical study. Clin Radiol 2018; 73:818-826. [PMID: 29929904 DOI: 10.1016/j.crad.2018.05.012] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 05/09/2018] [Indexed: 02/07/2023]
Abstract
AIM To evaluate renal fibrosis in immunoglobulin A nephropathy (IgAN) using diffusion kurtosis imaging (DKI). MATERIALS AND METHODS Twenty patients with biopsy-proven IgAN were enrolled. DKI was performed on a clinical 3 T magnetic resonance imaging (MRI) system, and region-of-interest measurements were conducted to determine mean kurtosis (K), mean diffusivity (D), and apparent diffusion coefficient (ADC) of the kidney cortex. Renal biopsy specimens were scored based on the severity of renal fibrosis. The associations between the DKI data and clinicopathological parameters were investigated. RESULTS Both the K and ADC were not only well correlated with the estimated glomerular filtration rate, but also significantly associated with the pathological scores of fibrosis, including the glomerular sclerosis index (K: r=0.759, p<0.001; ADC: r=-0.636, p=0.003) and the percentage of tubular atrophy and interstitial fibrosis (K: r=0.767, p<0.001; ADC: r=-0.702, p=0.001). Further receiver operating characteristic analysis showed that K demonstrated better diagnostic performance in discriminating severe glomerulosclerosis (area under curve [AUC] 0.970, sensitivity 81.8%, specificity 100%), and ADC displayed better capabilities in identifying severe tubular atrophy/interstitial fibrosis (AUC 0.976, sensitivity 100%, specificity 92.9%). CONCLUSION This DKI method can be used to detect renal fibrosis in IgAN in a non-invasive manner and may provide additional information for characterisation and surveillance.
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Affiliation(s)
- Y Liu
- Department of Nephrology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - G-M-Y Zhang
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - X Peng
- Department of Nephrology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Y Wen
- Department of Nephrology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - W Ye
- Department of Nephrology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - K Zheng
- Department of Nephrology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - X Li
- Department of Nephrology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - H Sun
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China.
| | - L Chen
- Department of Nephrology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China.
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Erokwu BO, Anderson CE, Flask CA, Dell KM. Quantitative magnetic resonance imaging assessments of autosomal recessive polycystic kidney disease progression and response to therapy in an animal model. Pediatr Res 2018. [PMID: 29538364 DOI: 10.1038/pr.2018.24] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BackgroundAutosomal recessive polycystic kidney disease (ARPKD) is associated with significant mortality and morbidity, and currently, there are no disease-specific treatments available for ARPKD patients. One major limitation in establishing new therapies for ARPKD is a lack of sensitive measures of kidney disease progression. Magnetic resonance imaging (MRI) can provide multiple quantitative assessments of the disease.MethodsWe applied quantitative image analysis of high-resolution (noncontrast) T2-weighted MRI techniques to study cystic kidney disease progression and response to therapy in the PCK rat model of ARPKD.ResultsSerial imaging over a 2-month period demonstrated that renal cystic burden (RCB, %)=[total cyst volume (TCV)/total kidney volume (TKV) × 100], TCV, and, to a lesser extent, TKV detected cystic kidney disease progression, as well as the therapeutic effect of octreotide, a clinically available medication shown previously to slow both kidney and liver disease progression in this model. All three MRI measures correlated significantly with histologic measures of renal cystic area, although the correlation of RCB and TCV was stronger than that of TKV.ConclusionThese preclinical MRI results provide a basis for applying these quantitative MRI techniques in clinical studies, to stage and measure progression in human ARPKD kidney disease.
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Affiliation(s)
| | | | - Chris A Flask
- Department of Radiology, Case Western Reserve University, Cleveland, Ohio
| | - Katherine M Dell
- Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio
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Li ZC, Cai YZ, Tang ZG, Zuo PL, Liu RB, Liu F. Lipo-prostaglandin E1 improves renal hypoxia evaluated by BOLD-MRI in patients with diabetic kidney disease. Clin Imaging 2018; 50:239-242. [PMID: 29689479 DOI: 10.1016/j.clinimag.2018.04.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 04/12/2018] [Accepted: 04/16/2018] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To evaluate the effect of lipo-PGE1 on renal hypoxia in patients with DKD by BOLD-MRI. MATERIALS AND METHODS All patients were divided into DKD group and CKD-without-diabetes group. All patients received intravenous 10 μg lipo-PGE1 once daily for 14 days. BOLD-MRI was performed before and after lipo-PGE1 administration to acquire renal CR2* and MR2* values. RESULTS Renal MR2* value in DKD group after lipo-PGE1 treatment were significantly decreased compared with the baseline. However, no significant differences in MR2* values were found in the CKD-without-diabetes group. CONCLUSIONS Lipo-PGE1 was shown to improve kidney medullary oxygenation in patients with DKD.
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Affiliation(s)
- Zhi-Cheng Li
- Department of Nephrology, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, China; Department of Nephrology, Zigong First People's Hospital, Zigong, Sichuan 643000, China
| | - Yu-Zhe Cai
- Department of Radiology, West China Hospital of Sichuan University, No. 37 Guoxue Street, Wuhou District, Chengdu, Sichuan 610041, China
| | - Zhi-Gang Tang
- Department of Nephrology, Zigong First People's Hospital, Zigong, Sichuan 643000, China
| | - Pan-Li Zuo
- Siemens Healthcare, MR Collaboration NE Asia, Beijing, China
| | - Rong-Bo Liu
- Department of Radiology, West China Hospital of Sichuan University, No. 37 Guoxue Street, Wuhou District, Chengdu, Sichuan 610041, China
| | - Fang Liu
- Department of Nephrology, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, China.
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Donnola SB, Piccone CM, Lu L, Batesole J, Little J, Dell KM, Flask CA. Diffusion tensor imaging MRI of sickle cell kidney disease: initial results and comparison with iron deposition. NMR IN BIOMEDICINE 2018; 31:10.1002/nbm.3883. [PMID: 29350437 PMCID: PMC5822685 DOI: 10.1002/nbm.3883] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 10/19/2017] [Accepted: 11/14/2017] [Indexed: 06/07/2023]
Abstract
Chronic kidney disease (CKD) occurs in over one-third of patients with sickle cell disease (SCD) and can progress to end-stage renal disease. Unfortunately, current clinical assessments of kidney function are insensitive to early-stage CKD. Previous studies have shown that diffusion magnetic resonance imaging (MRI) can sensitively detect regional renal microstructural changes associated with early-stage CKD. However, previous MRI studies in patients with SCD have been largely limited to the detection of renal iron deposition assessed by T2 * relaxometry. In this pilot imaging study, we compare MRI assessments of renal microstructure (diffusion) and iron deposition (T2 *) in patients with SCD and in non-SCD control subjects. Diffusion tensor imaging (DTI) and T2 * relaxometry MRI data were obtained for pediatric (n = 5) and adult (n = 4) patients with SCD, as well as for non-SCD control subjects (n = 10), on a Siemens Espree 1.5-T MRI scanner. A region-of-interest analysis was used to calculate mean medullary and cortical values for each MRI metric. MRI findings were also compared with clinical assessments of renal function and hemolysis. Patients with SCD showed a significant decrease in medullary fractional anisotropy (FA, p = 0.0001) in comparison with non-SCD subjects, indicative of microstructural alterations in the renal medulla of patients with SCD. Cortical and medullary reductions in T2 * (increased iron deposition, p = ≤0.0001) were also observed. Significant correlations were also observed between kidney T2 * assessments and multiple measures of hemolysis. This is the first DTI MRI study of patients with SCD to demonstrate reductions in medullary FA despite no overt CKD [estimated glomerular filtration rate (eGFR) > 100 mL/min/1.73 m2 ]. These medullary FA changes are consistent with previous studies in patients with CKD, and suggest that DTI MRI can provide a useful measure of kidney injury to complement MRI assessments of iron deposition.
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Affiliation(s)
- Shannon B. Donnola
- Department of Radiology, Case Western Reserve University, Cleveland, Ohio, USA
| | - Connie M. Piccone
- Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio, USA
- Divison of Hematology/Oncology, Rainbow Babies and Children’s Hospital, Cleveland, Ohio, USA
| | - Lan Lu
- Department of Radiology, Case Western Reserve University, Cleveland, Ohio, USA
| | - Joshua Batesole
- Department of Radiology, Case Western Reserve University, Cleveland, Ohio, USA
| | - Jane Little
- Department of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
- Division of Hematology and Oncology, University Hospitals - Cleveland Medical Center, Cleveland, Ohio, USA
| | - Katherine M. Dell
- Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio, USA
- Center for Pediatric Nephrology, Cleveland Clinic Children’s, Cleveland, Ohio, USA
- CWRU Center for Kidney Research, The MetroHealth System, Cleveland, Ohio, USA
| | - Chris A. Flask
- Department of Radiology, Case Western Reserve University, Cleveland, Ohio, USA
- Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio, USA
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA
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Zhang B, Dong Y, Guo B, Chen W, Ouyang F, Lian Z, Liu J, Zhang S. Application of noninvasive functional imaging to monitor the progressive changes in kidney diffusion and perfusion in contrast-induced acute kidney injury rats at 3.0 T. Abdom Radiol (NY) 2018; 43:655-662. [PMID: 28677006 DOI: 10.1007/s00261-017-1247-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Contrast-induced acute kidney injury is a prevalent cause of renal failure, and the noninvasive tools to monitor its progress are lacking. We applied intravoxel incoherent motion (IVIM) DWI to measure the progressive changes in kidney diffusion and perfusion of CI-AKI. METHODS Twenty-four rats received Iopromide (370 mg/ml, 1600 mg iodine/kg) to induce CI-AKI. IVIM DWI was performed on rats (n = 6) at 24 h prior to and 12, 24, 48, 72, and 96 h after the injection using a 3.0 T MRI scanner. The progressive changes in the diffusion (D) and perfusion parameters (D* and f) were studied in the cortex (CO), outer medulla (OM), and inner medulla (IM). For the histology group (n = 18), three rats were sacrificed at each time point. RESULTS In the CO, D reduced progressively from 24 to 48 h (P < 0.001) and increased starting from 72 h (P < 0.001). However, D decreased until to 72 h in the medulla (P < 0.001) and increased starting from 96 h (P < 0.001). D* decreased to the bottom at 24 h in the cortex and medulla (P = 0.037) and started to recover at 48 h (P = 0.007). f decreased in the cortex and medulla in an early stage (12 h) (P = 0.035) of CI-AKI and then ascended in the later stage (72 h) (P = 0.017). The H & E staining showed different degrees of serial pathological change including cloudy swelling, atrophy, even necrosis, and interstitial vasodilation of tubule epithelial cells and glomerulus cells. CONCLUSION Our study demonstrates the feasibility of using IVIM DWI to monitor the progress of CI-AKI, implying that IVIM DWI is a useful biomarker in the staging of CI-AKI.
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Kline TL, Edwards ME, Garg I, Irazabal MV, Korfiatis P, Harris PC, King BF, Torres VE, Venkatesh SK, Erickson BJ. Quantitative MRI of kidneys in renal disease. Abdom Radiol (NY) 2018; 43:629-638. [PMID: 28660330 DOI: 10.1007/s00261-017-1236-y] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate the reproducibility and utility of quantitative magnetic resonance imaging (MRI) sequences for the assessment of kidneys in young adults with normal renal function (eGFR ranged from 90 to 130 mL/min/1.73 m2) and patients with early renal disease (autosomal dominant polycystic kidney disease). MATERIALS AND METHODS This prospective case-control study was performed on ten normal young adults (18-30 years old) and ten age- and sex-matched patients with early renal parenchymal disease (autosomal dominant polycystic kidney disease). All subjects underwent a comprehensive kidney MRI protocol, including qualitative imaging: T1w, T2w, FIESTA, and quantitative imaging: 2D cine phase contrast of the renal arteries, and parenchymal diffusion weighted imaging (DWI), magnetization transfer imaging (MTI), blood oxygen level dependent (BOLD) imaging, and magnetic resonance elastography (MRE). The normal controls were imaged on two separate occasions ≥24 h apart (range 24-210 h) to assess reproducibility of the measurements. RESULTS Quantitative MR imaging sequences were found to be reproducible. The mean ± SD absolute percent difference between quantitative parameters measured ≥24 h apart were: MTI-derived ratio = 4.5 ± 3.6%, DWI-derived apparent diffusion coefficient (ADC) = 6.5 ± 3.4%, BOLD-derived R2* = 7.4 ± 5.9%, and MRE-derived tissue stiffness = 7.6 ± 3.3%. Compared with controls, the ADPKD patient's non-cystic renal parenchyma (NCRP) had statistically significant differences with regard to quantitative parenchymal measures: lower MTI percent ratios (16.3 ± 4.4 vs. 23.8 ± 1.2, p < 0.05), higher ADCs (2.46 ± 0.20 vs. 2.18 ± 0.10 × 10-3 mm2/s, p < 0.05), lower R2*s (14.9 ± 1.7 vs. 18.1 ± 1.6 s-1, p < 0.05), and lower tissue stiffness (3.2 ± 0.3 vs. 3.8 ± 0.5 kPa, p < 0.05). CONCLUSION Excellent reproducibility of the quantitative measurements was obtained in all cases. Significantly different quantitative MR parenchymal measurement parameters between ADPKD patients and normal controls were obtained by MT, DWI, BOLD, and MRE indicating the potential for detecting and following renal disease at an earlier stage than the conventional qualitative imaging techniques.
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Affiliation(s)
- Timothy L Kline
- Department of Radiology, Mayo Clinic College of Medicine, 200 First St SW, Rochester, 55905, MN, USA.
| | - Marie E Edwards
- Division of Nephrology and Hypertension, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Ishan Garg
- Department of Radiology, Mayo Clinic College of Medicine, 200 First St SW, Rochester, 55905, MN, USA
| | - Maria V Irazabal
- Division of Nephrology and Hypertension, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Panagiotis Korfiatis
- Department of Radiology, Mayo Clinic College of Medicine, 200 First St SW, Rochester, 55905, MN, USA
| | - Peter C Harris
- Division of Nephrology and Hypertension, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Bernard F King
- Department of Radiology, Mayo Clinic College of Medicine, 200 First St SW, Rochester, 55905, MN, USA
| | - Vicente E Torres
- Division of Nephrology and Hypertension, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Sudhakar K Venkatesh
- Department of Radiology, Mayo Clinic College of Medicine, 200 First St SW, Rochester, 55905, MN, USA
| | - Bradley J Erickson
- Department of Radiology, Mayo Clinic College of Medicine, 200 First St SW, Rochester, 55905, MN, USA
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Zun Z, Limperopoulos C. Placental perfusion imaging using velocity-selective arterial spin labeling. Magn Reson Med 2018; 80:1036-1047. [PMID: 29436733 DOI: 10.1002/mrm.27100] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 12/30/2017] [Accepted: 01/02/2018] [Indexed: 11/10/2022]
Affiliation(s)
- Zungho Zun
- Division of Diagnostic Imaging and Radiology, Children's National Medical Center, Washington, DC.,Division of Fetal and Transitional Medicine, Children's National Medical Center, Washington, DC.,Department of Pediatrics, School of Medicine and Health Sciences, George Washington University, Washington, DC.,Department of Radiology, School of Medicine and Health Sciences, George Washington University, Washington, DC
| | - Catherine Limperopoulos
- Division of Diagnostic Imaging and Radiology, Children's National Medical Center, Washington, DC.,Division of Fetal and Transitional Medicine, Children's National Medical Center, Washington, DC.,Department of Pediatrics, School of Medicine and Health Sciences, George Washington University, Washington, DC.,Department of Radiology, School of Medicine and Health Sciences, George Washington University, Washington, DC
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Bafaraj SM. Value of Magnetic Resonance Urography Versus Computerized Tomography Urography (CTU) in Evaluation of Obstructive Uropathy: An Observational Study. Curr Med Imaging 2018; 14:129-134. [PMID: 29399012 PMCID: PMC5759170 DOI: 10.2174/1573405613666171020110522] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Revised: 10/10/2017] [Accepted: 10/17/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND Obstructive uropathy is a common public health issue that requires imaging research for providing necessary information. The data is important for determining treatment options, and may influence selective management choices. OBJECTIVE The aim of the study is to determine whether magnetic resonance urography or computerized tomography urography is the best imaging modality among patients with suspected obstructive uropathy. METHODS Seventy patients; referred from the emergency department for the evaluation of renal colic or hematuria that highly suggested urinary tract abnormalities, were prospectively enrolled. Thirty five women and 35 men were categorized with a mean age of 43.52 years and the mean body weight of 61.31 kg. All participants underwent abdominal ultrasonography and clinical examination to detect the causes of urinary obstruction. Pregnant women were excluded from the study. Both magnetic resonance urography and computerized tomography urography were performed within 30 days of each analysis. RESULTS Only 54.3% of the participants had urinary stones. Mean size of the renal stone was 11 mm; while mean size of the ureteral stone was 3.8 mm. The approach of magnetic resonance is not only limited to diagnosis, but is also effectively involved in the real time investigations. MRU has more reliability in terms of the diagnosis and anatomic presentation of the kidneys along with the vasculature. All cases of urinary stones were detected by computed tomography (100%); whereas, 78.9% cases were detected by magnetic resonance urography. CONCLUSION Computerized tomography urography is more sensitive in detecting kidney stones; whereas, magnetic resonance urography is better in detecting pathology behind the development of kidney stones.
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Affiliation(s)
- Saeed M. Bafaraj
- Department of Diagnostic Radiology, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
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43
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Imaging the kidney using magnetic resonance techniques: structure to function. Curr Opin Nephrol Hypertens 2018; 25:487-493. [PMID: 27636770 DOI: 10.1097/mnh.0000000000000266] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
PURPOSE OF REVIEW MRI can noninvasively assess the structure and function of the kidney in a single MRI scan session. This review summarizes recent advancements in functional renal MRI techniques, with a particular focus on clinical applications. RECENT FINDINGS A number of MRI techniques now provide measures of relevance to the pathophysiology of kidney disease. Diffusion-weighted imaging, used in chronic kidney disease and renal transplantation, shows promise as a measure of renal fibrosis. Longitudinal relaxation time (T1) mapping has been utilized in cardiac MRI to measure fibrosis and oedema; recent work shows its potential in the kidney. Blood oxygen-level-dependent MRI to measure renal oxygenation has been extensively studied, but a number of other factors affect results making it hard to draw definite conclusions as to its utility as an independent measure. Phase contrast and arterial spin labelling can measure renal artery blood flow and renal perfusion without exogenous contrast, as opposed to dynamic contrast-enhanced studies. In general, current data on clinical use of functional renal MRI are restricted to cross-sectional studies. SUMMARY Renal MRI has seen significant recent advances. Current evidence demonstrates its potential, and next steps include wider evaluation of its clinical application.
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Conlin CC, Huang Y, Gordon BAJ, Zhang JL. Quantitative characterization of glomerular fibrosis with magnetic resonance imaging: a feasibility study in a rat glomerulonephritis model. Am J Physiol Renal Physiol 2018; 314:F747-F752. [PMID: 29357425 DOI: 10.1152/ajprenal.00529.2017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Glomerular fibrosis occurs in the early stages of multiple renal diseases, including hypertensive and diabetic nephropathy. Conventional assessment of glomerular fibrosis relies on kidney biopsy, which is invasive and does not reflect physiological aspects such as blood perfusion. In this study, we sought to assess potential changes of cortical perfusion and microstructure at different degrees of glomerular fibrosis using magnetic resonance imaging (MRI). A rat model of glomerular fibrosis was induced by injecting anti-Thy-1 monoclonal antibody OX-7 to promote mesangial extracellular matrix proliferation. For six rats on day 5 and five rats on day 12 after the induction, we measured renal cortical perfusion and spin-spin relaxation time (T2) in a 3-Tesla MRI scanner. T2 reflects tissue microstructural changes. Glomerular fibrosis severity was evaluated by histological analysis and proteinuria. Four rats without fibrosis were included as controls. In the control rats, the periodic acid-Schiff (PAS)-positive area was 22 ± 1% of total glomerular tuft, which increased significantly to 56 ± 12% and 45 ± 10% in the day 5 and day 12 fibrotic groups, respectively ( P < 0.01). For the three groups (control, day 5, and day 12 after OX-7 injection), cortical perfusion was 7.27 ± 2.54, 3.78 ± 2.17, and 3.32 ± 2.62 ml·min-1·g-1, respectively, decreasing with fibrosis severity ( P < 0.01), and cortical T2 was 75.2 ± 4.6, 84.1 ± 3.0, and 87.9 ± 5.6 ms, respectively ( P < 0.01). In conclusion, extracellular matrix proliferation in glomerular mesangial cells severely diminished blood flow through the glomeruli and also altered cortical microstructure to increase cortical T2. The MRI-measured parameters are proven to be sensitive markers for characterizing glomerular fibrosis.
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Affiliation(s)
- Christopher C Conlin
- Department of Radiology and Imaging Sciences, University of Utah , Salt Lake City, Utah.,Department of Bioengineering, University of Utah , Salt Lake City, Utah
| | - Yufeng Huang
- Division of Nephrology, Department of Internal Medicine, University of Utah , Salt Lake City, Utah
| | | | - Jeff L Zhang
- Department of Radiology and Imaging Sciences, University of Utah , Salt Lake City, Utah.,Department of Bioengineering, University of Utah , Salt Lake City, Utah
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45
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Niles DJ, Gordon JW, Huang G, Reese S, Adamson EB, Djamali A, Fain SB. Evaluation of renal metabolic response to partial ureteral obstruction with hyperpolarized 13 C MRI. NMR IN BIOMEDICINE 2018; 31. [PMID: 29130537 PMCID: PMC5736002 DOI: 10.1002/nbm.3846] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 09/17/2017] [Accepted: 09/18/2017] [Indexed: 05/13/2023]
Abstract
Hyperpolarized 13 C magnetic resonance imaging (MRI) may be used to non-invasively image the transport and chemical conversion of 13 C-labeled compounds in vivo. In this study, we utilize hyperpolarized 13 C MRI to evaluate metabolic markers in the kidneys longitudinally in a mouse model of partial unilateral ureteral obstruction (pUUO). Partial obstruction was surgically induced in the left ureter of nine adult mice, leaving the right ureter as a control. 1 H and hyperpolarized [1-13 C]pyruvate MRI of the kidneys was performed 2 days prior to surgery (baseline) and at 3, 7 and 14 days post-surgery. Images were evaluated for changes in renal pelvis volume, pyruvate, lactate and the lactate to pyruvate ratio. After 14 days, mice were sacrificed and immunohistological staining of both kidneys for collagen fibrosis (picrosirius red) and macrophage infiltration (F4/80) was performed. Statistical analysis was performed using a linear mixed effects model. Significant kidney × time interaction effects were observed for both lactate and pyruvate, indicating that these markers changed differently between time points for the obstructed and unobstructed kidneys. Both kidneys showed an increase in the lactate to pyruvate ratio after obstruction, suggesting a shift towards glycolytic metabolism. These changes were accompanied by marked hydronephrosis, fibrosis and macrophage infiltration in the obstructed kidney, but not in the unobstructed kidney. Our results show that pUUO is associated with increased pyruvate to lactate metabolism in both kidneys, with injury and inflammation specific to the obstructed kidney. The work also demonstrates the feasibility of the use of hyperpolarized 13 C MRI to study metabolism in renal disease.
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Affiliation(s)
- David J Niles
- Medical Physics, University of Wisconsin-Madison, Madison, WI, USA
| | - Jeremy W Gordon
- Medical Physics, University of Wisconsin-Madison, Madison, WI, USA
| | - Gengwen Huang
- Surgery, University of Wisconsin-Madison, Madison, WI, USA
| | - Shannon Reese
- Medicine, Nephrology, University of Wisconsin-Madison, Madison, WI, USA
| | - Erin B Adamson
- Medical Physics, University of Wisconsin-Madison, Madison, WI, USA
| | - Arjang Djamali
- Medicine, Nephrology, University of Wisconsin-Madison, Madison, WI, USA
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Sean B Fain
- Medical Physics, University of Wisconsin-Madison, Madison, WI, USA
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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46
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Mariager CØ, Nielsen PM, Qi H, Ringgaard S, Laustsen C. Hyperpolarized 13
C,15
N2
-urea T2
relaxation changes in acute kidney injury. Magn Reson Med 2017; 80:696-702. [DOI: 10.1002/mrm.27050] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 11/29/2017] [Accepted: 11/29/2017] [Indexed: 01/18/2023]
Affiliation(s)
| | - Per Mose Nielsen
- MR Research Centre, Department of Clinical Medicine; Aarhus University; Aarhus Denmark
| | - Haiyun Qi
- MR Research Centre, Department of Clinical Medicine; Aarhus University; Aarhus Denmark
| | - Steffen Ringgaard
- MR Research Centre, Department of Clinical Medicine; Aarhus University; Aarhus Denmark
| | - Christoffer Laustsen
- MR Research Centre, Department of Clinical Medicine; Aarhus University; Aarhus Denmark
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47
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Pohlmann A, Cantow K, Huelnhagen T, Grosenick D, Dos Santos Periquito J, Boehmert L, Gladytz T, Waiczies S, Flemming B, Seeliger E, Niendorf T. Experimental MRI Monitoring of Renal Blood Volume Fraction Variations En Route to Renal Magnetic Resonance Oximetry. ACTA ACUST UNITED AC 2017; 3:188-200. [PMID: 30042981 PMCID: PMC6024389 DOI: 10.18383/j.tom.2017.00012] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Diagnosis of early-stage acute kidney injury (AKI) will benefit from a timely identification of local tissue hypoxia. Renal tissue hypoxia is an early feature in AKI pathophysiology, and renal oxygenation is increasingly being assessed through T2*-weighted magnetic resonance imaging (MRI). However, changes in renal blood volume fraction (BVf) confound renal T2*. The aim of this study was to assess the feasibility of intravascular contrast-enhanced MRI for monitoring renal BVf during physiological interventions that are concomitant with variations in BVf and to explore the possibility of correcting renal T2* for BVf variations. A dose-dependent study of the contrast agent ferumoxytol was performed in rats. BVf was monitored throughout short-term occlusion of the renal vein, which is known to markedly change renal blood partial pressure of O2 and BVf. BVf calculated from MRI measurements was used to estimate oxygen saturation of hemoglobin (SO2). BVf and SO2 were benchmarked against cortical data derived from near-infrared spectroscopy. As estimated from magnetic resonance parametric maps of T2 and T2*, BVf was shown to increase, whereas SO2 was shown to decline during venous occlusion (VO). This observation could be quantitatively reproduced in test–retest scenarios. Changes in BVf and SO2 were in good agreement with data obtained from near-infrared spectroscopy. Our findings provide motivation to advance multiparametric MRI for studying AKIs, with the ultimate goal of translating MRI-based renal BVf mapping into clinical practice en route noninvasive renal magnetic resonance oximetry as a method of assessing AKI and progression to chronic damage.
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Affiliation(s)
- Andreas Pohlmann
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin Ultrahigh Field Facility (B.U.F.F.), Berlin, Germany
| | - Kathleen Cantow
- Institute of Physiology and Center for Cardiovascular Research, Charité - Universitätsmedizin Berlin, Campus Charité Mitte, Berlin, Germany
| | - Till Huelnhagen
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin Ultrahigh Field Facility (B.U.F.F.), Berlin, Germany
| | - Dirk Grosenick
- Physikalisch-Technische-Bundesanstalt (PTB), Berlin, Germany
| | - Joāo Dos Santos Periquito
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin Ultrahigh Field Facility (B.U.F.F.), Berlin, Germany
| | - Laura Boehmert
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin Ultrahigh Field Facility (B.U.F.F.), Berlin, Germany
| | - Thomas Gladytz
- Physikalisch-Technische-Bundesanstalt (PTB), Berlin, Germany
| | - Sonia Waiczies
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin Ultrahigh Field Facility (B.U.F.F.), Berlin, Germany
| | - Bert Flemming
- Institute of Physiology and Center for Cardiovascular Research, Charité - Universitätsmedizin Berlin, Campus Charité Mitte, Berlin, Germany
| | - Erdmann Seeliger
- Institute of Physiology and Center for Cardiovascular Research, Charité - Universitätsmedizin Berlin, Campus Charité Mitte, Berlin, Germany
| | - Thoralf Niendorf
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin Ultrahigh Field Facility (B.U.F.F.), Berlin, Germany.,Experimental and Clinical Research Center, Charité Medical Faculty and the Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany; and.,Deutsches Zentrum für Herz- Kreislauf-Forschung (DZHK; German Centre for Cardiovascular Research), Berlin, Germany
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48
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Perkovic V, Agarwal R, Fioretto P, Hemmelgarn BR, Levin A, Thomas MC, Wanner C, Kasiske BL, Wheeler DC, Groop PH. Management of patients with diabetes and CKD: conclusions from a "Kidney Disease: Improving Global Outcomes" (KDIGO) Controversies Conference. Kidney Int 2017; 90:1175-1183. [PMID: 27884312 DOI: 10.1016/j.kint.2016.09.010] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 09/16/2016] [Accepted: 09/22/2016] [Indexed: 12/17/2022]
Abstract
The prevalence of diabetes around the world has reached epidemic proportions and is projected to increase to 642 million people by 2040. Diabetes is already the leading cause of end-stage kidney disease (ESKD) in most developed countries, and the growth in the number of people with ESKD around the world parallels the increase in diabetes. The presence of kidney disease is associated with a markedly elevated risk of cardiovascular disease and death in people with diabetes. Several new therapies and novel investigational agents targeting chronic kidney disease patients with diabetes are now under development. This conference was convened to assess our current state of knowledge regarding optimal glycemic control, current antidiabetic agents and their safety, and new therapies being developed to improve kidney function and cardiovascular outcomes for this vulnerable population.
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Affiliation(s)
- Vlado Perkovic
- George Institute for Global Health, University of Sydney, Sydney, NSW, Australia; Royal North Shore Hospital, Sydney, New South Wales, Australia.
| | - Rajiv Agarwal
- Department of Medicine, Indiana University School of Medicine and Richard L. Roudebush Veterans Administration Medical Center, Indianapolis, Indiana, USA
| | | | - Brenda R Hemmelgarn
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada; Interdisciplinary Chronic Disease Collaboration, Calgary, Alberta, Canada; Libin Cardiovascular Institute and Institute of Public Health, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Adeera Levin
- Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada; BC Provincial Renal Agency, Vancouver, British Columbia, Canada; Centre for Health Evaluation and Outcomes Research, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Merlin C Thomas
- Diabetic Complications Division, Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia; Department of Medicine, Monash University, Melbourne, Victoria, Australia
| | - Christoph Wanner
- Renal Division, University Hospital of Würzburg, Würzburg, Germany
| | - Bertram L Kasiske
- Division of Nephrology, Hennepin County Medical Center, Minneapolis, Minnesota, USA
| | | | - Per-Henrik Groop
- Diabetic Complications Division, Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia; Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland; Diabetes and Obesity Research Program, Research Programs Unit, University of Helsinki, Helsinki, Finland; Abdominal Center Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
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49
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Fibrosis imaging: Current concepts and future directions. Adv Drug Deliv Rev 2017; 121:9-26. [PMID: 29108860 DOI: 10.1016/j.addr.2017.10.013] [Citation(s) in RCA: 98] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 10/26/2017] [Accepted: 10/30/2017] [Indexed: 02/08/2023]
Abstract
Fibrosis plays an important role in many different pathologies. It results from tissue injury, chronic inflammation, autoimmune reactions and genetic alterations, and it is characterized by the excessive deposition of extracellular matrix components. Biopsies are routinely employed for fibrosis diagnosis, but they suffer from several drawbacks, including their invasive nature, sampling variability and limited spatial information. To overcome these limitations, multiple different imaging tools and technologies have been evaluated over the years, including X-ray imaging, computed tomography (CT), ultrasound (US), magnetic resonance imaging (MRI), positron emission tomography (PET) and single-photon emission computed tomography (SPECT). These modalities can provide anatomical, functional and molecular imaging information which is useful for fibrosis diagnosis and staging, and they may also hold potential for the longitudinal assessment of therapy responses. Here, we summarize the use of non-invasive imaging techniques for monitoring fibrosis in systemic autoimmune diseases, in parenchymal organs (such as liver, kidney, lung and heart), and in desmoplastic cancers. We also discuss how imaging biomarkers can be integrated in (pre-) clinical research to individualize and improve anti-fibrotic therapies.
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50
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Eikefjord E, Andersen E, Hodneland E, Hanson EA, Sourbron S, Svarstad E, Lundervold A, Rørvik JT. Dynamic contrast-enhanced MRI measurement of renal function in healthy participants. Acta Radiol 2017; 58:748-757. [PMID: 27694276 DOI: 10.1177/0284185116666417] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background High repeatability, accuracy, and precision for renal function measurements need to be achieved to establish renal dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) as a clinically useful diagnostic tool. Purpose To investigate the repeatability, accuracy, and precision of DCE-MRI measured renal perfusion and glomerular filtration rate (GFR) using iohexol-GFR as the reference method. Material and Methods Twenty healthy non-smoking volunteers underwent repeated DCE-MRI and an iohexol-GFR within a period of 10 days. Single-kidney (SK) MRI measurements of perfusion (blood flow, Fb) and filtration (GFR) were derived from parenchymal intensity time curves fitted to a two-compartment filtration model. The repeatability of the SK-MRI measurements was assessed using coefficient of variation (CV). Using iohexol-GFR as reference method, the accuracy of total MR-GFR was determined by mean difference (MD) and precision by limits of agreement (LoA). Results SK-Fb (MR1, 345 ± 84; MR2, 371 ± 103 mL/100 mL/min) and SK-GFR (MR1, 52 ± 14; MR2, 54 ± 10 mL/min/1.73 m2) measurements achieved a repeatability (CV) in the range of 15-22%. With reference to iohexol-GFR, MR-GFR was determined with a low mean difference but high LoA (MR1, MD 1.5 mL/min/1.73 m2, LoA [-42, 45]; MR2, MD 6.1 mL/min/1.73 m2, LoA [-26, 38]). Eighty percent and 90% of MR-GFR measurements were determined within ± 30% of the iohexol-GFR for MR1 and MR2, respectively. Conclusion Good repeatability of SK-MRI measurements and good agreement between MR-GFR and iohexol-GFR provide a high clinical potential of DCE-MRI for renal function assessment. A moderate precision in MR-derived estimates indicates that the method cannot yet be used in clinical routine.
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Affiliation(s)
- Eli Eikefjord
- Department of Radiology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Erling Andersen
- Department of Radiology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Engineering, Haukeland University Hospital, Bergen, Norway
| | - Erlend Hodneland
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Christian Michelsen Research (CMR) AS, Bergen, Norway
| | - Erik A Hanson
- Department of Mathematics, University of Bergen, Bergen, Norway
| | - Steven Sourbron
- Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Einar Svarstad
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Arvid Lundervold
- Department of Radiology, Haukeland University Hospital, Bergen, Norway
- Department of Biomedicine, University of Bergen, Bergen, Norway
| | - Jarle T Rørvik
- Department of Radiology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
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