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Álvarez MGM, Madhuranthakam AJ, Udayakumar D. Quantitative non-contrast perfusion MRI in the body using arterial spin labeling. MAGMA (NEW YORK, N.Y.) 2024:10.1007/s10334-024-01188-1. [PMID: 39105949 DOI: 10.1007/s10334-024-01188-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 05/10/2024] [Accepted: 07/02/2024] [Indexed: 08/07/2024]
Abstract
Arterial spin labeling (ASL) is a non-invasive magnetic resonance imaging (MRI) method that enables the assessment and the quantification of perfusion without the need for an exogenous contrast agent. ASL was originally developed in the early 1990s to measure cerebral blood flow. The utility of ASL has since then broadened to encompass various organ systems, offering insights into physiological and pathological states. In this review article, we present a synopsis of ASL for quantitative non-contrast perfusion MRI, as a contribution to the special issue titled "Quantitative MRI-how to make it work in the body?" The article begins with an introduction to ASL principles, followed by different labeling strategies, such as pulsed, continuous, pseudo-continuous, and velocity-selective approaches, and their role in perfusion quantification. We proceed to address the technical challenges associated with ASL in the body and outline some of the innovative approaches devised to surmount these issues. Subsequently, we summarize potential clinical applications, challenges, and state-of-the-art ASL methods to quantify perfusion in some of the highly perfused organs in the thorax (lungs), abdomen (kidneys, liver, pancreas), and pelvis (placenta) of the human body. The article concludes by discussing future directions for successful translation of quantitative ASL in body imaging.
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Affiliation(s)
| | - Ananth J Madhuranthakam
- Department of Radiology, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9061, USA
- Advanced Imaging Research Center, UT Southwestern Medical Center, Dallas, TX, USA
| | - Durga Udayakumar
- Department of Radiology, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9061, USA.
- Advanced Imaging Research Center, UT Southwestern Medical Center, Dallas, TX, USA.
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Tarchi SM, Salvatore M, Lichtenstein P, Sekar T, Capaccione K, Luk L, Shaish H, Makkar J, Desperito E, Leb J, Navot B, Goldstein J, Laifer S, Beylergil V, Ma H, Jambawalikar S, Aberle D, D'Souza B, Bentley-Hibbert S, Marin MP. Radiology of fibrosis part III: genitourinary system. J Transl Med 2024; 22:616. [PMID: 38961396 PMCID: PMC11223291 DOI: 10.1186/s12967-024-05333-1] [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: 02/12/2024] [Accepted: 05/20/2024] [Indexed: 07/05/2024] Open
Abstract
Fibrosis is a pathological process involving the abnormal deposition of connective tissue, resulting from improper tissue repair in response to sustained injury caused by hypoxia, infection, or physical damage. It can impact any organ, leading to their dysfunction and eventual failure. Additionally, tissue fibrosis plays an important role in carcinogenesis and the progression of cancer.Early and accurate diagnosis of organ fibrosis, coupled with regular surveillance, is essential for timely disease-modifying interventions, ultimately reducing mortality and enhancing quality of life. While extensive research has already been carried out on the topics of aberrant wound healing and fibrogenesis, we lack a thorough understanding of how their relationship reveals itself through modern imaging techniques.This paper focuses on fibrosis of the genito-urinary system, detailing relevant imaging technologies used for its detection and exploring future directions.
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Affiliation(s)
- Sofia Maria Tarchi
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.
- Department of Radiology, Columbia University Irving Medical Center, 630 W 168th Street, New York, NY, 10032, USA.
| | - Mary Salvatore
- Department of Radiology, Columbia University Irving Medical Center, 630 W 168th Street, New York, NY, 10032, USA
| | - Philip Lichtenstein
- Department of Radiology, Columbia University Irving Medical Center, 630 W 168th Street, New York, NY, 10032, USA
| | - Thillai Sekar
- Department of Radiology, Columbia University Irving Medical Center, 630 W 168th Street, New York, NY, 10032, USA
| | - Kathleen Capaccione
- Department of Radiology, Columbia University Irving Medical Center, 630 W 168th Street, New York, NY, 10032, USA
| | - Lyndon Luk
- Department of Radiology, Columbia University Irving Medical Center, 630 W 168th Street, New York, NY, 10032, USA
| | - Hiram Shaish
- Department of Radiology, Columbia University Irving Medical Center, 630 W 168th Street, New York, NY, 10032, USA
| | - Jasnit Makkar
- Department of Radiology, Columbia University Irving Medical Center, 630 W 168th Street, New York, NY, 10032, USA
| | - Elise Desperito
- Department of Radiology, Columbia University Irving Medical Center, 630 W 168th Street, New York, NY, 10032, USA
| | - Jay Leb
- Department of Radiology, Columbia University Irving Medical Center, 630 W 168th Street, New York, NY, 10032, USA
| | - Benjamin Navot
- Department of Radiology, Columbia University Irving Medical Center, 630 W 168th Street, New York, NY, 10032, USA
| | - Jonathan Goldstein
- Department of Radiology, Columbia University Irving Medical Center, 630 W 168th Street, New York, NY, 10032, USA
| | - Sherelle Laifer
- Department of Radiology, Columbia University Irving Medical Center, 630 W 168th Street, New York, NY, 10032, USA
| | - Volkan Beylergil
- Department of Radiology, Columbia University Irving Medical Center, 630 W 168th Street, New York, NY, 10032, USA
| | - Hong Ma
- Department of Radiology, Columbia University Irving Medical Center, 630 W 168th Street, New York, NY, 10032, USA
| | - Sachin Jambawalikar
- Department of Radiology, Columbia University Irving Medical Center, 630 W 168th Street, New York, NY, 10032, USA
| | - Dwight Aberle
- Department of Radiology, Columbia University Irving Medical Center, 630 W 168th Street, New York, NY, 10032, USA
| | - Belinda D'Souza
- Department of Radiology, Columbia University Irving Medical Center, 630 W 168th Street, New York, NY, 10032, USA
| | - Stuart Bentley-Hibbert
- Department of Radiology, Columbia University Irving Medical Center, 630 W 168th Street, New York, NY, 10032, USA
| | - Monica Pernia Marin
- Department of Radiology, Columbia University Irving Medical Center, 630 W 168th Street, New York, NY, 10032, USA
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Jaafar N, Alsop DC. Arterial Spin Labeling: Key Concepts and Progress Towards Use as a Clinical Tool. Magn Reson Med Sci 2024; 23:352-366. [PMID: 38880616 PMCID: PMC11234948 DOI: 10.2463/mrms.rev.2024-0013] [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: 02/06/2024] [Accepted: 05/15/2024] [Indexed: 06/18/2024] Open
Abstract
Arterial spin labeling (ASL), a non-invasive MRI technique, has emerged as a valuable tool for researchers that can measure blood flow and related parameters. This review aims to provide a qualitative overview of the technical principles and recent developments in ASL and to highlight its potential clinical applications. A growing literature demonstrates impressive ASL sensitivity to a range of neuropathologies and treatment responses. Despite its potential, challenges persist in the translation of ASL to widespread clinical use, including the lack of standardization and the limited availability of comprehensive training. As experience with ASL continues to grow, the final stage of translation will require moving beyond single site observational studies to multi-site experience and measurement of the added contribution of ASL to patient care and outcomes.
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Affiliation(s)
- Narjes Jaafar
- Department of Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - David C. Alsop
- Department of Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
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Hillaert A, Sanmiguel Serpa LC, Bogaert S, Broeckx BJG, Hesta M, Vandermeulen E, Germonpré J, Stock E, Pullens P, Vanderperren K. Assessment of pharmacologically induced changes in canine kidney function by multiparametric magnetic resonance imaging and contrast enhanced ultrasound. Front Vet Sci 2024; 11:1406343. [PMID: 38966564 PMCID: PMC11223176 DOI: 10.3389/fvets.2024.1406343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Accepted: 06/11/2024] [Indexed: 07/06/2024] Open
Abstract
IntroductionDynamic contrast-enhanced (DCE) MRI and arterial spin labeling (ASL) MRI enable non-invasive measurement of renal blood flow (RBF), whereas blood oxygenation level-dependent (BOLD) MRI enables non-invasive measurement of the apparent relaxation rate (R2*), an indicator of oxygenation. This study was conducted to evaluate the potential role of these MRI modalities in assessing RBF and oxygenation in dogs. The correlation between contrast-enhanced ultrasound (CEUS) and the MRI modalities was examined and also the ability of the MRI modalities to detect pharmacologically induced changes.MethodsRBF, using CEUS, ASL- and DCE-MRI, as well as renal oxygenation, using BOLD-MRI of eight adult beagles were assessed at two time-points, 2–3 weeks apart. During each time point, the anesthetized dogs received either a control (0.9% sodium chloride) or a dopamine treatment. For each time point, measurements were carried out over 2 days. An MRI scan at 3 T was performed on day one, followed by CEUS on day two.ResultsUsing the model-free model with caudal placement of the arterial input function (AIF) region of interest (ROI) in the aorta, the DCE results showed a significant correlation with ASL measured RBF and detected significant changes in blood flow during dopamine infusion. Additionally, R2* negatively correlated with ASL measured RBF at the cortex and medulla, as well as with medullary wash-in rate (WiR) and peak intensity (PI). ASL measured RBF, in its turn, showed a positive correlation with cortical WiR, PI, area under the curve (AUC) and fall time (FT), and with medullary WiR and PI, but a negative correlation with medullary rise time (RT). During dopamine infusion, BOLD-MRI observed a significant decrease in R2* at the medulla and entire kidney, while ASL-MRI demonstrated a significant increase in RBF at the cortex, medulla and the entire kidney.ConclusionASL- and BOLD-MRI can measure pharmacologically induced changes in renal blood flow and renal oxygenation in dogs and might allow detection of changes that cannot be observed with CEUS. However, further research is needed to confirm the potential of ASL- and BOLD-MRI in dogs and to clarify which analysis method is most suitable for DCE-MRI in dogs.
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Affiliation(s)
- Amber Hillaert
- Department of Morphology, Imaging, Orthopedics, Rehabilitation and Nutrition, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Luis Carlos Sanmiguel Serpa
- Department of Medical Imaging, Ghent University Hospital, Ghent, Belgium
- Ghent Institute for Functional and Metabolic Imaging, Ghent University, Ghent, Belgium
- Department of Diagnostic Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Stephanie Bogaert
- Department of Medical Imaging, Ghent University Hospital, Ghent, Belgium
- Ghent Institute for Functional and Metabolic Imaging, Ghent University, Ghent, Belgium
| | - Bart J. G. Broeckx
- Department of Veterinary and Biosciences, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Myriam Hesta
- Department of Morphology, Imaging, Orthopedics, Rehabilitation and Nutrition, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Eva Vandermeulen
- Department of Morphology, Imaging, Orthopedics, Rehabilitation and Nutrition, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Jolien Germonpré
- Department of Morphology, Imaging, Orthopedics, Rehabilitation and Nutrition, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Emmelie Stock
- Department of Morphology, Imaging, Orthopedics, Rehabilitation and Nutrition, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Pim Pullens
- Department of Medical Imaging, Ghent University Hospital, Ghent, Belgium
- Ghent Institute for Functional and Metabolic Imaging, Ghent University, Ghent, Belgium
- Institute of Biomedical Engineering and Technology, Faculty of Engineering and Architecture, Ghent University, Ghent, Belgium
| | - Katrien Vanderperren
- Department of Morphology, Imaging, Orthopedics, Rehabilitation and Nutrition, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
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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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Tong X, He H, Ning Z, Shen R, Du C, Zeng X, Wang Q, He ZX, Xu D, Zhao X. Characterization of kidneys in patients with systemic sclerosis by multi-parametric magnetic resonance quantitative imaging. Magn Reson Imaging 2024; 109:203-210. [PMID: 38513788 DOI: 10.1016/j.mri.2024.03.025] [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: 10/12/2023] [Revised: 03/09/2024] [Accepted: 03/18/2024] [Indexed: 03/23/2024]
Abstract
PURPOSE To determine the usefulness of multiparametric magnetic resonance (MR) quantitative imaging in characterizing the kidneys in systemic sclerosis (SSc) patients. MATERIAL AND METHODS Forty-six SSc patients (47.9 ± 12.8 years, 40 females) and 22 age- and sex- matched healthy volunteers (46.1 ± 13.8 years, 20 females) were recruited and underwent renal MR imaging by acquiring blood oxygen level dependent and saturated multi-delay renal arterial spin labeling (SAMURAI) sequences. The T2* value, T1 value, renal blood flow (RBF), arterial bolus arrival time (aBAT), and tissue bolus arrival time (tBAT) of renal cortex were measured and compared among diffuse cutaneous SSc (dcSSc) and limited cutaneous SSc (lcSSc) groups and healthy controls using One-way ANOVA and analyzed by logistic regression. RESULTS Compared to healthy volunteers, SSc patients with normal estimated glomerular filtration rate (n = 40) had significantly lower T2* value (P = 0.026) in the left renal cortex, longer T1 value (right: P = 0.015; left: P = 0.023), lower RBF (right: P < 0.001; left: P < 0.001), and shorter tBAT (right: P < 0.001; left: P = 0.005) in both right and left renal cortex after adjusting for demographics. The dcSSc patients (n = 23) had significantly lower RBF in both right (226.7 ± 65.2 mL/100 g/min vs. 278.2 ± 73.5 mL/100 g/min, P = 0.022) and left (194.5 ± 71.5 mL/100 g/min vs. 252.7 ± 84.4 mL/100 g/min, P = 0.020) renal cortex compared to the lcSSc patients (n = 23) after adjusting for demographics, but the significance of the difference was attenuated after further adjusting for modified Rodnan skin score and digital ulcers. CONCLUSION Multi-parametric MR quantitative imaging, particularly multi-delay ASL perfusion imaging, is a useful technique for characterizing the kidneys and classification of SSc patients.
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Affiliation(s)
- Xinyu Tong
- Department of Nuclear Medicine, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Huilin He
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Key Laboratory of Rheumatology & Clinical Immunology, Ministry of Education, Beijing, China
| | - Zihan Ning
- Center for Biomedical Imaging Research, School of Biomedical Engineering, Tsinghua University, Beijing, China
| | - Rui Shen
- Center for Biomedical Imaging Research, School of Biomedical Engineering, Tsinghua University, Beijing, China
| | - Chenlin Du
- Center for Biomedical Imaging Research, School of Biomedical Engineering, Tsinghua University, Beijing, China
| | - Xiaofeng Zeng
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Key Laboratory of Rheumatology & Clinical Immunology, Ministry of Education, Beijing, China
| | - Qian Wang
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Key Laboratory of Rheumatology & Clinical Immunology, Ministry of Education, Beijing, China
| | - Zuo-Xiang He
- Department of Nuclear Medicine, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China.
| | - Dong Xu
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Key Laboratory of Rheumatology & Clinical Immunology, Ministry of Education, Beijing, China.
| | - Xihai Zhao
- Center for Biomedical Imaging Research, School of Biomedical Engineering, Tsinghua University, Beijing, China.
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Wang W, Yu Y, Li X, Chen J, Zhang L, Wen J. Significance of Arterial Spin Labeling for Reducing Biopsies in Patients With Kidney Allograft Dysfunction. J Magn Reson Imaging 2024; 59:1777-1784. [PMID: 37515309 DOI: 10.1002/jmri.28926] [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: 05/16/2023] [Revised: 07/15/2023] [Accepted: 07/17/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Although biopsy is often entailed for managing patients with kidney allograft dysfunction, it is associated with potential complications of severe hemorrhage. Arterial spin labeling (ASL) is a non-invasive technique that assesses tissue perfusion. PURPOSE To assess the utility of ASL for the discrimination of patients with post-transplant allograft dysfunction who do not need biopsy from those who need. STUDY TYPE Prospective. SUBJECTS Forty-six patients (34 males/12 females, aged 38.8 ± 9.5 years) with kidney allograft dysfunction, including 31 in which biopsy directly lead to changes in management (NECESSARY group) and 15 in which clinical management did not alter after biopsy (UNNECESSARY group). FIELD STRENGTH/SEQUENCE 3.0 T and 3D fast-spin echo sequence. ASSESSMENT All patients underwent both ASL scan and biopsies. The serum creatinine, proteinuria, pathologic results, and cortical ASL readings were obtained and compared between the two groups. STATISTICAL ANALYSES Chi-square test, independent student t-test, Mann-Whitney U test, receiver-operating characteristic curve. A two-tailed P < 0.05 denoted statistical significance. RESULTS The NECESSARY group presented with significantly elevated serum creatinine as compared with the UNNECESSARY group (1.87 ± 0.56 mg/dL vs. 1.31 ± 0.37 mg/dL). The acute composite score was significantly higher in the NECESSARY group than that in the UNNECESSARY group (7 [4-8] vs. 1 [0-2]). Cortical ASL in the NECESSARY group was significantly decreased as compared with the UNNECESSARY group (108.06 [69.96-134.92] mL/min/100 g vs. 153.48 [113.19-160.37] mL/min/100 g). Serum creatinine differentiated UNNCESSARY group from the NECESSARY group with an area under the curve (AUC) and specificity of 0.79 and 54.84%, respectively. By comparison, the cortical ASL yielded an AUC of 0.75 and a specificity of 70.97%. Notably, the specificity was increased to 90.30% by combined use of serum creatinine and cortical ASL. DATA CONCLUSION The combined use of ASL and serum creatinine yielded a high specificity for selecting patients who may not need allograft biopsy. LEVEL OF EVIDENCE 2 TECHNICAL EFFICACY: Stage 3.
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Affiliation(s)
- Wei Wang
- National Clinical Research Center of Kidney Disease, Jinling Hospital, Nanjing Medical University, Nanjing, China
- Department of Nephrology, Shanghai Tenth People's Hospital, Shanghai, China
| | - Yuanmeng Yu
- Department of Medical Imaging, Jinling Hospital, Clinical School of Southern University, Nanjing, China
- Department of MRI, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Xue Li
- National Clinical Research Center of Kidney Disease, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Jinsong Chen
- National Clinical Research Center of Kidney Disease, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Longjiang Zhang
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Jiqiu Wen
- National Clinical Research Center of Kidney Disease, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
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Zhao K, Seeliger E, Niendorf T, Liu Z. Noninvasive Assessment of Diabetic Kidney Disease With MRI: Hype or Hope? J Magn Reson Imaging 2024; 59:1494-1513. [PMID: 37675919 DOI: 10.1002/jmri.29000] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 08/22/2023] [Accepted: 08/23/2023] [Indexed: 09/08/2023] Open
Abstract
Owing to the increasing prevalence of diabetic mellitus, diabetic kidney disease (DKD) is presently the leading cause of chronic kidney disease and end-stage renal disease worldwide. Early identification and disease interception is of paramount clinical importance for DKD management. However, current diagnostic, disease monitoring and prognostic tools are not satisfactory, due to their low sensitivity, low specificity, or invasiveness. Magnetic resonance imaging (MRI) is noninvasive and offers a host of contrast mechanisms that are sensitive to pathophysiological changes and risk factors associated with DKD. MRI tissue characterization involves structural and functional information including renal morphology (kidney volume (TKV) and parenchyma thickness using T1- or T2-weighted MRI), renal microstructure (diffusion weighted imaging, DWI), renal tissue oxygenation (blood oxygenation level dependent MRI, BOLD), renal hemodynamics (arterial spin labeling and phase contrast MRI), fibrosis (DWI) and abdominal or perirenal fat fraction (Dixon MRI). Recent (pre)clinical studies demonstrated the feasibility and potential value of DKD evaluation with MRI. Recognizing this opportunity, this review outlines key concepts and current trends in renal MRI technology for furthering our understanding of the mechanisms underlying DKD and for supplementing clinical decision-making in DKD. Progress in preclinical MRI of DKD is surveyed, and challenges for clinical translation of renal MRI are discussed. Future directions of DKD assessment and renal tissue characterization with (multi)parametric MRI are explored. Opportunities for discovery and clinical break-through are discussed including biological validation of the MRI findings, large-scale population studies, standardization of DKD protocols, the synergistic connection with data science to advance comprehensive texture analysis, and the development of smart and automatic data analysis and data visualization tools to further the concepts of virtual biopsy and personalized DKD precision medicine. We hope that this review will convey this vision and inspire the reader to become pioneers in noninvasive assessment and management of DKD with MRI. LEVEL OF EVIDENCE: 1 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Kaixuan Zhao
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image Analysis and Application, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Erdmann Seeliger
- Institute of Translational Physiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Thoralf Niendorf
- Berlin Ultrahigh Field Facility (B.U.F.F.), Max Delbrueck Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany
| | - Zaiyi Liu
- Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image Analysis and Application, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
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Trujillo J, Alotaibi M, Seif N, Cai X, Larive B, Gassman J, Raphael KL, Cheung AK, Raj DS, Fried LF, Sprague SM, Block G, Chonchol M, Middleton JP, Wolf M, Ix JH, Prasad P, Isakova T, Srivastava A. Associations of Kidney Functional Magnetic Resonance Imaging Biomarkers with Markers of Inflammation in Individuals with CKD. KIDNEY360 2024; 5:681-689. [PMID: 38570905 PMCID: PMC11146641 DOI: 10.34067/kid.0000000000000437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 03/28/2024] [Indexed: 04/05/2024]
Abstract
Key Points Lower baseline apparent diffusion coefficient, indicative of greater cortical fibrosis, correlated with higher baseline concentrations of serum markers of inflammation. No association between baseline cortical R2* and baseline serum markers of inflammation were found. Baseline kidney functional magnetic resonance imaging biomarkers of fibrosis and oxygenation were not associated with changes in inflammatory markers over time, which may be due to small changes in kidney function in the study. Background Greater fibrosis and decreased oxygenation may amplify systemic inflammation, but data on the associations of kidney functional magnetic resonance imaging (fMRI) measurements of fibrosis (apparent diffusion coefficient [ADC]) and oxygenation (relaxation rate [R2*]) with systemic markers of inflammation are limited. Methods We evaluated associations of baseline kidney fMRI-derived ADC and R2* with baseline and follow-up serum IL-6 and C-reactive protein (CRP) in 127 participants from the CKD Optimal Management with Binders and NicotinamidE trial, a randomized, 12-month trial of nicotinamide and lanthanum carbonate versus placebo in individuals with CKD stages 3–4. Cross-sectional analyses of baseline kidney fMRI biomarkers and markers of inflammation used multivariable linear regression. Longitudinal analyses of baseline kidney fMRI biomarkers and change in markers of inflammation over time used linear mixed-effects models. Results Mean±SD eGFR, ADC, and R2* were 32.2±8.7 ml/min per 1.73 m2, 1.46±0.17×10−3 mm2/s, and 20.3±3.1 s−1, respectively. Median (interquartile range) IL-6 and CRP were 3.7 (2.4–4.9) pg/ml and 2.8 (1.2–6.3) mg/L, respectively. After multivariable adjustment, IL-6 and CRP were 13.1% and 27.3% higher per 1 SD decrease in baseline cortical ADC, respectively. Baseline cortical R2* did not have a significant association with IL-6 or CRP. Mean annual IL-6 and CRP slopes were 0.98 pg/ml per year and 0.91 mg/L per year, respectively. Baseline cortical ADC and R2* did not have significant associations with change in IL-6 or CRP over time. Conclusions Lower cortical ADC, suggestive of greater fibrosis, was associated with higher systemic inflammation. Baseline kidney fMRI biomarkers did not associate with changes in systemic markers of inflammation over time.
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Affiliation(s)
- Jacquelyn Trujillo
- The Graduate School, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Manal Alotaibi
- Division of Nephrology and Hypertension, Center for Translational Metabolism and Health, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Department of Medicine, College of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Nay Seif
- Division of Nephrology and Hypertension, Center for Translational Metabolism and Health, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Renal Electrolyte and Hypertension Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Xuan Cai
- Division of Nephrology and Hypertension, Center for Translational Metabolism and Health, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Brett Larive
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | - Jennifer Gassman
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | - Kalani L. Raphael
- Division of Nephrology and Hypertension, University of Utah Health, Salt Lake City, Utah
| | - Alfred K. Cheung
- Division of Nephrology and Hypertension, University of Utah Health, Salt Lake City, Utah
| | - Dominic S. Raj
- Division of Renal Diseases and Hypertension, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Linda F. Fried
- Division of Renal-Electrolyte, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Stuart M. Sprague
- Department of Medicine, NorthShore University HealthSystem, Evanston, Illinois
| | | | - Michel Chonchol
- Division of Renal Diseases and Hypertension, Department of Medicine, University of Colorado Denver School of Medicine, Aurora, Colorado
| | - John Paul Middleton
- Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Myles Wolf
- Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Joachim H. Ix
- Renal Section, Department of Medicine, University of California San Diego School of Medicine, San Diego, California
| | - Pottumarthi Prasad
- Department of Radiology, NorthShore University HealthSystem, Evanston, Illinois
| | - Tamara Isakova
- Division of Nephrology and Hypertension, Center for Translational Metabolism and Health, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Anand Srivastava
- Division of Nephrology and Hypertension, Center for Translational Metabolism and Health, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Division of Nephrology, Department of Medicine, University of Illinois Chicago, Chicago, Illinois
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10
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Hamelink TL, Ogurlu B, Pamplona CC, Castelein J, Bennedsgaard SS, Qi H, Weiss T, Lantinga VA, Pool MBF, Laustsen C, Jespersen B, Leuvenink HGD, Ringgaard S, Borra RJH, Keller AK, Moers C. Magnetic resonance imaging as a noninvasive adjunct to conventional assessment of functional differences between kidneys in vivo and during ex vivo normothermic machine perfusion. Am J Transplant 2024:S1600-6135(24)00272-7. [PMID: 38615901 DOI: 10.1016/j.ajt.2024.04.001] [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: 02/27/2024] [Revised: 03/26/2024] [Accepted: 04/07/2024] [Indexed: 04/16/2024]
Abstract
Normothermic machine perfusion (NMP) is increasingly considered for pretransplant kidney quality assessment. However, fundamental questions about differences between in vivo and ex vivo renal function, as well as the impact of ischemic injury on ex vivo physiology, remain unanswered. This study utilized magnetic resonance imaging (MRI), alongside conventional parameters to explore differences between in vivo and ex vivo renal function and the impact of warm ischemia on a kidney's behavior ex vivo. Renal MRI scans and samples were obtained from living pigs (n = 30) in vivo. Next, kidney pairs were procured and exposed to minimal, or 75 minutes of warm ischemia, followed by 6 hours of hypothermic machine perfusion. Both kidneys simultaneously underwent 6-hour ex vivo perfusion in MRI-compatible NMP circuits to obtain multiparametric MRI data. Ischemically injured ex vivo kidneys showed a significantly altered regional blood flow distribution compared to in vivo and minimally damaged organs. Both ex vivo groups showed diffusion restriction relative to in vivo. Our findings underscore the differences between in vivo and ex vivo MRI-based renal characteristics. Therefore, when assessing organ viability during NMP, it should be considered to incorporate parameters beyond the conventional functional markers that are common in vivo.
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Affiliation(s)
- Tim L Hamelink
- Department of Surgery - Organ Donation and Transplantation, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
| | - Baran Ogurlu
- Department of Surgery - Organ Donation and Transplantation, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Carolina C Pamplona
- Department of Surgery - Organ Donation and Transplantation, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Johannes Castelein
- Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands; Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Haiyun Qi
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Thomas Weiss
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Veerle A Lantinga
- Department of Surgery - Organ Donation and Transplantation, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Merel B F Pool
- Department of Surgery - Organ Donation and Transplantation, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Christoffer Laustsen
- Department of Clinical Medicine, MR Research Centre, Aarhus University Hospital, Aarhus, Denmark
| | - Bente Jespersen
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Henri G D Leuvenink
- Department of Surgery - Organ Donation and Transplantation, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Steffen Ringgaard
- Department of Clinical Medicine, MR Research Centre, Aarhus University Hospital, Aarhus, Denmark
| | - Ronald J H Borra
- Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Anna K Keller
- Department of Urology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Cyril Moers
- Department of Surgery - Organ Donation and Transplantation, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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11
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Wang Y, Greer JS, Zhou L, Lin SQ, Hulsey KM, Udayakumar D, Madhuranthakam AJ. A 3D-printed phantom for quality-controlled reproducibility measurements of arterial spin labeled perfusion. Magn Reson Med 2024; 91:819-827. [PMID: 37815014 PMCID: PMC10841664 DOI: 10.1002/mrm.29886] [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: 04/06/2023] [Revised: 08/29/2023] [Accepted: 09/22/2023] [Indexed: 10/11/2023]
Abstract
PURPOSE To develop a portable MR perfusion phantom for quality-controlled assessment and reproducibility of arterial spin labeled (ASL) perfusion measurement. METHODS A 3D-printed perfusion phantom was developed that mimics the branching of arterial vessels, capillaries, and a chamber containing cellulose sponge representing tissue characteristics. A peristaltic pump circulated distilled water through the phantom, and was first evaluated at 300, 400, and 500 mL/min. Longitudinal reproducibility of perfusion was performed using 2D pseudo-continuous ASL at 20 post-label delays (PLDs, ranging between 0.2 and 7.8 s at 0.4-s intervals) over a period of 16 weeks, with three repetitions each week. Multi-PLD data were fitted into a general kinetic model for perfusion quantification (f) and arterial transit time (ATT). Intraclass correlation coefficient was used to assess intersession reproducibility. RESULTS MR perfusion signals acquired in the 3D-printed perfusion phantom agreed well with the experimental conditions, with progressively increasing signal intensities and decreasing ATT for pump flow rates from 300 to 500 mL/min. The perfusion signal at 400 mL/min and the general kinetic model-derived f and ATT maps were similar across all PLDs for both intrasession and intersession reproducibility. Across all 48 experimental time points, the average f was 75.55 ± 3.83 × 10-3 mL/mL/s, the corresponding ATT was 2.10 ± 0.20 s, and the T1 was 1.84 ± 0.102 s. Intraclass correlation coefficient was 0.92 (95% confidence interval 0.83-0.97) for f, 0.96 (0.91-0.99) for ATT, and 0.94 (0.88-0.98) for T1 , demonstrating excellent reproducibility. CONCLUSION A simple, portable 3D-printed perfusion phantom with excellent reproducibility of 2D pseudo-continuous ASL measurements was demonstrated that can serve for quality-controlled and reliable measurements of ASL perfusion.
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Affiliation(s)
- Yiming Wang
- Department of Radiology, UT Southwestern Medical Center, Dallas, Texas, USA
- Philips Healthcare, Shanghai, China
| | - Joshua S Greer
- Department of Radiology, UT Southwestern Medical Center, Dallas, Texas, USA
- Philips Healthcare, Cincinnati, Ohio, USA
| | - Limin Zhou
- Department of Radiology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Sheng-Qing Lin
- Department of Radiology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Keith M Hulsey
- Department of Radiology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Durga Udayakumar
- Department of Radiology, UT Southwestern Medical Center, Dallas, Texas, USA
- Advanced Imaging Research Center, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Ananth J Madhuranthakam
- Department of Radiology, UT Southwestern Medical Center, Dallas, Texas, USA
- Advanced Imaging Research Center, UT Southwestern Medical Center, Dallas, Texas, USA
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12
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Wu M, Zhang JL. MR Perfusion Imaging for Kidney Disease. Magn Reson Imaging Clin N Am 2024; 32:161-170. [PMID: 38007278 DOI: 10.1016/j.mric.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2023]
Abstract
Renal perfusion reflects overall function of a kidney. As an important indicator of kidney diseases, renal perfusion can be noninvasively measured by multiple methods of MR imaging, such as dynamic contrast-enhanced MR imaging, intravoxel incoherent motion analysis, and arterial spin labeling method. In this article we introduce the principle of the methods, review their recent technical improvements, and then focus on summarizing recent applications of the methods in assessing various renal diseases. By this review, we demonstrate the capability and clinical potential of the imaging methods, with the hope of accelerating their adoption to clinical practice.
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Affiliation(s)
- Mingyan Wu
- Central Research Institute, UIH Group, Shanghai, China; School of Biomedical Engineering Building, Room 409, 393 Huaxia Middle Road, Shanghai 201210, China
| | - Jeff L Zhang
- School of Biomedical Engineering, ShanghaiTech University, Room 409, School of Biomedical Engineering Building, 393 Huaxia Middle Road, Shanghai 201210, China.
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13
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Deshpande RS, Langham MC, Susztak K, Wehrli FW. MRI-based quantification of whole-organ renal metabolic rate of oxygen. NMR IN BIOMEDICINE 2024; 37:e5036. [PMID: 37750009 PMCID: PMC10841084 DOI: 10.1002/nbm.5036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 08/02/2023] [Accepted: 08/21/2023] [Indexed: 09/27/2023]
Abstract
During the early stages of diabetes, kidney oxygen utilization increases. The mismatch between oxygen demand and supply contributes to tissue hypoxia, a key driver of chronic kidney disease. Thus, whole-organ renal metabolic rate of oxygen (rMRO2 ) is a potentially valuable biomarker of kidney function. The key parameters required to determine rMRO2 include the renal blood flow rate (RBF) in the feeding artery and oxygen saturation in the draining renal vein (SvO2 ). However, there is currently no noninvasive method to quantify rMRO2 in absolute physiologic units. Here, a new MRI pulse sequence, Kidney Metabolism of Oxygen via T2 and Interleaved Velocity Encoding (K-MOTIVE), is described, along with evaluation of its performance in the human kidney in vivo. K-MOTIVE interleaves a phase-contrast module before a background-suppressed T2 -prepared balanced steady-state-free-precession (bSSFP) readout to measure RBF and SvO2 in a single breath-hold period of 22 s, yielding rMRO2 via Fick's principle. Variants of K-MOTIVE to evaluate alternative bSSFP readout strategies were studied. Kidney mass was manually determined from multislice gradient recalled echo images. Healthy subjects were recruited to quantify rMRO2 of the left kidney at 3-T field strength (N = 15). Assessments of repeat reproducibility and comparisons with individual measurements of RBF and SvO2 were performed, and the method's sensitivity was evaluated with a high-protein meal challenge (N = 8). K-MOTIVE yielded the following metabolic parameters: T2 = 157 ± 19 ms; SvO2 = 92% ± 6%; RBF = 400 ± 110 mL/min; and rMRO2 = 114 ± 117(μmol O2 /min)/100 g tissue. Reproducibility studies of T2 and RBF (parameters directly measured by K-MOTIVE) resulted in coefficients of variation less than 10% and intraclass correlation coefficients more than 0.75. The high-protein meal elicited an increase in rMRO2 , which was corroborated by serum biomarkers. The K-MOTIVE sequence measures SvO2 and RBF, the parameters necessary to quantify whole-organ rMRO2 , in a single breath-hold. The present work demonstrates that rMRO2 quantification is feasible with good reproducibility. rMRO2 is a potentially valuable physiological biomarker.
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Affiliation(s)
- Rajiv S. Deshpande
- Laboratory for Structural Physiologic and Functional Imaging, Department of Radiology, Perelman School of Medicine, University of Pennsylvania, PA, USA
| | - Michael C. Langham
- Laboratory for Structural Physiologic and Functional Imaging, Department of Radiology, Perelman School of Medicine, University of Pennsylvania, PA, USA
| | - Katalin Susztak
- Department of Nephrology and Hypertension, Perelman School of Medicine, University of Pennsylvania, PA, USA
- Department of Medicine and Genetics, Perelman School of Medicine, University of Pennsylvania, PA, USA
| | - Felix W. Wehrli
- Laboratory for Structural Physiologic and Functional Imaging, Department of Radiology, Perelman School of Medicine, University of Pennsylvania, PA, USA
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14
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Bane O, Seeliger E, Cox E, Stabinska J, Bechler E, Lewis S, Hickson LJ, Francis S, Sigmund E, Niendorf T. Renal MRI: From Nephron to NMR Signal. J Magn Reson Imaging 2023; 58:1660-1679. [PMID: 37243378 PMCID: PMC11025392 DOI: 10.1002/jmri.28828] [Citation(s) in RCA: 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: 02/03/2023] [Revised: 05/11/2023] [Accepted: 05/12/2023] [Indexed: 05/28/2023] Open
Abstract
Renal diseases pose a significant socio-economic burden on healthcare systems. The development of better diagnostics and prognostics is well-recognized as a key strategy to resolve these challenges. Central to these developments are MRI biomarkers, due to their potential for monitoring of early pathophysiological changes, renal disease progression or treatment effects. The surge in renal MRI involves major cross-domain initiatives, large clinical studies, and educational programs. In parallel with these translational efforts, the need for greater (patho)physiological specificity remains, to enable engagement with clinical nephrologists and increase the associated health impact. The ISMRM 2022 Member Initiated Symposium (MIS) on renal MRI spotlighted this issue with the goal of inspiring more solutions from the ISMRM community. This work is a summary of the MIS presentations devoted to: 1) educating imaging scientists and clinicians on renal (patho)physiology and demands from clinical nephrologists, 2) elucidating the connection of MRI parameters with renal physiology, 3) presenting the current state of leading MR surrogates in assessing renal structure and functions as well as their next generation of innovation, and 4) describing the potential of these imaging markers for providing clinically meaningful renal characterization to guide or supplement clinical decision making. We hope to continue momentum of recent years and introduce new entrants to the development process, connecting (patho)physiology with (bio)physics, and conceiving new clinical applications. We envision this process to benefit from cross-disciplinary collaboration and analogous efforts in other body organs, but also to maximally leverage the unique opportunities of renal physiology. LEVEL OF EVIDENCE: 1 TECHNICAL EFFICACY STAGE: 2.
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Affiliation(s)
- Octavia Bane
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
- Icahn School of Medicine at Mount Sinai, BioMedical Engineering and Imaging Institute, New York City, New York, USA
| | - Erdmann Seeliger
- Institute of Translational Physiology, Charité-University Medicine Berlin, Berlin, Germany
| | - Eleanor Cox
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, UK
| | - Julia Stabinska
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Maryland, USA
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Eric Bechler
- Department of Diagnostic and Interventional Radiology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Sara Lewis
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - LaTonya J Hickson
- Division of Nephrology and Hypertension, Mayo Clinic, Jacksonville, Florida, USA
| | - Sue Francis
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, UK
| | - Eric Sigmund
- Bernard and Irene Schwartz Center for Biomedical Imaging Center for Advanced Imaging Innovation and Research (CAI2R), New York University Langone Health, New York City, New York, USA
| | - Thoralf Niendorf
- Berlin Ultrahigh Field Facility (B.U.F.F.), Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany
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15
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Greer JS, Wang Y, Udayakumar D, Hussain T, Madhuranthakam AJ. On the application of pseudo-continuous arterial spin labeled MRI for pulmonary perfusion imaging. Magn Reson Imaging 2023; 104:80-87. [PMID: 37769882 DOI: 10.1016/j.mri.2023.09.009] [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: 06/14/2023] [Revised: 08/21/2023] [Accepted: 09/25/2023] [Indexed: 10/03/2023]
Abstract
PURPOSE To evaluate different approaches for the effective assessment of pulmonary perfusion with a pseudo-continuous arterial spin labeled (pCASL) MRI. MATERIALS AND METHODS Four different approaches were evaluated: 1) Cardiac-triggered inferior vena cava (IVC) labeling; 2) IVC labeling with cardiac-triggered acquisition; 3) Right pulmonary artery (RPA) labeling with cardiac-triggered acquisition; and 4) Cardiac-triggered RPA labeling with background suppression (BGS). Each approach was evaluated in 5 healthy volunteers (n = 20) using coefficient of variation (COV) across averages. Approach 4 was also compared against a flow alternating inversion recovery (FAIR). RESULTS The IVC labeling (Approach 1) achieved perfusion-weighted images of both lungs, although this approach was more sensitive to variations in heart rate. Cardiac-triggered acquisitions using IVC (Approach 2) and RPA (Approach 3) labeling improved signal consistencies, but were incompatible with BGS. The cardiac-triggered RPA labeling with BGS (Approach 4) achieved a COV of 0.34 ± 0.03 (p < 0.05 compared to IVC labeling approaches) and resulted in perfusion value of 434 ± 64 mL/100 g/min, which was comparable to 451 ± 181 mL/100 g/min measured by FAIR (p = 0.82). DISCUSSION Pulmonary perfusion imaging using pCASL-MRI is highly sensitive to cardiac phase, and requires approaches to minimize flow-induced signal variations. Cardiac-triggered RPA labeling with BGS achieves reduced COV and enables robust pulmonary perfusion imaging.
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Affiliation(s)
- Joshua S Greer
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX, USA; Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX, USA
| | - Yiming Wang
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Durga Udayakumar
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX, USA; Advanced Imaging Research Center, UT Southwestern Medical Center, Dallas, TX, USA
| | - Tarique Hussain
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX, USA; Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX, USA
| | - Ananth J Madhuranthakam
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX, USA; Advanced Imaging Research Center, UT Southwestern Medical Center, Dallas, TX, USA.
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16
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Päivärinta J, Anastasiou IA, Koivuviita N, Sharma K, Nuutila P, Ferrannini E, Solini A, Rebelos E. Renal Perfusion, Oxygenation and Metabolism: The Role of Imaging. J Clin Med 2023; 12:5141. [PMID: 37568543 PMCID: PMC10420088 DOI: 10.3390/jcm12155141] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 08/02/2023] [Accepted: 08/03/2023] [Indexed: 08/13/2023] Open
Abstract
Thanks to technical advances in the field of medical imaging, it is now possible to study key features of renal anatomy and physiology, but so far poorly explored due to the inherent difficulties in studying both the metabolism and vasculature of the human kidney. In this narrative review, we provide an overview of recent research findings on renal perfusion, oxygenation, and substrate uptake. Most studies evaluating renal perfusion with positron emission tomography (PET) have been performed in healthy controls, and specific target populations like obese individuals or patients with renovascular disease and chronic kidney disease (CKD) have rarely been assessed. Functional magnetic resonance (fMRI) has also been used to study renal perfusion in CKD patients, and recent studies have addressed the kidney hemodynamic effects of therapeutic agents such as glucagon-like receptor agonists (GLP-1RA) and sodium-glucose co-transporter 2 inhibitors (SGLT2-i) in an attempt to characterise the mechanisms leading to their nephroprotective effects. The few available studies on renal substrate uptake are discussed. In the near future, these imaging modalities will hopefully become widely available with researchers more acquainted with them, gaining insights into the complex renal pathophysiology in acute and chronic diseases.
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Affiliation(s)
- Johanna Päivärinta
- Department of Medicine, Division of Nephrology, Turku University Hospital, 20521 Turku, Finland; (J.P.); (N.K.)
| | - Ioanna A. Anastasiou
- 1st Department of Propaedeutic and Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, 11527 Athens, Greece;
| | - Niina Koivuviita
- Department of Medicine, Division of Nephrology, Turku University Hospital, 20521 Turku, Finland; (J.P.); (N.K.)
| | - Kanishka Sharma
- Department of Imaging, Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield S10 2TN, UK;
| | - Pirjo Nuutila
- Turku PET Centre, 20521 Turku, Finland;
- Department of Endocrinology, Turku University Hospital, 20521 Turku, Finland
| | - Ele Ferrannini
- CNR, Institute of Clinical Physiology, 56124 Pisa, Italy;
| | - Anna Solini
- Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa, 56124 Pisa, Italy;
| | - Eleni Rebelos
- Turku PET Centre, 20521 Turku, Finland;
- Department of Clinical and Experimental Medicine, University of Pisa, 56124 Pisa, Italy
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17
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Caroli A, Kline TL. Abdominal Imaging in ADPKD: Beyond Total Kidney Volume. J Clin Med 2023; 12:5133. [PMID: 37568535 PMCID: PMC10420262 DOI: 10.3390/jcm12155133] [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: 05/26/2023] [Revised: 08/02/2023] [Accepted: 08/03/2023] [Indexed: 08/13/2023] Open
Abstract
In the context of autosomal dominant polycystic kidney disease (ADPKD), measurement of the total kidney volume (TKV) is crucial. It acts as a marker for tracking disease progression, and evaluating the effectiveness of treatment strategies. The TKV has also been recognized as an enrichment biomarker and a possible surrogate endpoint in clinical trials. Several imaging modalities and methods are available to calculate the TKV, and the choice depends on the purpose of use. Technological advancements have made it possible to accurately assess the cyst burden, which can be crucial to assessing the disease state and helping to identify rapid progressors. Moreover, the development of automated algorithms has increased the efficiency of total kidney and cyst volume measurements. Beyond these measurements, the quantification and characterization of non-cystic kidney tissue shows potential for stratifying ADPKD patients early on, monitoring disease progression, and possibly predicting renal function loss. A broad spectrum of radiological imaging techniques are available to characterize the kidney tissue, showing promise when it comes to non-invasively picking up the early signs of ADPKD progression. Radiomics have been used to extract textural features from ADPKD images, providing valuable information about the heterogeneity of the cystic and non-cystic components. This review provides an overview of ADPKD imaging biomarkers, focusing on the quantification methods, potential, and necessary steps toward a successful translation to clinical practice.
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Affiliation(s)
- Anna Caroli
- Bioengineering Department, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, 24020 Ranica, BG, Italy
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18
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Xu L, Shao J, Li K, Wang C, Lai Z, Ma J, Yu X, Du F, Chen J, Liu X, Yuan J, Liu B, Wang C. Renal perfusion improvement in the perioperative period after unilateral endovascular revascularization in patients with atherosclerotic renal artery stenosis. Front Cardiovasc Med 2023; 10:1193864. [PMID: 37502187 PMCID: PMC10369776 DOI: 10.3389/fcvm.2023.1193864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 06/12/2023] [Indexed: 07/29/2023] Open
Abstract
Background The clinical benefits of endovascular treatment in renal artery stenosis (RAS) remain controversial. This study used an intraoperative renal perfusion imaging technique, called flat-panel detector parenchymal blood volume imaging (FD-PBV), to observe the change in renal perfusion after endovascular treatment in RAS. Materials and methods In a prospective, single-center study, we assigned 30 patients with atherosclerotic RAS who underwent endovascular treatment between March 2016 and March 2021. The preoperative and postoperative results of renal perfusion, blood pressure, and renal function, were compared. Results Both median kidney volume (p < 0.001) and median preoperative mean density of contrast medium (MDCM) (p = 0.028) increased significantly after endovascular treatment. The ratio of postoperative and preoperative MDCM differed greatly among the patients. For patients with preoperative MDCM <304.0 HU (Subgroup A, 15 cases), MDCM significantly increased after treatment (p = 0.001) and 12 (80.0%) patients had more than 10% increase in renal perfusion. For patients who had relatively high preoperative renal perfusion (MDCM ≥304.0 HU, Subgroup B, 15 cases), preoperative and postoperative MDCM were similar (p = 0.776). On the other hand, the serum creatinine levels significantly decreased in Subgroup A (p = 0.033) and fewer antihypertensive drugs were used after endovascular revascularization (p = 0.041). The preoperative and postoperative creatinine levels and number of antihypertensive drugs were similar in Subgroup B. Conclusions During the perioperative period, RAS patients with relatively low preoperative renal perfusion levels had greater improvement in renal perfusion, renal function, and blood pressure control after endovascular treatment. The improvement of renal function needs to be confirmed by long-term follow-up.
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Affiliation(s)
- Leyin Xu
- Department of Vascular Surgery, Peking Union Medical College Hospital (Dongdan Campus), Beijing, China
| | - Jiang Shao
- Department of Vascular Surgery, Peking Union Medical College Hospital (Dongdan Campus), Beijing, China
| | - Kang Li
- Department of Vascular Surgery, Peking Union Medical College Hospital (Dongdan Campus), Beijing, China
| | - Chaonan Wang
- Department of Vascular Surgery, Peking Union Medical College Hospital (Dongdan Campus), Beijing, China
| | - Zhichao Lai
- Department of Vascular Surgery, Peking Union Medical College Hospital (Dongdan Campus), Beijing, China
| | - Jiangyu Ma
- Department of Vascular Surgery, Peking Union Medical College Hospital (Dongdan Campus), Beijing, China
| | - Xiaoxi Yu
- Department of Vascular Surgery, Peking Union Medical College Hospital (Dongdan Campus), Beijing, China
| | - Fenghe Du
- Department of Vascular Surgery, Peking Union Medical College Hospital (Dongdan Campus), Beijing, China
| | - Junye Chen
- Department of Vascular Surgery, Peking Union Medical College Hospital (Dongdan Campus), Beijing, China
| | - Xiaolong Liu
- Department of Vascular Surgery, Peking Union Medical College Hospital (Dongdan Campus), Beijing, China
| | - Jinghui Yuan
- Department of Vascular Surgery, Peking Union Medical College Hospital (Dongdan Campus), Beijing, China
| | - Bao Liu
- Department of Vascular Surgery, Peking Union Medical College Hospital (Dongdan Campus), Beijing, China
| | - Chunyang Wang
- Department of Urology, PLA General Hospital, Beijing, China
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19
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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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20
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Zhang Z, Chen Y, Zhou X, Liu S, Yu J. The value of functional magnetic resonance imaging in the evaluation of diabetic kidney disease: a systematic review and meta-analysis. Front Endocrinol (Lausanne) 2023; 14:1226830. [PMID: 37484949 PMCID: PMC10360195 DOI: 10.3389/fendo.2023.1226830] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 06/19/2023] [Indexed: 07/25/2023] Open
Abstract
Background The diversity of clinical trajectories in diabetic kidney disease (DKD) has made blood and biochemical urine markers less precise, while renal puncture, the gold standard, is almost impossible in the assessment of diabetic kidney disease, and the value of functional magnetic resonance imaging in the evaluation of diabetic pathological alterations is increasingly recognized. Methods The literature on functional magnetic resonance imaging (fMRI) for the assessment of renal alterations in diabetic kidney disease was searched in PubMed, Web of Science, Cochrane Library, and Embase databases. The search time limit is from database creation to March 10, 2023. RevMan was used to perform a meta-analysis of the main parameters of fMRIs extracted from DKD patients and healthy volunteers (HV). Results 24 publications (1550 subjects) were included in this study, using five functional MRIs with seven different parameters. The renal blood flow (RBF) values on Arterial spin labeling magnetic resonance imaging (ASL-MRI) was significantly lower in the DKD group than in the HV group. The [WMD=-99.03, 95% CI (-135.8,-62.27), P<0.00001]; Diffusion tensor imaging magnetic resonance imaging (DTI-MRI) showed that the fractional anisotropy (FA) values in the DKD group were significantly lower than that in HV group [WMD=-0.02, 95%CI (-0.03,-0.01), P<0.0001]. And there were no statistically significant differences in the relevant parameters in Blood oxygen level-dependent magnetic resonance imaging (BOLD-MRI) or Intro-voxel incoherent movement magnetic resonance imaging (IVIM-DWI). Discussion ASL and DWI can identify the differences between DKD and HV. DTI has a significant advantage in assessing renal cortical changes; IVIM has some value in determining early diabetic kidney disease from the cortex or medulla. We recommend combining multiple fMRI parameters to assess structural or functional changes in the kidney to make the assessment more comprehensive. We did not observe a significant risk of bias in the present study. Systematic review registration https://www.crd.york.ac.uk, identifier CRD42023409249.
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Affiliation(s)
- Ziqi Zhang
- Department of Endocrinology, Jiangsu Provincial Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
- The First Clinical Medical College of Nanjing University of Chinese Medicine, Nanjing, China
| | - Yu Chen
- Department of Endocrinology, Jiangsu Provincial Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
- The First Clinical Medical College of Nanjing University of Chinese Medicine, Nanjing, China
| | - Xiqiao Zhou
- Department of Endocrinology, Jiangsu Provincial Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Su Liu
- Department of Endocrinology, Jiangsu Provincial Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Jiangyi Yu
- Department of Endocrinology, Jiangsu Provincial Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
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21
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Ulpiano Trillig A, Damianaki A, Hendriks-Balk M, Brito W, Garessus J, Burnier M, Wuerzner G, Pruijm M. Determinants of Renal Micro-Perfusion as Assessed with Contrast-Enhanced Ultrasound in Healthy Males and Females. J Clin Med 2023; 12:4141. [PMID: 37373834 DOI: 10.3390/jcm12124141] [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: 04/07/2023] [Revised: 06/09/2023] [Accepted: 06/16/2023] [Indexed: 06/29/2023] Open
Abstract
(1) Background: The renal microcirculation is essential to maintain the renal function, but its determinants in humans have been poorly studied. Contrast-enhanced ultrasound (CEUS) allows the non-invasive quantification of the cortical micro-perfusion at the bedside using the perfusion index (PI). The aims of this study were to assess whether differences exist in PI between healthy males and females and to identify clinical determinants associated with cortical micro-perfusion. (2) Methods: Healthy, normotensive volunteers (eGFR > 60 mL/min/1.73 m2, no albuminuria) underwent CEUS under standardized conditions with the destruction-reperfusion (DR) technique. The mean PI of four DR sequences was reported as the primary outcome measure (3) Results: A total of 115 subjects (77 females and 38 males) completed the study; the mean ± SD age was, respectively, 37.1 ± 12.2 and 37.1 ± 12.7 years in females and males, and the mean eGFR was 105.9 ± 15.1 and 91.0 ± 17.4 mL/min/1.73 m2. The PI (median) was higher in females than in males, i.e., 2705 (IQR 1641-3777) vs. 1965 (IQR 1294-3346) arbitrary units (a.u), p = 0.02). A correlation analysis showed positive associations between PI and eGFR, female sex, heart rate, plasma renin activity (PRA) and plasma aldosterone concentrations (PAC), negative associations with potassium, bicarbonate and systolic blood pressure, and no associations with age, body mass index and renal resistive index (RRI). In a multivariate linear regression analysis, only PRA remained significantly associated with PI. (4) Conclusions: Although the PI was higher among females, this association was no longer significant after adjustment for covariates. There was no difference in females tested during the follicular or the luteal phases. In conclusion, the PI was only weakly influenced by classic clinical variables, but was positively associated with PRA, suggesting that the renin-angiotensin system plays a role in the regulation of the cortical micro-perfusion in humans. Identifying which other factors contribute to the large variations in micro-perfusion across individuals needs further study.
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Affiliation(s)
- Antonio Ulpiano Trillig
- Service of Nephrology and Hypertension, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 17, 1005 Lausanne, Switzerland
| | - Aikaterini Damianaki
- Service of Nephrology and Hypertension, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 17, 1005 Lausanne, Switzerland
| | - Mariëlle Hendriks-Balk
- Service of Nephrology and Hypertension, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 17, 1005 Lausanne, Switzerland
| | - Wendy Brito
- Service of Nephrology and Hypertension, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 17, 1005 Lausanne, Switzerland
| | - Jonas Garessus
- Service of Nephrology and Hypertension, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 17, 1005 Lausanne, Switzerland
| | - Michel Burnier
- Service of Nephrology and Hypertension, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 17, 1005 Lausanne, Switzerland
| | - Grégoire Wuerzner
- Service of Nephrology and Hypertension, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 17, 1005 Lausanne, Switzerland
| | - Menno Pruijm
- Service of Nephrology and Hypertension, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 17, 1005 Lausanne, Switzerland
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22
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Prasad PV, Li LP, Hack B, Leloudas N, Sprague SM. Quantitative Blood Oxygenation Level Dependent Magnetic Resonance Imaging for Estimating Intra-renal Oxygen Availability Demonstrates Kidneys Are Hypoxemic in Human CKD. Kidney Int Rep 2023; 8:1057-1067. [PMID: 37180507 PMCID: PMC10166744 DOI: 10.1016/j.ekir.2023.02.1092] [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: 12/30/2022] [Revised: 02/08/2023] [Accepted: 02/27/2023] [Indexed: 03/09/2023] Open
Abstract
Introduction Kidney blood oxygenation level dependent (BOLD) magnetic resonance imaging (MRI) has shown great promise in evaluating relative oxygen availability. This method is quite efficacious in evaluating acute responses to physiological and pharmacologic maneuvers. Its outcome parameter, R2∗ is defined as the apparent spin-spin relaxation rate measured in the presence of magnetic susceptibility differences and it is measured using gradient echo MRI. Although associations between R2∗ and renal function decline have been described, it remains uncertain to what extent R2∗ is a true reflection of tissue oxygenation. This is primarily because of not taking into account the confounding factors, especially fractional blood volume (fBV) in tissue. Methods This case-control study included 7 healthy controls and 6 patients with diabetes and chronic kidney disease (CKD). Using data before and after administration of ferumoxytol, a blood pool MRI contrast media, the fBVs in kidney cortex and medulla were measured. Results This pilot study independently measured fBV in kidney cortex (0.23 ± 0.03 vs. 0.17 ± 0.03) and medulla (0.36 ± 0.08 vs. 0.25 ± 0.03) in a small number of healthy controls (n = 7) versus CKD (n = 6). These were then combined with BOLD MRI measurements to estimate oxygen saturation of hemoglobin (StO2) (0.87 ± 0.03 vs. 0.72 ± 0.10 in cortex; 0.82 ± 0.05 vs. 0.72 ± 0.06 in medulla) and partial pressure of oxygen in blood (bloodPO2) (55.4 ± 6.5 vs. 38.4 ± 7.6 mm Hg in cortex; 48.4 ± 6.2 vs. 38.1 ± 4.5 mm Hg in medulla) in control versus CKD. The results for the first time demonstrate that cortex is normoxemic in controls and moderately hypoxemic in CKD. In the medulla, it is mildly hypoxemic in controls and moderately hypoxemic in CKD. Whereas fBV, StO2, and bloodPO2 were strongly associated with estimated glomerular filtration rate (eGFR), R2∗ was not. Conclusion Our results support the feasibility of quantitatively assessing oxygen availability using noninvasive quantitative BOLD MRI that could be translated to the clinic.
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Affiliation(s)
- Pottumarthi V. Prasad
- Department of Radiology, NorthShore University HealthSystem, Evanston, Illinois, USA
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Lu-Ping Li
- Department of Radiology, NorthShore University HealthSystem, Evanston, Illinois, USA
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Bradley Hack
- Department of Radiology, NorthShore University HealthSystem, Evanston, Illinois, USA
| | - Nondas Leloudas
- Department of Radiology, NorthShore University HealthSystem, Evanston, Illinois, USA
| | - Stuart M. Sprague
- Department of Medicine, NorthShore University HealthSystem, Evanston, Illinois, USA
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois, USA
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23
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Taso M, Aramendía-Vidaurreta V, Englund EK, Francis S, Franklin S, Madhuranthakam AJ, Martirosian P, Nayak KS, Qin Q, Shao X, Thomas DL, Zun Z, Fernández-Seara MA. Update on state-of-the-art for arterial spin labeling (ASL) human perfusion imaging outside of the brain. Magn Reson Med 2023; 89:1754-1776. [PMID: 36747380 DOI: 10.1002/mrm.29609] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 01/09/2023] [Accepted: 01/16/2023] [Indexed: 02/08/2023]
Abstract
This review article provides an overview of developments for arterial spin labeling (ASL) perfusion imaging in the body (i.e., outside of the brain). It is part of a series of review/recommendation papers from the International Society for Magnetic Resonance in Medicine (ISMRM) Perfusion Study Group. In this review, we focus on specific challenges and developments tailored for ASL in a variety of body locations. After presenting common challenges, organ-specific reviews of challenges and developments are presented, including kidneys, lungs, heart (myocardium), placenta, eye (retina), liver, pancreas, and muscle, which are regions that have seen the most developments outside of the brain. Summaries and recommendations of acquisition parameters (when appropriate) are provided for each organ. We then explore the possibilities for wider adoption of body ASL based on large standardization efforts, as well as the potential opportunities based on recent advances in high/low-field systems and machine-learning. This review seeks to provide an overview of the current state-of-the-art of ASL for applications in the body, highlighting ongoing challenges and solutions that aim to enable more widespread use of the technique in clinical practice.
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Affiliation(s)
- Manuel Taso
- Division of MRI Research, Department of Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | | | - Erin K Englund
- Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Susan Francis
- Sir Peter Mansfield Imaging Center, University of Nottingham, Nottingham, UK
| | - Suzanne Franklin
- C.J. Gorter Center for High Field MRI, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
- Center for Image Sciences, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Ananth J Madhuranthakam
- Department of Radiology, Advanced Imaging Research Center, and Biomedical Engineering, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Petros Martirosian
- Section on Experimental Radiology, Department of Radiology, University Hospital of Tuebingen, Tuebingen, Germany
| | - Krishna S Nayak
- Ming Hsieh Department of Electrical and Computer Engineering, University of Southern California, Los Angeles, California, USA
| | - Qin Qin
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, Maryland, USA
| | - Xingfeng Shao
- Laboratory of FMRI Technology (LOFT), Mark & Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - David L Thomas
- Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Zungho Zun
- Department of Radiology, Weill Cornell Medicine, New York, New York, USA
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24
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Staub E. Current and potential methods to assess kidney structure and morphology in term and preterm neonates. Anat Rec (Hoboken) 2023. [PMID: 36883787 DOI: 10.1002/ar.25195] [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: 11/20/2022] [Revised: 01/25/2023] [Accepted: 02/21/2023] [Indexed: 03/09/2023]
Abstract
After birth, the kidney structure in neonates adapt to the functional demands of extrauterine life. Nephrogenesis is complete in the third trimester, but glomeruli, tubuli, and vasculature mature with the rapidly increasing renal blood flow and glomerular filtration. In preterm infants, nephrogenesis remains incomplete and maturation is slower and may be aberrant. This structural and functional deficit has life-long consequences: preterm born individuals are at higher risk for chronic kidney disease and arterial hypertension later in life. This review assembles the literature on existing and potential methods to visualize neonatal kidney structure and morphology and explore their potential to longitudinally document the developmental deviation after preterm birth. X-rays with and without contrast, fluoroscopy and computed tomography (CT) involve relevant ionizing radiation exposure and, apart from CT, do not provide sufficient structural details. Ultrasound has evolved into a safe and noninvasive high-resolution imaging method which is excellent for longitudinal observations. Doppler ultrasound modes can characterize and quantify blood flow to and through the kidneys. Microvascular flow imaging has opened new possibilities of visualizing previously unseen vascular structures. Recent advances in magnetic resonance imaging display renal structure and function in unprecedented detail, but are offset by the logistical challenges of the imaging procedure and limited experience with the new techniques in neonates. Kidney biopsies visualize structure histologically, but are too invasive and remain anecdotal in newborns. All the explored methods have predominantly been examined in term newborns and require further research on longitudinal structural observation in the kidneys of preterm infants.
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Affiliation(s)
- Eveline Staub
- Department of Neonatology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
- University of Sydney Northern Clinical School, Royal North Shore Hospital, St Leonards, New South Wales, Australia
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25
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Franklin SL, Schuurmans M, Otikovs M, Borman PTS, van Osch MJP, Bos C. Arterial spin labeling using spatio-temporal encoding readout for robust perfusion imaging in inhomogenous magnetic fields. Magn Reson Med 2023; 89:1092-1101. [PMID: 36420871 PMCID: PMC10099794 DOI: 10.1002/mrm.29506] [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: 11/30/2021] [Revised: 10/10/2022] [Accepted: 10/10/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate the feasibility of spatio-temporal encoding (SPEN) readout for pseudo-continuous ASL (pCASL) in brain, and its robustness to susceptibility artifacts as introduced by aneurysm clips. METHODS A 2D self-refocused T2 *-compensated hybrid SPEN scheme, with super-resolution reconstruction was implemented on a 1.5T Philips system. Q (=BWchirp *Tchirp ) was varied and, the aneurysm clip-induced artifact was evaluated in phantom (label-images) as well as in vivo (perfusion-weighted signal (PWS)-maps and temporal SNR (tSNR)). In vivo results were compared to gradient-echo EPI (GE-EPI) and spin-echo EPI (SE-EPI). The dependence of tSNR on TR was evaluated separately for SPEN and SE-EPI. SPEN with Q ˜ 75 encodes with the same off-resonance robustness as EPI. RESULTS The clip-induced artifact with SPEN decreased with increase in Q, and was smaller compared to SE-EPI and GE-EPI in vivo. tSNR decreased with Q and the tSNR of GE-EPI and SE-EPI corresponded to SPEN with a Q-value of approximately ˜85 and ˜108, respectively. In addition, SPEN perfusion images showed a higher tSNR (p < 0.05) for TR = 4000 ms compared to TR = 2100 ms, while SE-EPI did not. tSNR remained relatively stable when the time between SPEN-excitation and start of the next labeling-module was more than ˜1000 ms. CONCLUSION Feasibility of combining SPEN with pCASL imaging was demonstrated, enabling cerebral perfusion measurements with a higher robustness to field inhomogeneity (Q > 75) compared to SE-EPI and GE-EPI. However, the SPEN chirp-pulse saturates incoming blood, thereby reducing pCASL labeling efficiency of the next acquisition for short TRs. Future developments are needed to enable 3D scanning.
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Affiliation(s)
- Suzanne L Franklin
- Center for Image Sciences, University Medical Center Utrecht, Utrecht, The Netherlands.,C.J. Gorter Center for High Field MRI, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Megan Schuurmans
- Center for Image Sciences, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Martins Otikovs
- Department of Chemical and Biological Physics, Weizmann Institute of Science, Rehovot, Israel
| | - Pim T S Borman
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Matthias J P van Osch
- C.J. Gorter Center for High Field MRI, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.,Leiden Institute for Brain and Cognition, Leiden University, Leiden, The Netherlands
| | - Clemens Bos
- Center for Image Sciences, University Medical Center Utrecht, Utrecht, The Netherlands
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26
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Zhang K, Triphan SMF, Ziener CH, Jende JME, Kauczor HU, Schlemmer HP, Sedlaczek O, Kurz FT. Navigator-based slice tracking for kidney pCASL using spin-echo EPI acquisition. Magn Reson Med 2023; 90:231-239. [PMID: 36806110 DOI: 10.1002/mrm.29621] [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: 08/22/2022] [Revised: 01/26/2023] [Accepted: 02/06/2023] [Indexed: 02/21/2023]
Abstract
PURPOSE To apply a navigator-based slice-tracking method to prospectively compensate respiratory motion for kidney pseudo-continuous arterial spin labeling (pCASL), using spin-echo (SE) EPI acquisition. METHODS 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 of the readouts of a 2D-SE-EPI-based pCASL sequence. Motion information was calculated after exclusion of the signal saturation in the navigator signal caused by EPI excitations. The motion information was then used to directly adjust the slice positioning in real time. RESULTS The respiratory motion from the navigator signal was calculated, and slice positioning was changed in real time based on the motion information. We could show that motion compensation reduces kidney movement, and that the coefficients of variation across renal perfusion values were significantly reduced when motion correction was applied. The average reduction of coefficients of variation was approximately 20%, resulting in a more accurate and detailed structure of the respective perfusion maps. CONCLUSIONS This study demonstrates the feasibility of a navigator-based slice-tracking technique in kidney imaging with a SE-EPI readout pCASL sequence to reduce kidney motion.
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Affiliation(s)
- Ke Zhang
- Department of Diagnostic & Interventional Radiology, Heidelberg University Hospital, Heidelberg, Germany.,Division of Radiology, German Cancer Research Center, Heidelberg, Germany
| | - Simon M F Triphan
- Department of Diagnostic & Interventional Radiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Christian H Ziener
- Division of Radiology, German Cancer Research Center, Heidelberg, Germany
| | - Johann M E Jende
- Department of Neuroradiology, Heidelberg University Hospital, 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.,Division of Radiology, German Cancer Research Center, Heidelberg, Germany
| | - Felix T Kurz
- Division of Radiology, German Cancer Research Center, Heidelberg, Germany.,Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
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27
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Functional MRI to quantify perfusion changes of a renal allograft after embolization of an arteriovenous fistula. J Nephrol 2023; 36:1175-1180. [PMID: 36696037 DOI: 10.1007/s40620-022-01539-y] [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: 08/16/2022] [Accepted: 11/20/2022] [Indexed: 01/26/2023]
Abstract
Acute allograft injury was observed in a 37-year-old woman within a few weeks after kidney transplantation. Neither renal ultrasound nor computerized tomography (CT) and magnetic resonance (MR) angiography revealed any anomaly. An MR protocol was then performed including arterial spin labeling and intravoxel incoherent motion diffusion weighted imaging. Both arterial spin labeling and the perfusion fraction in the diffusion weighted imaging showed decreased perfusion compared to reference values. The patient subsequently underwent angiography, where an arteriovenous fistula in the upper calix of the transplant kidney was detected and immediate embolization was performed. A second functional MR, performed one week later, demonstrated a 40% increase in organ perfusion. We conclude that functional MR with arterial spin labeling and intravoxel incoherent motion have the potential to provide complementary information of clinical value to conventional imaging for monitoring renal allografts.
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Schutter R, van Varsseveld OC, Lantinga VA, Pool MBF, Hamelink TH, Potze JH, Leuvenink HGD, Laustsen C, Borra RJH, Moers C. Magnetic resonance imaging during warm ex vivo kidney perfusion. Artif Organs 2023; 47:105-116. [PMID: 35996889 PMCID: PMC10086841 DOI: 10.1111/aor.14391] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 06/30/2022] [Accepted: 08/02/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND The shortage of donor organs for transplantation remains a worldwide problem. The utilization of suboptimal deceased donors enlarges the pool of potential organs, yet consequently, clinicians face the difficult decision of whether these sub-optimal organs are of sufficient quality for transplantation. Novel technologies could play a pivotal role in making pre-transplant organ assessment more objective and reliable. METHODS Ex vivo normothermic machine perfusion (NMP) at temperatures around 35-37°C allows organ quality assessment in a near-physiological environment. Advanced magnetic resonance imaging (MRI) techniques convey unique information about an organ's structural and functional integrity. The concept of applying magnetic resonance imaging during renal normothermic machine perfusion is novel in both renal and radiological research and we have developed the first MRI-compatible NMP setup for human-sized kidneys. RESULTS We were able to obtain a detailed and real-time view of ongoing processes inside renal grafts during ex vivo perfusion. This new technique can visualize structural abnormalities, quantify regional flow distribution, renal metabolism, and local oxygen availability, and track the distribution of ex vivo administered cellular therapy. CONCLUSION This platform allows for advanced pre-transplant organ assessment, provides a new realistic tool for studies into renal physiology and metabolism, and may facilitate therapeutic tracing of pharmacological and cellular interventions to an isolated kidney.
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Affiliation(s)
- Rianne Schutter
- Department of Surgery - Organ Donation and Transplantation, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Otis C van Varsseveld
- Department of Surgery - Organ Donation and Transplantation, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Veerle A Lantinga
- Department of Surgery - Organ Donation and Transplantation, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Merel B F Pool
- Department of Surgery - Organ Donation and Transplantation, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Tim H Hamelink
- Department of Surgery - Organ Donation and Transplantation, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Jan Hendrik Potze
- Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Henri G D Leuvenink
- Department of Surgery - Organ Donation and Transplantation, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Christoffer Laustsen
- Department of Clinical Medicine, The MR Research Center, Aarhus University, Aarhus, Denmark
| | - Ronald J H Borra
- Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Cyril Moers
- Department of Surgery - Organ Donation and Transplantation, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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El-Shaer W, Haggag MS, Elshaer A, Shaboob I, Kandeel W, Elmohamady B, Abdelmotaleb DS, Abdel-Lateef S. Can trajectory nor-epinephrine infiltration reduce blood loss during percutaneous nephrolithotomy? A double-blinded randomized controlled trial. Int J Urol 2022; 29:1535-1542. [PMID: 36094821 DOI: 10.1111/iju.15036] [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: 05/04/2022] [Accepted: 08/17/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE To determine the efficacy and safety of trajectory infiltration with 1:150 000 Norepinephrine (NE) in reducing blood loss during percutaneous nephrolithotomy (PCNL). MATERIALS AND METHODS This is a prospective randomized double-blinded placebo-controlled trial. In all, 140 consecutive patients underwent PCNL for the management of large renal calculi. They were randomly assigned (1:1) to one of either study groups, the NE-PCNL group (70 patients whose PCNL-trajectory was infiltrated by NE) or the Placebo group (saline PCNL) (70 patients whose PCNL tracts were infiltrated by normal saline). Procedure-related blood loss (the primary outcome) was assessed and statistically analyzed. Also, all other procedure-related events and complications were recorded and compared. RESULTS The median blood loss was 378 ml (IQR: 252-504) in the NE-PCNL group versus 592 ml (IQR: 378-756) in the S-PCNL group (p < 0.0001). In addition, Hemoglobin and Hematocrit deficits were lower in NE-PCNL (p < 0.05). Patients who were randomized to the NE-PCNL group had a higher immediate stone-free rate (SFR) (80%) compared with those of the S-PCNL group (70%) (p = 0.034). However, no statistical differences were found in the final SFR. The reported overall complications between the 2 groups were similar (p > 0.05). Indeed, bleeding-related complications were 1 (1.4%) versus 10 (14.3%) for NE-PCNL and S-PCNL, respectively (p = 0.009). CONCLUSIONS Trajectory infiltration of PCNL tracts by NE was found to be effective and safe in mitigation of PCNL-related blood loss. This step is a timeless and cost-effective as NE is readily available in surgical theaters and of very low cost.
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Affiliation(s)
- Waleed El-Shaer
- Department of Urology, Benha University Hospital, Banha, Egypt
| | | | - Alaa Elshaer
- Department of Urology, Benha University Hospital, Banha, Egypt
| | - Islam Shaboob
- Department of Anaesthesiology, Benha University Hospital, Banha, Egypt
| | - Wael Kandeel
- Department of Urology, Benha University Hospital, Banha, Egypt
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Aramendía-Vidaurreta V, Solis-Barquero SM, Ezponda A, Vidorreta M, Echeverria-Chasco R, Pascual M, Bastarrika G, Fernández-Seara MA. Assessment of Splenic Switch-Off With Arterial Spin Labeling in Adenosine Perfusion Cardiac MRI. J Magn Reson Imaging 2022. [PMID: 36218288 DOI: 10.1002/jmri.28460] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 09/21/2022] [Accepted: 09/22/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND In patients with suspected coronary artery disease (CAD), myocardial perfusion is assessed under rest and pharmacological stress to identify ischemia. Splenic switch-off, defined as the stress to rest splenic perfusion attenuation in response to adenosine, has been proposed as an indicator of stress adequacy. Its occurrence has been previously assessed in first-pass perfusion images, but the use of noncontrast techniques would be highly beneficial. PURPOSE To explore the ability of pseudo-continuous arterial spin labeling (PCASL) to identify splenic switch-off in patients with suspected CAD. STUDY TYPE Prospective. POPULATION Five healthy volunteers (age 24.8 ± 3.8 years) and 32 patients (age 66.4 ± 8.2 years) with suspected CAD. FIELD STRENGTH/SEQUENCE A 1.5-T/PCASL (spin-echo) and first-pass imaging (gradient-echo). ASSESSMENT In healthy subjects, multi-delay PCASL data (500-2000 msec) were acquired to quantify splenic blood flow (SBF) and determine the adequate postlabeling delay (PLD) for single-delay acquisitions (PLD > arterial transit time). In patients, single-delay PCASL (1200 msec) and first-pass perfusion images were acquired under rest and adenosine conditions. PCASL data were used to compute SBF maps and SBF stress-to-rest ratios. Three observers classified patients into "switch-off" and "failed switch-off" groups by visually comparing rest-stress perfusion data acquired with PCASL and first-pass, independently. First-pass categories were used as reference to evaluate the accuracy of quantitative classification. STATISTICAL TESTS Wilcoxon signed-rank, Pearson correlation, kappa, percentage agreement, Generalized Linear Mixed Model, Mann-Whitney, Pearson Chi-squared, receiver operating characteristic, area-under-the-curve (AUC) and confusion matrix. SIGNIFICANCE P value < 0.05. RESULTS A total of 27 patients (84.4%) experienced splenic switch-off according to first-pass categories. Comparison of PCASL-derived SBF maps during stress and rest allowed assessment of splenic switch-off, reflected in a reduction of SBF values during stress. SBF stress-to-rest ratios showed a 97% accuracy (sensitivity = 80%, specificity = 100%, AUC = 85.2%). DATA CONCLUSION This study could demonstrate the feasibility of PCASL to identify splenic switch-off during adenosine perfusion MRI, both by qualitative and quantitative assessments. EVIDENCE LEVEL 2 TECHNICAL EFFICACY: 2.
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Affiliation(s)
- Verónica Aramendía-Vidaurreta
- Department of Radiology, Clínica Universidad de Navarra, Pamplona, Navarra, Spain.,Idisna, Instituto de Investigación Sanitaria de Navarra, Spain
| | - Sergio M Solis-Barquero
- Department of Radiology, Clínica Universidad de Navarra, Pamplona, Navarra, Spain.,Idisna, Instituto de Investigación Sanitaria de Navarra, Spain
| | - Ana Ezponda
- Department of Radiology, Clínica Universidad de Navarra, Pamplona, Navarra, Spain.,Idisna, Instituto de Investigación Sanitaria de Navarra, Spain
| | | | - Rebeca Echeverria-Chasco
- Department of Radiology, Clínica Universidad de Navarra, Pamplona, Navarra, Spain.,Idisna, Instituto de Investigación Sanitaria de Navarra, Spain
| | - Marina Pascual
- Department of Cardiology, Clínica Universidad de Navarra, Pamplona, Navarra, Spain
| | - Gorka Bastarrika
- Department of Radiology, Clínica Universidad de Navarra, Pamplona, Navarra, Spain.,Idisna, Instituto de Investigación Sanitaria de Navarra, Spain
| | - María A Fernández-Seara
- Department of Radiology, Clínica Universidad de Navarra, Pamplona, Navarra, Spain.,Idisna, Instituto de Investigación Sanitaria de Navarra, Spain
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31
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Edwards A, Kurtcuoglu V. Renal blood flow and oxygenation. Pflugers Arch 2022; 474:759-770. [PMID: 35438336 PMCID: PMC9338895 DOI: 10.1007/s00424-022-02690-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 03/19/2022] [Accepted: 03/21/2022] [Indexed: 02/07/2023]
Abstract
Our kidneys receive about one-fifth of the cardiac output at rest and have a low oxygen extraction ratio, but may sustain, under some conditions, hypoxic injuries that might lead to chronic kidney disease. This is due to large regional variations in renal blood flow and oxygenation, which are the prerequisite for some and the consequence of other kidney functions. The concurrent operation of these functions is reliant on a multitude of neuro-hormonal signaling cascades and feedback loops that also include the regulation of renal blood flow and tissue oxygenation. Starting with open questions on regulatory processes and disease mechanisms, we review herein the literature on renal blood flow and oxygenation. We assess the current understanding of renal blood flow regulation, reasons for disparities in oxygen delivery and consumption, and the consequences of disbalance between O2 delivery, consumption, and removal. We further consider methods for measuring and computing blood velocity, flow rate, oxygen partial pressure, and related parameters and point out how limitations of these methods constitute important hurdles in this area of research. We conclude that to obtain an integrated understanding of the relation between renal function and renal blood flow and oxygenation, combined experimental and computational modeling studies will be needed.
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Affiliation(s)
- Aurelie Edwards
- Department of Biomedical Engineering, Boston University, 44 Cummington Mall, Boston, MA, 02215, USA
| | - Vartan Kurtcuoglu
- Institute of Physiology, University of Zurich, Winterthurerstrasse 190, 8057, Zurich, Switzerland.
- National Center of Competence in Research, Kidney.CH, University of Zurich, Zurich, Switzerland.
- Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland.
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32
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Brumer I, Bauer DF, Schad LR, Zöllner FG. Synthetic Arterial Spin Labeling MRI of the Kidneys for Evaluation of Data Processing Pipeline. Diagnostics (Basel) 2022; 12:1854. [PMID: 36010205 PMCID: PMC9406826 DOI: 10.3390/diagnostics12081854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 07/28/2022] [Accepted: 07/29/2022] [Indexed: 11/30/2022] Open
Abstract
Accurate quantification of perfusion is crucial for diagnosis and monitoring of kidney function. Arterial spin labeling (ASL), a completely non-invasive magnetic resonance imaging technique, is a promising method for this application. However, differences in acquisition (e.g., ASL parameters, readout) and processing (e.g., registration, segmentation) between studies impede the comparison of results. To alleviate challenges arising solely from differences in processing pipelines, synthetic data are of great value. In this work, synthetic renal ASL data were generated using body models from the XCAT phantom and perfusion was added using the general kinetic model. Our in-house developed processing pipeline was then evaluated in terms of registration, quantification, and segmentation using the synthetic data. Registration performance was evaluated qualitatively with line profiles and quantitatively with mean structural similarity index measures (MSSIMs). Perfusion values obtained from the pipeline were compared to the values assumed when generating the synthetic data. Segmentation masks obtained by semi-automated procedure of the processing pipeline were compared to the original XCAT organ masks using the Dice index. Overall, the pipeline evaluation yielded good results. After registration, line profiles were smoother and, on average, MSSIMs increased by 25%. Mean perfusion values for cortex and medulla were close to the assumed perfusion of 250 mL/100 g/min and 50 mL/100 g/min, respectively. Dice indices ranged 0.80-0.93, 0.78-0.89, and 0.64-0.84 for whole kidney, cortex, and medulla, respectively. The generation of synthetic ASL data allows flexible choice of parameters and the generated data are well suited for evaluation of processing pipelines.
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Affiliation(s)
- Irène Brumer
- Computer Assisted Clinical Medicine, Mannheim Institute for Intelligent Systems in Medicine, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany; (D.F.B.); (L.R.S.); (F.G.Z.)
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Ahn HS, Jung Y, Park SH. Measuring glomerular blood transfer rate in kidney using diffusion-weighted arterial spin labeling. Magn Reson Med 2022; 88:2408-2418. [PMID: 35877788 DOI: 10.1002/mrm.29401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 07/05/2022] [Accepted: 07/08/2022] [Indexed: 11/07/2022]
Abstract
PURPOSE To propose a two-compartment renal perfusion model for calculating glomerular blood transfer rate ( k G $$ {k}_G $$ ) as a new measure of renal function. THEORY The renal perfusion signal was divided into preglomerular and postglomerular flows according to flow velocity. By analyzing perfusion signals acquired with and without diffusion gradients, we estimated k G $$ {k}_G $$ , the blood transfer rate from the afferent arterioles into the glomerulus. METHODS A multislice multidelay diffusion-weighted arterial spin labeling sequence was applied to subjects with no history of renal dysfunctions. In the multiple b-value experiment, images were acquired with seven b-values to validate the bi-exponential decays of the renal perfusion signal and to determine the appropriate b-value for suppressing preglomerular flow. In the caffeine challenge, six subjects were scanned twice on the caffeine day and the control day. The k G $$ {k}_G $$ values of the two dates were compared. RESULTS The perfusion signal showed a bi-exponential decay with b-values. There was no significant difference in renal blood flow and arterial transit time between caffeine and control days. In contrast, cortical k G $$ {k}_G $$ was significantly higher on the caffeine day (caffeine day: 106 . 0 ± 20 . 3 $$ 106.0\pm 20.3 $$ min - 1 $$ {}^{-1} $$ control day: 78 . 8 ± 22 . 9 $$ 78.8\pm 22.9 $$ min - 1 $$ {}^{-1} $$ ). These results were consistent with those from the literature. CONCLUSION We showed that the perfusion signal consists of two compartments of preglomerular flow and postglomerular flow. The proposed diffusion-weighted arterial spin labeling could measure the glomerular blood transfer rate ( k G $$ {k}_G $$ ), which was sensitive enough to noninvasively monitor the caffeine-induced vasodilation of afferent arterioles.
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Affiliation(s)
- Hyun-Seo Ahn
- Department of Bio and Brain Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Korea
| | - Yujin Jung
- Department of Bio and Brain Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Korea
| | - Sung-Hong Park
- Department of Bio and Brain Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Korea
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Almushayt SJ, Pham A, Phillips BE, Williams JP, Taal MW, Selby NM. Repeatability of Contrast-Enhanced Ultrasound to Determine Renal Cortical Perfusion. Diagnostics (Basel) 2022; 12:diagnostics12051293. [PMID: 35626449 PMCID: PMC9141960 DOI: 10.3390/diagnostics12051293] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 05/13/2022] [Accepted: 05/16/2022] [Indexed: 11/16/2022] Open
Abstract
Alterations in renal perfusion play a major role in the pathogenesis of renal diseases. Renal contrast-enhanced ultrasound (CEUS) is increasingly applied to quantify renal cortical perfusion and to assess its change over time, but comprehensive assessment of the technique’s repeatability is lacking. Ten adults attended two renal CEUS scans within 14 days. In each session, five destruction/reperfusion sequences were captured. One-phase association was performed to derive the following parameters: acoustic index (AI), mean transit time (mTT), perfusion index (PI), and wash-in rate (WiR). Intra-individual and inter-operator (image analysis) repeatability for the perfusion variables were assessed using intra-class correlation (ICC), with the agreement assessed using a Bland–Altman analysis. The 10 adults had a median (IQR) age of 39 years (30–46). Good intra-individual repeatability was found for mTT (ICC: 0.71) and PI (ICC: 0.65). Lower repeatability was found for AI (ICC: 0.50) and WiR (ICC: 0.56). The correlation between the two operators was excellent for all variables: the ICCs were 0.99 for PI, 0.98 for AI, 0.87 for mTT, and 0.83 for WiR. The Bland–Altman analysis showed that the mean biases (± SD) between the two operators were 0.03 ± 0.16 for mTT, 0.005 ± 0.09 for PI, 0.04 ± 0.19 for AI, and −0.02 ± 0.11 for WiR.
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Affiliation(s)
- Shatha J. Almushayt
- Centre for Kidney Research and Innovation (CKRI), University of Nottingham, Nottingham DE22 3DT, UK; (A.P.); (M.W.T.); (N.M.S.)
- Department of Renal Medicine, Derby Hospitals NHS Foundation Trust, Derby DE22 3DT, UK
- Correspondence:
| | - Alisa Pham
- Centre for Kidney Research and Innovation (CKRI), University of Nottingham, Nottingham DE22 3DT, UK; (A.P.); (M.W.T.); (N.M.S.)
- Department of Renal Medicine, Derby Hospitals NHS Foundation Trust, Derby DE22 3DT, UK
| | - Bethan E. Phillips
- MRC/Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Nottingham, Nottingham DE22 3DT, UK; (B.E.P.); (J.P.W.)
| | - John P. Williams
- MRC/Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Nottingham, Nottingham DE22 3DT, UK; (B.E.P.); (J.P.W.)
- Department of Surgery and Anaesthetics, Royal Derby Hospital, Derby DE22 3NE, UK
| | - Maarten W. Taal
- Centre for Kidney Research and Innovation (CKRI), University of Nottingham, Nottingham DE22 3DT, UK; (A.P.); (M.W.T.); (N.M.S.)
- Department of Renal Medicine, Derby Hospitals NHS Foundation Trust, Derby DE22 3DT, UK
| | - Nicholas M. Selby
- Centre for Kidney Research and Innovation (CKRI), University of Nottingham, Nottingham DE22 3DT, UK; (A.P.); (M.W.T.); (N.M.S.)
- Department of Renal Medicine, Derby Hospitals NHS Foundation Trust, Derby DE22 3DT, UK
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Ning Z, Chen S, Chen Z, Han H, Qiao H, Zhang N, Wang R, Shen R, Zhao X. Saturated multi-delay renal arterial spin labeling technique for simultaneous perfusion and T 1 quantification in kidneys. Magn Reson Med 2022; 88:1055-1067. [PMID: 35506512 DOI: 10.1002/mrm.29268] [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: 12/28/2021] [Revised: 03/22/2022] [Accepted: 03/24/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE To propose a free-breathing simultaneous multi-delay arterial spin labeling (ASL) and T1 mapping technique with a stepwise kinetic model for renal assessment in a single 4-min scan at 3 T. METHODS The proposed saturated multi-delay renal arterial spin labeling (SAMURAI) sequence used flow-sensitive alternating inversion recovery (FAIR) preparation, followed by acquisition of 9 images with Look-Locker spoiled gradient recalled echo (SPGR). Pre-saturation at the imaging slice was used to achieve saturation-based T1 mapping. A 4-step 2-compartment kinetic model was proposed to characterize water transition through artery- and tissue-compartment. The impact of the Look-Locker sampling scheme on the ASL signal was corrected in this model. T1 estimation with dictionary searching method and perfusion quantification based on the proposed kinetic model fitting were conducted after groupwise registration of the acquired images. The feasibility and repeatability of SAMURAI were validated in healthy subjects (n = 11) and patients with different renal diseases (n = 4). RESULTS The proposed SAMURAI technique can provide accurate T1 map with strong correlation (R2 = 0.98) with inversion recovery spin echo (IR-SE) on phantom. SAMURAI provided equally reliable whole kidney and cortical ASL and T1 quantification results compared with multi-TI FAIR (intraclass correlation coefficient [ICC], 0.880-0.958) and IR-SPGR (ICC, 0.875-0.912), respectively. Low renal blood flow and increased T1 were detected by SAMURAI in the affected kidneys of the patients. SAMURAI had excellent scan-rescan repeatability (ICC, 0.905-0.992) and significantly reduced scan time (4 min 6 s vs. 45 min for 9 TIs) compared to multi-TI FAIR. CONCLUSION The proposed SAMURAI technique is feasible and repeatable for simultaneously quantifying T1 and perfusion of kidneys with high time-efficiency.
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Affiliation(s)
- Zihan Ning
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China
| | - Shuo Chen
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China.,Tsinghua University-Peking University Joint Center for Life Sciences, Beijing, China
| | - Zhensen Chen
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China
| | - Hualu Han
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China
| | - Huiyu Qiao
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China.,Tsinghua University-Peking University Joint Center for Life Sciences, Beijing, China
| | - Nan Zhang
- Department of Radiology, Beijing Anzhen Hospital, Beijing, China
| | - Rui Wang
- Department of Radiology, Peking University First Hospital, Beijing, China
| | - Rui Shen
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China
| | - Xihai Zhao
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China
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36
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Chhabra J, Karwarker GV, Rajamanuri M, Maligireddy AR, Dai E, Chahal M, Mannava SM, Alfonso M. The Role of Arterial Spin Labeling Functional MRI in Assessing Perfusion Impairment of Renal Allografts: A Systematic Review. Cureus 2022; 14:e25428. [PMID: 35769679 PMCID: PMC9236280 DOI: 10.7759/cureus.25428] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 05/28/2022] [Indexed: 11/05/2022] Open
Abstract
Arterial spin labeling (ASL) is a functional magnetic resonance imaging (fMRI) technique that uses water in arterial blood as a tracer to map an area of interest where the intravascular and extravascular compartments exchange. Our review article focuses primarily on the role of ASL fMRI in assessing perfusion impairment in renal allografts in order to take appropriate steps to eliminate the cause of perfusion impairment at an early stage, thereby extending graft life. The study also highlights various other fMRI techniques that are used to analyze other parameters that affect kidney transplants both acutely and chronically. We gathered our data in accordance with the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and our search strategy included exclusion/inclusion criteria. Several databases were used in the search strategy, including PubMed, Cochrane, and Science Direct, and the Medical Subject Headings (MeSH) strategy was specifically used for PubMed, and two people scrutinized those papers to conclude that a total of 10 research papers are included in our study. This review article includes papers involving 20 to 98 subjects who had renal allografts within the previous six months and had renal cortical perfusion values measured by ASL fMRI ranging from 35 to 304 ml/100 g/min. Furthermore, when compared to healthy kidney transplant patients, renal ASL perfusion values were significantly lower in subjects with the functional imbalance of kidney transplants. It had a positive correlation with the estimated glomerular filtration rate (eGFR). To summarize, ASL fMRI is critical in detecting renal allograft perfusion impairment.
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Affiliation(s)
- Jayksh Chhabra
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | | | - Medha Rajamanuri
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Anand Reddy Maligireddy
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Eiman Dai
- Psychiatry, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Meher Chahal
- Psychiatry, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Sai Mahitha Mannava
- Pediatrics, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Michael Alfonso
- Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
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Srivastava A, Sridharan A, Walmer RW, Kasoji SK, Burke LM, Dayton PA, Johnson KA, Chang EH. Association of Contrast-Enhanced Ultrasound-Derived Kidney Cortical Microvascular Perfusion with Kidney Function. KIDNEY360 2022; 3:647-656. [PMID: 35721623 PMCID: PMC9136891 DOI: 10.34067/kid.0005452021] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 01/26/2022] [Indexed: 06/02/2023]
Abstract
BACKGROUND Individuals with chronic kidney disease (CKD) have decreased kidney cortical microvascular perfusion, which may lead to worsening kidney function over time, but methods to quantify kidney cortical microvascular perfusion are not feasible to incorporate into clinical practice. Contrast-enhanced ultrasound (CEUS) may quantify kidney cortical microvascular perfusion, which requires further investigation in individuals across the spectrum of kidney function. METHODS We performed CEUS on a native kidney of 83 individuals across the spectrum of kidney function and calculated quantitative CEUS-derived kidney cortical microvascular perfusion biomarkers. Participants had a continuous infusion of the microbubble contrast agent (Definity) with a flash-replenishment sequence during their CEUS scan. Lower values of the microbubble velocity (β) and perfusion index (β×A) may represent lower kidney cortical microvascular perfusion. Multivariable linear regression models tested the associations of the microbubble velocity (β) and perfusion index (β×A) with estimated glomerular filtration rate (eGFR). RESULTS Thirty-eight individuals with CKD (mean age±SD 65.2±12.6 years, median [IQR] eGFR 31.5 [18.9-41.5] ml/min per 1.73 m2), 37 individuals with end stage kidney disease (ESKD; age 54.8±12.3 years), and eight healthy volunteers (age 44.1±15.0 years, eGFR 117 [106-120] ml/min per 1.73 m2) underwent CEUS without side effects. Individuals with ESKD had the lowest microbubble velocity (β) and perfusion index (β×A) compared with individuals with CKD and healthy volunteers. The microbubble velocity (β) and perfusion index (β×A) had moderate positive correlations with eGFR (β: rs=0.44, P<0.001; β×A: rs=0.50, P<0.001). After multivariable adjustment, microbubble velocity (β) and perfusion index (β×A) remained significantly associated with eGFR (change in natural log transformed eGFR per 1 unit increase in natural log transformed biomarker: β, 0.38 [95%, CI 0.17 to 0.59]; β×A, 0.79 [95% CI, 0.45 to 1.13]). CONCLUSIONS CEUS-derived kidney cortical microvascular perfusion biomarkers are associated with eGFR. Future studies are needed to determine if CEUS-derived kidney cortical microvascular perfusion biomarkers have prognostic value.
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Affiliation(s)
- Anand Srivastava
- Division of Nephrology and Hypertension, Center for Translational Metabolism and Health, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Anush Sridharan
- Department of Radiology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Rachel W. Walmer
- Joint Department of Biomedical Engineering at North Carolina State University and the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Sandeep K. Kasoji
- Joint Department of Biomedical Engineering at North Carolina State University and the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Lauren M.B. Burke
- Deparatment of Radiology, University of North Carolina, Chapel Hill, North Carolina
| | - Paul A. Dayton
- Joint Department of Biomedical Engineering at North Carolina State University and the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Kennita A. Johnson
- Joint Department of Biomedical Engineering at North Carolina State University and the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Emily H. Chang
- University of North Carolina Kidney Center, Chapel Hill, North Carolina
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Multiparametric Functional MRI of the Kidney: Current State and Future Trends with Deep Learning Approaches. ROFO-FORTSCHR RONTG 2022; 194:983-992. [PMID: 35272360 DOI: 10.1055/a-1775-8633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Until today, assessment of renal function has remained a challenge for modern medicine. In many cases, kidney diseases accompanied by a decrease in renal function remain undetected and unsolved, since neither laboratory tests nor imaging diagnostics provide adequate information on kidney status. In recent years, developments in the field of functional magnetic resonance imaging with application to abdominal organs have opened new possibilities combining anatomic imaging with multiparametric functional information. The multiparametric approach enables the measurement of perfusion, diffusion, oxygenation, and tissue characterization in one examination, thus providing more comprehensive insight into pathophysiological processes of diseases as well as effects of therapeutic interventions. However, application of multiparametric fMRI in the kidneys is still restricted mainly to research areas and transfer to the clinical routine is still outstanding. One of the major challenges is the lack of a standardized protocol for acquisition and postprocessing including efficient strategies for data analysis. This article provides an overview of the most common fMRI techniques with application to the kidney together with new approaches regarding data analysis with deep learning. METHODS This article implies a selective literature review using the literature database PubMed in May 2021 supplemented by our own experiences in this field. RESULTS AND CONCLUSION Functional multiparametric MRI is a promising technique for assessing renal function in a more comprehensive approach by combining multiple parameters such as perfusion, diffusion, and BOLD imaging. New approaches with the application of deep learning techniques could substantially contribute to overcoming the challenge of handling the quantity of data and developing more efficient data postprocessing and analysis protocols. Thus, it can be hoped that multiparametric fMRI protocols can be sufficiently optimized to be used for routine renal examination and to assist clinicians in the diagnostics, monitoring, and treatment of kidney diseases in the future. KEY POINTS · Multiparametric fMRI is a technique performed without the use of radiation, contrast media, and invasive methods.. · Multiparametric fMRI provides more comprehensive insight into pathophysiological processes of kidney diseases by combining functional and structural parameters.. · For broader acceptance of fMRI biomarkers, there is a need for standardization of acquisition, postprocessing, and analysis protocols as well as more prospective studies.. · Deep learning techniques could significantly contribute to an optimization of data acquisition and the postprocessing and interpretation of larger quantities of data.. CITATION FORMAT · Zhang C, Schwartz M, Küstner T et al. Multiparametric Functional MRI of the Kidney: Current State and Future Trends with Deep Learning Approaches. Fortschr Röntgenstr 2022; DOI: 10.1055/a-1775-8633.
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van der Hoek S, Stevens J. Current Use and Complementary Value of Combining in Vivo Imaging Modalities to Understand the Renoprotective Effects of Sodium-Glucose Cotransporter-2 Inhibitors at a Tissue Level. Front Pharmacol 2022; 13:837993. [PMID: 35264970 PMCID: PMC8899288 DOI: 10.3389/fphar.2022.837993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 02/04/2022] [Indexed: 11/13/2022] Open
Abstract
Sodium-glucose cotransporter-2 inhibitors (SGLT2i) were initially developed to treat diabetes and have been shown to improve renal and cardiovascular outcomes in patients with- but also without diabetes. The mechanisms underlying these beneficial effects are incompletely understood, as is the response variability between- and within patients. Imaging modalities allow in vivo quantitative assessment of physiological, pathophysiological, and pharmacological processes at kidney tissue level and are therefore increasingly being used in nephrology. They provide unique insights into the renoprotective effects of SGLT2i and the variability in response and may thus contribute to improved treatment of the individual patient. In this mini-review, we highlight current work and opportunities of renal imaging modalities to assess renal oxygenation and hypoxia, fibrosis as well as interaction between SGLT2i and their transporters. Although every modality allows quantitative assessment of particular parameters of interest, we conclude that especially the complementary value of combining imaging modalities in a single clinical trial aids in an integrated understanding of the pharmacology of SGLT2i and their response variability.
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de Boer A, Villa G, Bane O, Bock M, Cox EF, Dekkers IA, Eckerbom P, Fernández‐Seara MA, Francis ST, Haddock B, Hall ME, Hall Barrientos P, Hermann I, Hockings PD, Lamb HJ, Laustsen C, Lim RP, Morris DM, Ringgaard S, Serai SD, Sharma K, Sourbron S, Takehara Y, Wentland AL, Wolf M, Zöllner FG, Nery F, Caroli A. Consensus-Based Technical Recommendations for Clinical Translation of Renal Phase Contrast MRI. J Magn Reson Imaging 2022; 55:323-335. [PMID: 33140551 PMCID: PMC9291014 DOI: 10.1002/jmri.27419] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 10/15/2020] [Accepted: 10/16/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Phase-contrast (PC) MRI is a feasible and valid noninvasive technique to measure renal artery blood flow, showing potential to support diagnosis and monitoring of renal diseases. However, the variability in measured renal blood flow values across studies is large, most likely due to differences in PC-MRI acquisition and processing. Standardized acquisition and processing protocols are therefore needed to minimize this variability and maximize the potential of renal PC-MRI as a clinically useful tool. PURPOSE To build technical recommendations for the acquisition, processing, and analysis of renal 2D PC-MRI data in human subjects to promote standardization of renal blood flow measurements and facilitate the comparability of results across scanners and in multicenter clinical studies. STUDY TYPE Systematic consensus process using a modified Delphi method. POPULATION Not applicable. SEQUENCE FIELD/STRENGTH Renal fast gradient echo-based 2D PC-MRI. ASSESSMENT An international panel of 27 experts from Europe, the USA, Australia, and Japan with 6 (interquartile range 4-10) years of experience in 2D PC-MRI formulated consensus statements on renal 2D PC-MRI in two rounds of surveys. Starting from a recently published systematic review article, literature-based and data-driven statements regarding patient preparation, hardware, acquisition protocol, analysis steps, and data reporting were formulated. STATISTICAL TESTS Consensus was defined as ≥75% unanimity in response, and a clear preference was defined as 60-74% agreement among the experts. RESULTS Among 60 statements, 57 (95%) achieved consensus after the second-round survey, while the remaining three showed a clear preference. Consensus statements resulted in specific recommendations for subject preparation, 2D renal PC-MRI data acquisition, processing, and reporting. DATA CONCLUSION These recommendations might promote a widespread adoption of renal PC-MRI, and may help foster the set-up of multicenter studies aimed at defining reference values and building larger and more definitive evidence, and will facilitate clinical translation of PC-MRI. LEVEL OF EVIDENCE 1 TECHNICAL EFFICACY STAGE: 1.
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Affiliation(s)
- Anneloes de Boer
- Department of RadiologyUniversity Medical Center Utrecht, Utrecht UniversityUtrechtThe Netherlands
| | - Giulia Villa
- Department of BioengineeringIstituto di Ricerche Farmacologiche Mario Negri IRCCSBergamoItaly
| | - Octavia Bane
- Biomedical Engineering and Imaging Institute/RadiologyIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Michael Bock
- Department of Radiology ‐ Medical Physics, Medical CenterUniversity of Freiburg, Faculty of Medicine, University of FreiburgFreiburgGermany
| | - Eleanor F. Cox
- Sir Peter Mansfield Imaging Centre, School of Physics and AstronomyUniversity of NottinghamNottinghamUK
| | - Ilona A. Dekkers
- Department of RadiologyLeiden University Medical CenterLeidenThe Netherlands
| | - Per Eckerbom
- Department of Surgical SciencesUppsala UniversityUppsalaSweden
| | | | - Susan T. Francis
- Sir Peter Mansfield Imaging Centre, School of Physics and AstronomyUniversity of NottinghamNottinghamUK
| | - Bryan Haddock
- Department of Clinical Physiology, Nuclear Medicine and PET, RigshospitaletCopenhagen University HospitalCopenhagenDenmark
| | - Michael E. Hall
- Department of MedicineUniversity of Mississippi Medical CenterJacksonMississippiUSA
| | | | - Ingo Hermann
- Computer Assisted Clinical Medicine, Mannheim Institute for Intelligent Systems in Medicine, Medical Faculty MannheimHeidelberg UniversityMannheimGermany
| | | | - Hildo J. Lamb
- Department of RadiologyLeiden University Medical CenterLeidenThe Netherlands
| | - Christoffer Laustsen
- Department of Clinical Medicine, MR Research CentreAarhus UniversityAarhusDenmark
| | - Ruth P. Lim
- Departments of Radiology, Surgery and MedicineThe University of MelbourneParkvilleVictoriaAustralia
- Department of RadiologyAustin HealthHeidelbergVictoriaAustralia
| | - David M. Morris
- Centre for Inflammation ResearchUniversity of Edinburgh, Edinburgh BioquarterEdinburghUK
| | - Steffen Ringgaard
- Department of Clinical Medicine, MR Research CentreAarhus UniversityAarhusDenmark
| | - Suraj D. Serai
- Department of RadiologyChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
| | - Kanishka Sharma
- Department of Imaging, Infection, Immunity and Cardiovascular DiseaseThe University of SheffieldSheffieldUK
| | - Steven Sourbron
- Department of Imaging, Infection, Immunity and Cardiovascular DiseaseThe University of SheffieldSheffieldUK
| | - Yasuo Takehara
- Department of Fundamental Development for Advanced Low Invasive Diagnostic ImagingNagoya University, Graduate School of MedicineNagoyaJapan
| | | | - Marcos Wolf
- High Field MR Center, Center for Medical Physics and Biomedical EngineeringMedical University of ViennaViennaAustria
| | - Frank G. Zöllner
- Computer Assisted Clinical Medicine, Mannheim Institute for Intelligent Systems in Medicine, Medical Faculty MannheimHeidelberg UniversityMannheimGermany
| | - Fabio Nery
- Developmental Imaging and Biophysics SectionUCL Great Ormond Street Institute of Child HealthLondonUK
| | - Anna Caroli
- Department of BioengineeringIstituto di Ricerche Farmacologiche Mario Negri IRCCSBergamoItaly
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Rankin AJ, Mayne K, Allwood-Spiers S, Hall Barrientos P, Roditi G, Gillis KA, Mark PB. Will advances in functional renal magnetic resonance imaging translate to the nephrology clinic? Nephrology (Carlton) 2021; 27:223-230. [PMID: 34724286 DOI: 10.1111/nep.13985] [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: 07/23/2021] [Revised: 10/01/2021] [Accepted: 10/09/2021] [Indexed: 11/28/2022]
Abstract
Characterizing structural and tissue abnormalities of the kidney is fundamental to understanding kidney disease. Functional multi-parametric renal magnetic resonance imaging (MRI) is a noninvasive imaging strategy whereby several sequences are employed within a single session to quantify renal perfusion, tissue oxygenation, fibrosis, inflammation, and oedema without using ionizing radiation. In this review, we discuss evidence surrounding its use in several clinical settings including acute kidney injury, chronic kidney disease, hypertension, polycystic kidney disease and around renal transplantation. Kidney size on MRI is already a validated measure for making therapeutic decisions in the setting of polycystic kidney disease. Functional MRI sequences, T1 mapping and apparent diffusion coefficient, can non-invasively quantify interstitial fibrosis and so may have a near-future role in the nephrology clinic to stratify the risk of progressive chronic kidney disease or transplant dysfunction. Beyond this, multi-parametric MRI may be used diagnostically, for example differentiating inflammatory versus ischaemic causes of renal dysfunction, but this remains to be proven. Changes in MRI properties of kidney parenchyma may be useful surrogate markers to use as end points in clinical trials to assess if drugs prevent renal fibrosis or alter kidney perfusion. Large, multi-centre studies of functional renal MRI are ongoing which aim to provide definitive answers as to its role in the management of patients with renal dysfunction.
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Affiliation(s)
- Alastair J Rankin
- Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, UK.,Glasgow Renal and Transplant Unit, Queen Elizabeth University Hospital, Glasgow, UK
| | - Kaitlin Mayne
- Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, UK.,Glasgow Renal and Transplant Unit, Queen Elizabeth University Hospital, Glasgow, UK
| | - Sarah Allwood-Spiers
- Department of Clinical Physics and Bioengineering, NHS Greater Glasgow & Clyde, Glasgow, UK
| | | | - Giles Roditi
- Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, UK.,Department of Radiology, NHS Greater Glasgow & Clyde, Glasgow, UK
| | - Keith A Gillis
- Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, UK.,Glasgow Renal and Transplant Unit, Queen Elizabeth University Hospital, Glasgow, UK
| | - Patrick B Mark
- Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, UK.,Glasgow Renal and Transplant Unit, Queen Elizabeth University Hospital, Glasgow, UK
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Hysi E, Kaur H, Young A. Evolving Medical Imaging Techniques for the Assessment of Delayed Graft Function: A Narrative Review. Can J Kidney Health Dis 2021; 8:20543581211048341. [PMID: 34707880 PMCID: PMC8544764 DOI: 10.1177/20543581211048341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 09/04/2021] [Indexed: 11/15/2022] Open
Abstract
Purpose of review Delayed graft function (DGF) is a significant complication that contributes to poorer graft function and shortened graft survival. In this review, we sought to evaluate the current and emerging role of medical imaging modalities in the assessment of DGF and how it may guide clinical management. Sources of information PubMed, Google Scholar, and ClinicalTrial.gov up until February 2021. Methods This narrative review first examined the pathophysiology of DGF and current clinical management. We then summarized relevant studies that utilized medical imaging to assess posttransplant renal complications, namely, DGF. We focused our attention on noninvasive, evolving imaging modalities with the greatest potential for clinical translation, including contrast-enhanced ultrasound (CEUS) and multiparametric magnetic resonance imaging (MRI). Key findings A kidney biopsy in the setting of DGF can be used to assess the degree of ischemic renal injury and to rule out acute rejection. Biopsies are accompanied by complications and may be limited by sampling bias. Early studies on CEUS and MRI have shown their potential to distinguish between the 2 most common causes of DGF (acute tubular necrosis and acute rejection), but they have generally included only small numbers of patients and have not kept pace with more recent technical advances of these imaging modalities. There remains unharnessed potential with CEUS and MRI, and more robust clinical studies are needed to better evaluate their role in the current era. Limitations The adaptation of emerging approaches for imaging DGF will depend on additional clinical trials to study the feasibility and diagnostic test characteristics of a given modality. This is limited by access to devices, technical competence, and the need for interdisciplinary collaborations to ensure that such studies are well designed to appropriately inform clinical decision-making.
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Affiliation(s)
- Eno Hysi
- Division of Nephrology, St. Michael's Hospital, Unity Health Toronto, ON, Canada.,Li Ka Shing Knowledge Institute, Keenan Research Centre for Biomedical Sciences, St. Michael's Hospital, Unity Health Toronto, ON, Canada
| | - Harmandeep Kaur
- Li Ka Shing Knowledge Institute, Keenan Research Centre for Biomedical Sciences, St. Michael's Hospital, Unity Health Toronto, ON, Canada
| | - Ann Young
- Division of Nephrology, St. Michael's Hospital, Unity Health Toronto, ON, Canada.,Li Ka Shing Knowledge Institute, Keenan Research Centre for Biomedical Sciences, St. Michael's Hospital, Unity Health Toronto, ON, Canada.,Division of Nephrology, Department of Medicine, University of Toronto, ON, Canada
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The utilization of positron emission tomography in the evaluation of renal health and disease. Clin Transl Imaging 2021. [DOI: 10.1007/s40336-021-00469-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Abstract
Purpose
Positron emission tomography (PET) is a nuclear imaging technique that uses radiotracers to visualize metabolic processes of interest across different organs, to diagnose and manage diseases, and monitor therapeutic response. This systematic review aimed to characterize the value of PET for the assessment of renal metabolism and function in subjects with non-oncological metabolic disorders.
Methods
This review was conducted and reported in accordance with the PRISMA statement. Research articles reporting “kidney” or “renal” metabolism evaluated with PET imaging between 1980 and 2021 were systematically searched in Medline/PubMed, Science Direct, and the Cochrane Library. Search results were exported and stored in RefWorks, the duplicates were removed, and eligible studies were identified, evaluated, and summarized.
Results
Thirty reports met the inclusion criteria. The majority of the studies were prospective (73.33%, n = 22) in nature. The most utilized PET radiotracers were 15O-labeled radio water (H215O, n = 14) and 18F-fluorodeoxyglucose (18F-FDG, n = 8). Other radiotracers used in at least one study were 14(R,S)-(18)F-fluoro-6-thia-heptadecanoic acid (18F-FTHA), 18F-Sodium Fluoride (18F-NaF), 11C-acetate, 68-Gallium (68Ga), 13N-ammonia (13N-NH3), Rubidium-82 (82Rb), radiolabeled cationic ferritin (RadioCF), 11C‐para-aminobenzoic acid (11C-PABA), Gallium-68 pentixafor (68Ga-Pentixafor), 2-deoxy-2-F-fluoro-d-sorbitol (F-FDS) and 55Co-ethylene diamine tetra acetic acid (55Co-EDTA).
Conclusion
PET imaging provides an effective modality for evaluating a range of metabolic functions including glucose and fatty acid uptake, oxygen consumption and renal perfusion. Multiple positron emitting radiolabeled racers can be used for renal imaging in clinical settings. PET imaging thus holds the potential to improve the diagnosis of renal disorders, and to monitor disease progression and treatment response.
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Bones IK, Bos C, Moonen C, Hendrikse J, van Stralen M. Workflow for automatic renal perfusion quantification using ASL-MRI and machine learning. Magn Reson Med 2021; 87:800-809. [PMID: 34672029 PMCID: PMC9297892 DOI: 10.1002/mrm.29016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 08/31/2021] [Accepted: 09/01/2021] [Indexed: 11/07/2022]
Abstract
PURPOSE Clinical applicability of renal arterial spin labeling (ASL) MRI is hampered because of time consuming and observer dependent post-processing, including manual segmentation of the cortex to obtain cortical renal blood flow (RBF). Machine learning has proven its value in medical image segmentation, including the kidneys. This study presents a fully automatic workflow for renal cortex perfusion quantification by including machine learning-based segmentation. METHODS Fully automatic workflow was achieved by construction of a cascade of 3 U-nets to replace manual segmentation in ASL quantification. All 1.5T ASL-MRI data, including M0 , T1 , and ASL label-control images, from 10 healthy volunteers was used for training (dataset 1). Trained cascade performance was validated on 4 additional volunteers (dataset 2). Manual segmentations were generated by 2 observers, yielding reference and second observer segmentations. To validate the intended use of the automatic segmentations, manual and automatic RBF values in mL/min/100 g were compared. RESULTS Good agreement was found between automatic and manual segmentations on dataset 1 (dice score = 0.78 ± 0.04), which was in line with inter-observer variability (dice score = 0.77 ± 0.02). Good agreement was confirmed on dataset 2 (dice score = 0.75 ± 0.03). Moreover, similar cortical RBF was obtained with automatic or manual segmentations, on average and at subject level; with 211 ± 31 mL/min/100 g and 208 ± 31 mL/min/100 g (P < .05), respectively, with narrow limits of agreement at -11 and 4.6 mL/min/100 g. RBF accuracy with automated segmentations was confirmed on dataset 2. CONCLUSION Our proposed method automates ASL quantification without compromising RBF accuracy. With quick processing and without observer dependence, renal ASL-MRI is more attractive for clinical application as well as for longitudinal and multi-center studies.
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Affiliation(s)
- Isabell K Bones
- Center for Image Sciences, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Clemens Bos
- Center for Image Sciences, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Chrit Moonen
- Center for Image Sciences, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jeroen Hendrikse
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marijn van Stralen
- Center for Image Sciences, University Medical Center Utrecht, Utrecht, The Netherlands
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Valentin B, Stabinska J, Reurik F, Tell C, Mewes AD, Müller-Lutz A, Antoch G, Rump LC, Wittsack HJ, Ljimani A. Feasibility of renal perfusion quantification by Fourier decomposition MRI. Magn Reson Imaging 2021; 85:3-9. [PMID: 34655728 DOI: 10.1016/j.mri.2021.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 09/19/2021] [Accepted: 10/10/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE To evaluate the feasibility of perfusion measurements in the human kidney by Fourier decomposition MRI (FD-MRI). METHODS Renal perfusion measurements by FD-MRI and arterial spin labeling (ASL) were performed using a 1.5 T whole-body MR-scanner (Magnetom Avanto, Siemens Healthineers AG, Germany) in 15 healthy volunteers (mean age 33.0 ± 13.6 years). Five healthy volunteers were measured twice to evaluate the reproducibility. Besides, five patients with renal artery stenosis (RAS) (mean age 58.4 ± 16.2 years) were included in the study to evaluate potential clinical use of the FD-MRI for evaluating renal perfusion. For renal FD-MRI, coronal 2D-TrueFisp sequence (1 section; section thickness: 10 mm; FOV: 400 × 400 mm 2; TR/TE: 2.06/0.89 ms; 250 images; 0,36 s/image), for renal ASL, coronal FAIR-TrueFisp sequence (1 section; section thickness: 10 mm; FOV: 400 × 400 mm2; TR/TE 4.0/2.0 ms, TI 1200 ms, 30 averages; 8,32 s/average) were acquired without any triggering. Perfusion parameter maps of the kidneys were calculated for both methods. After manual segmentation, ROI-based analysis (whole kidney, cortex and medulla, respectively) was performed and the results were subsequently compared using the Student t-test. RESULTS The acquisition times were 1.30 min and 4.16 min, for renal FD-MRI and ASL, respectively. No significant difference in global renal perfusion (RBF) between both methods was detected (mean RBF in the right kidney: 308.4 ± 31.5 mL/100 mL/min for FD-MRI; 315.2 ± 41.1 for ASL; in the left kidney: 315.6 ± 32.8 mL/100 mL/min for FD-MRI; 310.2 ± 39.1 mL/100 mL/min for ASL, respectively). The results indicated good reproducibility of both considered methods. However, cortico-medullar differentiation was not possible by FD-MRI, probably due to lower SNR compared to ASL. Significant difference in the side-separated RBF were measured by FD-MRI as well as by ASL (p < 0.05) in patients with RAS. CONCLUSIONS FD-MRI is a novel, rapid approach for contrast-free perfusion quantification in the human kidney. Main advantage of this new method compared to ASL perfusion is the significant shorter acquisition time and lower dependency on patient's compliance. However, lower SNR of FD-MRI needs further improvement to make FD-MRI a competitive alternative to ASL.
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Affiliation(s)
- B Valentin
- University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225 Dusseldorf, Germany
| | - J Stabinska
- University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225 Dusseldorf, Germany
| | - F Reurik
- University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225 Dusseldorf, Germany
| | - C Tell
- University Dusseldorf, Medical Faculty, Department of Nephrology, D-40225 Dusseldorf, Germany
| | - A D Mewes
- University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225 Dusseldorf, Germany
| | - A Müller-Lutz
- University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225 Dusseldorf, Germany
| | - G Antoch
- University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225 Dusseldorf, Germany
| | - L C Rump
- University Dusseldorf, Medical Faculty, Department of Nephrology, D-40225 Dusseldorf, Germany
| | - H J Wittsack
- University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225 Dusseldorf, Germany
| | - A Ljimani
- University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225 Dusseldorf, Germany.
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Thiel TA, Schweitzer J, Xia T, Bechler E, Valentin B, Steuwe A, Boege F, Westenfeld R, Wittsack HJ, Ljimani A. Evaluation of Radiographic Contrast-Induced Nephropathy by Functional Diffusion Weighted Imaging. J Clin Med 2021; 10:4573. [PMID: 34640591 PMCID: PMC8509538 DOI: 10.3390/jcm10194573] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 09/27/2021] [Accepted: 09/29/2021] [Indexed: 01/07/2023] Open
Abstract
Contrast-induced nephropathy (CIN) resembles an important complication of radiographic contrast medium (XCM) displayed by a rise in creatinine levels 48-72 h after XCM administration. The purpose of the current study was to evaluate microstructural renal changes due to CIN in high-risk patients by diffusion weighted (DWI) and diffusion tensor imaging (DTI). Fifteen patients (five CIN and ten non-CIN) scheduled for cardiological intervention were included in the study. All patients were investigated pre- and post-intervention on a clinical 3T scanner. After anatomical imaging, renal DWI was performed by a paracoronal echo-planar-imaging sequence. Renal clinical routine serum parameters and advanced urinary injury markers were determined to monitor renal function. We observed a drop in cortical and medullar apparent diffusion coefficient (ADC) and fractional anisotropy (FA) before and after XCM administration in the CIN group. In contrast, the non-CIN group differed only in medullary ADC. The decrease of ADC and FA was apparent even before serum parameters of the kidney changed. In conclusion, DWI/DTI may be a useful tool for monitoring high-risk CIN patients as part of multi-modality based clinical protocol. Further studies, including advanced analysis of the diffusion signal, may improve the identification of patients at risk for CIN.
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Affiliation(s)
- Thomas Andreas Thiel
- Department of Diagnostic and Interventional Radiology, Medical Faculty, Heinrich Heine University Dusseldorf, D-40225 Düsseldorf, Germany; (T.A.T.); (E.B.); (B.V.); (A.S.); (H.-J.W.)
| | - Julian Schweitzer
- Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, Heinrich Heine University Düsseldorf, D-40225 Düsseldorf, Germany; (J.S.); (R.W.)
| | - Taogetu Xia
- Institute of Clinical Chemistry and Laboratory Diagnostics, Medical Faculty, Heinrich Heine University Düsseldorf, D-40225 Düsseldorf, Germany; (T.X.); (F.B.)
| | - Eric Bechler
- Department of Diagnostic and Interventional Radiology, Medical Faculty, Heinrich Heine University Dusseldorf, D-40225 Düsseldorf, Germany; (T.A.T.); (E.B.); (B.V.); (A.S.); (H.-J.W.)
| | - Birte Valentin
- Department of Diagnostic and Interventional Radiology, Medical Faculty, Heinrich Heine University Dusseldorf, D-40225 Düsseldorf, Germany; (T.A.T.); (E.B.); (B.V.); (A.S.); (H.-J.W.)
| | - Andrea Steuwe
- Department of Diagnostic and Interventional Radiology, Medical Faculty, Heinrich Heine University Dusseldorf, D-40225 Düsseldorf, Germany; (T.A.T.); (E.B.); (B.V.); (A.S.); (H.-J.W.)
| | - Friedrich Boege
- Institute of Clinical Chemistry and Laboratory Diagnostics, Medical Faculty, Heinrich Heine University Düsseldorf, D-40225 Düsseldorf, Germany; (T.X.); (F.B.)
| | - Ralf Westenfeld
- Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, Heinrich Heine University Düsseldorf, D-40225 Düsseldorf, Germany; (J.S.); (R.W.)
| | - Hans-Jörg Wittsack
- Department of Diagnostic and Interventional Radiology, Medical Faculty, Heinrich Heine University Dusseldorf, D-40225 Düsseldorf, Germany; (T.A.T.); (E.B.); (B.V.); (A.S.); (H.-J.W.)
| | - Alexandra Ljimani
- Department of Diagnostic and Interventional Radiology, Medical Faculty, Heinrich Heine University Dusseldorf, D-40225 Düsseldorf, Germany; (T.A.T.); (E.B.); (B.V.); (A.S.); (H.-J.W.)
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47
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Malik PRV, Yeung CHT, Ismaeil S, Advani U, Djie S, Edginton AN. A Physiological Approach to Pharmacokinetics in Chronic Kidney Disease. J Clin Pharmacol 2021; 60 Suppl 1:S52-S62. [PMID: 33205424 DOI: 10.1002/jcph.1713] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 07/20/2020] [Indexed: 12/27/2022]
Abstract
The conventional approach to approximating the pharmacokinetics of drugs in patients with chronic kidney disease (CKD) only accounts for changes in the estimated glomerular filtration rate. However, CKD is a systemic and multifaceted disease that alters many body systems. Therefore, the objective of this exercise was to develop and evaluate a whole-body mechanistic approach to predicting pharmacokinetics in patients with CKD. Physiologically based pharmacokinetic models were developed in PK-Sim v8.0 (www.open-systems-pharmacology.org) to mechanistically represent the disposition of 7 compounds in healthy human adults. The 7 compounds selected were eliminated by glomerular filtration and active tubular secretion by the organic cation transport system to varying degrees. After a literature search, the healthy adult models were adapted to patients with CKD by numerically accounting for changes in glomerular filtration rate, kidney volume, renal perfusion, hematocrit, plasma protein concentrations, and gastrointestinal transit. Literature-informed interindividual variability was applied to the physiological parameters to facilitate a population approach. Model performance in CKD was evaluated against pharmacokinetic data from 8 clinical trials in the literature. Overall, integration of the CKD parameterization enabled exposure predictions that were within 1.5-fold error across all compounds and patients with varying stages of renal impairment. Notable improvement was observed over the conventional approach to scaling exposure, which failed in all but 1 scenario in patients with advanced CKD. Further research is required to qualify its use for first-in-CKD dose selection and clinical trial planning for a wider selection of renally eliminated compounds, including those subject to anion transport.
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Affiliation(s)
- Paul R V Malik
- School of Pharmacy, University of Waterloo, Kitchener, Ontario, Canada
| | - Cindy H T Yeung
- School of Pharmacy, University of Waterloo, Kitchener, Ontario, Canada
| | - Shams Ismaeil
- School of Pharmacy, University of Waterloo, Kitchener, Ontario, Canada
| | - Urooj Advani
- School of Pharmacy, University of Waterloo, Kitchener, Ontario, Canada
| | - Sebastian Djie
- School of Pharmacy, University of Waterloo, Kitchener, Ontario, Canada
| | - Andrea N Edginton
- School of Pharmacy, University of Waterloo, Kitchener, Ontario, Canada
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48
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Schutter R, Lantinga VA, Hamelink TL, Pool MBF, van Varsseveld OC, Potze JH, Hillebrands JL, van den Heuvel MC, Dierckx RAJO, Leuvenink HGD, Moers C, Borra RJH. Magnetic resonance imaging assessment of renal flow distribution patterns during ex vivo normothermic machine perfusion in porcine and human kidneys. Transpl Int 2021; 34:1643-1655. [PMID: 34448269 PMCID: PMC9290094 DOI: 10.1111/tri.13991] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 07/13/2021] [Accepted: 07/14/2021] [Indexed: 02/06/2023]
Abstract
Acceptance criteria of deceased donor organs have gradually been extended toward suboptimal quality, posing an urgent need for more objective pre‐transplant organ assessment. Ex vivo normothermic machine perfusion (NMP) combined with magnetic resonance imaging (MRI) could assist clinicians in deciding whether a donor kidney is suitable for transplantation. Aim of this study was to characterize the regional distribution of perfusate flow during NMP, to better understand how ex vivo kidney assessment protocols should eventually be designed. Nine porcine and 4 human discarded kidneys underwent 3 h of NMP in an MRI‐compatible perfusion setup. Arterial spin labeling scans were performed every 15 min, resulting in perfusion‐weighted images that visualize intrarenal flow distribution. At the start of NMP, all kidneys were mainly centrally perfused and it took time for the outer cortex to reach its physiological dominant perfusion state. Calculated corticomedullary ratios based on the perfusion maps reached a physiological range comparable to in vivo observations, but only after 1 to 2 h after the start of NMP. Before that, the functionally important renal cortex appeared severely underperfused. Our findings suggest that early functional NMP quality assessment markers may not reflect actual physiology and should therefore be interpreted with caution.
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Affiliation(s)
- Rianne Schutter
- Department of Surgery - Organ Donation and Transplantation, University of Groningen, University Medical Center, Groningen, The Netherlands
| | - Veerle A Lantinga
- Department of Surgery - Organ Donation and Transplantation, University of Groningen, University Medical Center, Groningen, The Netherlands
| | - Tim L Hamelink
- Department of Surgery - Organ Donation and Transplantation, University of Groningen, University Medical Center, Groningen, The Netherlands
| | - Merel B F Pool
- Department of Surgery - Organ Donation and Transplantation, University of Groningen, University Medical Center, Groningen, The Netherlands
| | - Otis C van Varsseveld
- Department of Surgery - Organ Donation and Transplantation, University of Groningen, University Medical Center, Groningen, The Netherlands
| | - Jan Hendrik Potze
- Department of Radiology, University of Groningen, University Medical Center, Groningen, The Netherlands
| | - Jan-Luuk Hillebrands
- Department of Pathology & Medical Biology, University of Groningen, University Medical Center, Groningen, The Netherlands
| | - Marius C van den Heuvel
- Department of Pathology & Medical Biology, University of Groningen, University Medical Center, Groningen, The Netherlands
| | - Rudi A J O Dierckx
- Department of Radiology, University of Groningen, University Medical Center, Groningen, The Netherlands.,Department of Nuclear Medicine, University of Groningen, University Medical Center, Groningen, The Netherlands
| | - Henri G D Leuvenink
- Department of Surgery - Organ Donation and Transplantation, University of Groningen, University Medical Center, Groningen, The Netherlands
| | - Cyril Moers
- Department of Surgery - Organ Donation and Transplantation, University of Groningen, University Medical Center, Groningen, The Netherlands
| | - Ronald J H Borra
- Department of Radiology, University of Groningen, University Medical Center, Groningen, The Netherlands.,Department of Nuclear Medicine, University of Groningen, University Medical Center, Groningen, The Netherlands
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49
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Martín-Noguerol T, Kirsch CFE, Montesinos P, Luna A. Arterial spin labeling for head and neck lesion assessment: technical adjustments and clinical applications. Neuroradiology 2021; 63:1969-1983. [PMID: 34427708 DOI: 10.1007/s00234-021-02772-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 07/12/2021] [Indexed: 12/21/2022]
Abstract
PURPOSE Despite, currently, "state-of-the-art" magnetic resonance imaging (MRI) protocols for head and neck (H&N) lesion assessment incorporate perfusion sequences, these acquisitions require the intravenous injection of exogenous gadolinium-based contrast agents (GBCAs), which may have potential risks. Alternative techniques such as arterial spin labeling (ASL) can provide quantitative microvascular information similar to conventional perfusion sequences for H&N lesions evaluation, as a potential alternative without GBCA administration. METHODS We review the existing literature and analyze the latest evidence regarding ASL in H&N area highlighting the technical adjustments needed for a proper ASL acquisition in this challenging region for lesion characterization, treatment monitoring, and tumor recurrence detection. RESULTS ASL techniques, widely used for central nervous system lesions evaluation, can be also applied to the H&N region. Technical adjustments, especially regarding post-labeling delay, are mandatory to obtain robust and reproducible results. Several studies have demonstrated the feasibility of ASL in the H&N area including the orbits, skull base, paranasal sinuses, upper airway, salivary glands, and thyroid. CONCLUSION ASL is a feasible technique for the assessment of H&N lesions without the need of GBCAs. This manuscript reviews ASL's physical basis, emphasizing the technical adjustments necessary for proper ASL acquisition in this unique and challenging anatomical region, and the main applications in evaluating H&N lesions.
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Affiliation(s)
| | - Claudia F E Kirsch
- Department of Radiology, Northwell Health, Zucker Hofstra School of Medicine At Northwell, North Shore University Hospital, 300 Community Drive, Manhasset, NY, 11030, USA
| | - Paula Montesinos
- Philips Iberia, Calle de María de Portugal, 1, 28050, Madrid, Spain
| | - Antonio Luna
- MRI Unit, Radiology Department, HT Medica, Carmelo Torres 2, 23007, Jaén, Spain
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50
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Alhummiany BA, Shelley D, Saysell M, Olaru MA, Kühn B, Buckley DL, Bailey J, Wroe K, Coupland C, Mansfield MW, Sourbron SP, Sharma K. Bias and Precision in Magnetic Resonance Imaging-Based Estimates of Renal Blood Flow: Assessment by Triangulation. J Magn Reson Imaging 2021; 55:1241-1250. [PMID: 34397124 DOI: 10.1002/jmri.27888] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 07/31/2021] [Accepted: 08/03/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Renal blood flow (RBF) can be measured with dynamic contrast enhanced-MRI (DCE-MRI) and arterial spin labeling (ASL). Unfortunately, individual estimates from both methods vary and reference-standard methods are not available. A potential solution is to include a third, arbitrating MRI method in the comparison. PURPOSE To compare RBF estimates between ASL, DCE, and phase contrast (PC)-MRI. STUDY TYPE Prospective. POPULATION Twenty-five patients with type-2 diabetes (36% female) and five healthy volunteers (HV, 80% female). FIELD STRENGTH/SEQUENCES A 3 T; gradient-echo 2D-DCE, pseudo-continuous ASL (pCASL) and cine 2D-PC. ASSESSMENT ASL, DCE, and PC were acquired once in all patients. ASL and PC were acquired four times in each HV. RBF was estimated and split-RBF was derived as (right kidney RBF)/total RBF. Repeatability error (RE) was calculated for each HV, RE = 1.96 × SD, where SD is the standard deviation of repeat scans. STATISTICAL TESTS Paired t-tests and one-way analysis of variance (ANOVA) were used for statistical analysis. The 95% confidence interval (CI) for difference between ASL/PC and DCE/PC was assessed using two-sample F-test for variances. Statistical significance level was P < 0.05. Influential outliers were assessed with Cook's distance (Di > 1) and results with outliers removed were presented. RESULTS In patients, the mean RBF (mL/min/1.73m2 ) was 618 ± 62 (PC), 526 ± 91 (ASL), and 569 ± 110 (DCE). Differences between measurements were not significant (P = 0.28). Intrasubject agreement was poor for RBF with limits-of-agreement (mL/min/1.73m2 ) [-687, 772] DCE-ASL, [-482, 580] PC-DCE, and [-277, 460] PC-ASL. The difference PC-ASL was significantly smaller than PC-DCE, but this was driven by a single-DCE outlier (P = 0.31, after removing outlier). The difference in split-RBF was comparatively small. In HVs, mean RE (±95% CI; mL/min/1.73 m2 ) was significantly smaller for PC (79 ± 41) than for ASL (241 ± 85). CONCLUSIONS ASL, DCE, and PC RBF show poor agreement in individual subjects but agree well on average. Triangulation with PC suggests that the accuracy of ASL and DCE is comparable. EVIDENCE LEVEL 2 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
| | - David Shelley
- Department of Biomedical Imaging Sciences, University of Leeds, Leeds, UK.,Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Margaret Saysell
- Department of Biomedical Imaging Sciences, University of Leeds, Leeds, UK.,Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | - Bernd Kühn
- Siemens Healthcare GmbH, Erlangen, Germany
| | - David L Buckley
- Department of Biomedical Imaging Sciences, University of Leeds, Leeds, UK
| | | | - Kelly Wroe
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | | | - Steven P Sourbron
- Department of Imaging, Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, UK
| | - Kanishka Sharma
- Department of Imaging, Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, UK
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