1
|
Lal H, Singh P, Ponmalai K, Prasad R, Singh SP, Yadav P, Singh A, Bhadauria D, Kumar S, Agarwal V, Mishra P. Role of blood oxygen level-dependent magnetic resonance imaging in studying renal oxygenation changes in renal artery stenosis. Abdom Radiol (NY) 2022; 47:1112-1123. [PMID: 35059812 DOI: 10.1007/s00261-022-03408-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 12/31/2021] [Accepted: 01/05/2022] [Indexed: 11/29/2022]
Abstract
AIM Primary objective of this study was to compare R2* value of the post-stenotic kidney with contralateral kidney, kidneys of essential hypertensive patients, and healthy subjects using blood oxygen level-dependent magnetic resonance imaging (BOLD MRI) technique. The secondary objective was to study the effect of severity of stenosis and viability of kidneys on R2* value. METHODS We compared 4 groups of kidneys including 92 with renal artery stenosis, 37 normal contralateral kidneys of unilateral renal artery stenosis patients, 62 kidneys of essential hypertensive patients, and 40 kidneys of healthy controls using BOLD MRI. Deoxyhemoglobin level represented by R2* was calculated before and after giving furosemide and was compared among different groups. RESULTS Baseline means cortical R2* value did not differ between groups. Response to furosemide was reduced in stenotic kidneys as compared to essential hypertensive and healthy control groups (p < 0.001). The mean R2* value of the contralateral normal kidney group was not significantly different from the stenotic group. Baseline R2* value and delta R2* values did not differ between different degrees of stenosis. Higher mean cortical R2* was seen in stenotic kidneys which were small (< 7 cm) in size (24.27 ± 5.65 vs 21.7 ± 3.88; p value 0.02) or with poor corticomedullary differentiation (24.64 ± 5.8 vs 20.74 ± 3.34; p value 0.006) as compared to other stenotic kidneys. Similarly, the delta R2* value was also blunted in these small shrunken kidneys (p value < 0.001). CONCLUSION R2* values on BOLD MRI are significantly different between kidneys with and without renal artery stenosis and can potentially also predict the utility of revascularization.
Collapse
Affiliation(s)
- Hira Lal
- Department of Radiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareli Road, Lucknow, U.P., 226014, India.
- Department of Radiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raibareli Road, Lucknow, Uttar Pradesh, 226014, India.
| | - Priya Singh
- Department of Radiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareli Road, Lucknow, U.P., 226014, India
| | - Kaushik Ponmalai
- Department of Radiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareli Road, Lucknow, U.P., 226014, India
| | - Raghunandan Prasad
- Department of Radiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareli Road, Lucknow, U.P., 226014, India
| | - Surya Pratap Singh
- Department of Radiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareli Road, Lucknow, U.P., 226014, India
| | - Priyank Yadav
- Department of Urology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareli Road, Lucknow, U.P., 226014, India
| | - Anuradha Singh
- Department of Radiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareli Road, Lucknow, U.P., 226014, India
| | - Dharmendra Bhadauria
- Department of Nephrology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareli Road, Lucknow, U.P., 226014, India
| | - Sudeep Kumar
- Department of Cardiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareli Road, Lucknow, U.P., 226014, India
| | - Vikas Agarwal
- Department of Immunology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareli Road, Lucknow, U.P., 226014, India
| | - Prabhakar Mishra
- Department of Biostatistics and Health Informatics, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raibareli Road, Lucknow, U.P., 226014, India
| |
Collapse
|
2
|
Effects of low-dose oxygen administration on renal blood oxygenation level-dependent MRI in children with glomerulonephritis. MAGMA (NEW YORK, N.Y.) 2021; 34:823-831. [PMID: 34275036 DOI: 10.1007/s10334-021-00945-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 07/07/2021] [Accepted: 07/12/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Children are often sedated for renal blood oxygenation level-dependent (BOLD) magnetic resonance imaging (MRI) and may require low-dose oxygen administration. It is unclear whether low-dose oxygen administration affects results of BOLD MRI. We investigated the effect of low-dose oxygen administration on renal BOLD MRI and its variation by the presence or absence of renal disease. MATERIALS AND METHODS We retrospectively examined children undergoing MRI for renal disease between 2013 and 2020. Patients were divided into glomerulonephritis and non-glomerulonephritis groups; spin relaxation time (T2*) was determined using a 3.0 T MRI system. RESULTS The study included 10 children (5 patients in each group); patient characteristics between the groups did not differ significantly. In the entire cohort, oxygen administration reduced mean spin relaxation rate (R2*) value in the medulla (p < 0.04). The mean R2* value decreased with oxygen administration in the non-glomerulonephritis group, whereas this was not observed in the glomerulonephritis group. The responses to oxygen administration of the two groups differed significantly in the cortex (p < 0.05) and medulla (p < 0.02). DISCUSSION Low-dose oxygen administration affects the results of BOLD MRI. We suggest that understanding the fluctuations due to oxygen administration is useful in monitoring the disease activity of glomerulonephritis.
Collapse
|
3
|
Detection of renal hypoxia configuration in patients with lupus nephritis: a primary study using blood oxygen level-dependent MR imaging. Abdom Radiol (NY) 2021; 46:2032-2044. [PMID: 33079255 DOI: 10.1007/s00261-020-02794-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 09/15/2020] [Accepted: 09/27/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Renal microstructure and function are closely associated with oxygenation homeostasis. Analyzing renal blood oxygen level‒dependent (BOLD) magnetic resonance imaging (MRI) examination results will provide information on the biological status of the kidneys. The current study was performed to explore the hypoxia mode of the entire renal parenchyma in patients with lupus nephritis (LN). METHODS A total of 23 adult patients with LN and 18 healthy volunteers were recruited. R2* values were acquired using BOLD MRI analysis. The narrow rectangular region of interest was used to explore the hypoxia configuration in entire depths of renal parenchyma. Acquired sequential R2* data were fitted using four categories of mathematic functions. The tendency of R2* data in both patients with LN and healthy volunteers was also compared using repeated-measures analysis of variance. RESULTS R2* data from the superficial cortex to deep medulla displayed two patterns called a sharp uptrend style and a flat uptrend style. After sequential R2* data were fitted individually with the use of four mathematic formulas, the multiple-compartment Gaussian function showed the highest goodness of fit. Compared with two categories of R2* value styles, the R2* tendency of entire parenchyma in patients with LN was different from that in healthy volunteers. CONCLUSIONS Deep renal medullary oxygenation was not always overtly lower than oxygenation in the superficial renal cortical zone. The manifestation of renal parenchyma oxygenation could be described using a Gaussian function model. Deoxygenation tolerance was damaged in patients with LN.
Collapse
|
4
|
Non-invasive evaluation of renal structure and function of healthy individuals with multiparametric MRI: Effects of sex and age. Sci Rep 2019; 9:10661. [PMID: 31337796 PMCID: PMC6650480 DOI: 10.1038/s41598-019-46996-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 07/09/2019] [Indexed: 02/07/2023] Open
Abstract
Clinically, when applying multiparametric magnetic resonance imaging (MRI) examinations in renal diseases, assessment of renal structure and function has to account for age- and sex-related effects. The aim of this study was to investigate the influence of age and sex on multiparametric MRI assessment of renal structure and function in healthy human beings. Studies on 33 healthy volunteers were performed using multiparametric MRI on a 3.0-Tesla MR scanner, including T1-weighted imaging, blood oxygen level-dependent MRI (BOLD MRI), diffusion-weighted imaging (DWI) and diffusion tensor imaging (DTI). Our results revealed that the mean renal cortical thickness (RCT), ratio of cortex to parenchyma (CPR), and cortical R2* values were higher in males than in females. The cortical R2* value was higher in older group than in younger group (18.57 ± 0.99 vs 17.53 ± 0.58, p = 0.001); there was no significant difference in medullary R2* between the older and younger groups (38.18 ± 2.96 vs 36.45 ± 2.47, p = 0.077). The parenchymal thickness (PT) and medullary fractional anisotropy (FA) were lower in older group than in younger group (1.547 ± 0.06 vs 1.604 ± 0.05, p = 0.005 and 0.343 ± 0.03 vs 0.371 ± 0.03, p = 0.016, respectively). Pearson's correlation analysis showed that PT and medullary FA were inversely related with age (r = -0.483, p = 0.004; r = -0.446, p = 0.009) while cortical R2* values was positively related (r = 0.511, p = 0.002, respectively). The medullary apparent diffusion coefficient (ADC) value had a significant association with PT (r = 0.359, p = 0.04). This study indicated that multiparametric renal MRI parameters are age and sex dependent.
Collapse
|
5
|
Chen F, Li S, Sun D. Methods of Blood Oxygen Level-Dependent Magnetic Resonance Imaging Analysis for Evaluating Renal Oxygenation. Kidney Blood Press Res 2018. [PMID: 29539614 DOI: 10.1159/000488072] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Blood oxygen level-dependent magnetic resonance imaging (BOLD MRI) has recently been utilized as a noninvasive tool for evaluating renal oxygenation. Several methods have been proposed for analyzing BOLD images. Regional ROI selection is the earliest and most widely used method for BOLD analysis. In the last 20 years, many investigators have used this method to evaluate cortical and medullary oxygenation in patients with ischemic nephropathy, hypertensive nephropathy, diabetic nephropathy, chronic kidney disease (CKD), acute kidney injury and renal allograft rejection. However, clinical trials of BOLD MRI using regional ROI selection revealed that it was difficult to distinguish the renal cortico-medullary zones with this method, and that it was susceptible to observer variability. To overcome these deficiencies, several new methods were proposed for analyzing BOLD images, including the compartmental approach, fractional hypoxia method, concentric objects (CO) method and twelve-layer concentric objects (TLCO) method. The compartmental approach provides an algorithm to judge whether the pixel belongs to the cortex or medulla. Fractional kidney hypoxia, measured by using BOLD MRI, was negatively correlated with renal blood flow, tissue perfusion and glomerular filtration rate (GFR) in patients with atherosclerotic renal artery stenosis. The CO method divides the renal parenchyma into six or twelve layers of thickness in each coronal slice of BOLD images and provides a R2* radial profile curve. The slope of the R2* curve associated positively with eGFR in CKD patients. Indeed, each method invariably has advantages and disadvantages, and there is generally no consensus method so far. Undoubtedly, analytic approaches for BOLD MRI with better reproducibility would assist clinicians in monitoring the degree of kidney hypoxia and thus facilitating timely reversal of tissue hypoxia.
Collapse
Affiliation(s)
- Fen Chen
- Department of Nephrology, Xuzhou Medical University, Xuzhou, China
| | - Shulin Li
- Department of Nephrology, Xuzhou Medical University, Xuzhou, China.,Department of Nephrology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Dong Sun
- Department of Nephrology, Xuzhou Medical University, Xuzhou, China.,Department of Nephrology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| |
Collapse
|
6
|
Daloul R, Morrison AR. Approach to atherosclerotic renovascular disease: 2016. Clin Kidney J 2016; 9:713-21. [PMID: 27679718 PMCID: PMC5036906 DOI: 10.1093/ckj/sfw079] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 07/20/2016] [Indexed: 12/20/2022] Open
Abstract
The management of atherosclerotic renal artery stenosis in patients with hypertension or impaired renal function remains a clinical dilemma. The current general consensus, supported by the results of the Angioplasty and Stenting for Renal Atherosclerotic Lesions and Cardiovascular Outcomes for Renal Artery Lesions trials, argues strongly against endovascular intervention in favor of optimal medical management. We discuss the limitations and implications of the contemporary clinical trials and present our approach and formulate clear recommendations to help with the management of patients with atherosclerotic narrowing of the renal artery.
Collapse
Affiliation(s)
- Reem Daloul
- Renal Division, Department of Internal Medicine , Washington University School of Medicine , 660 South Euclid, Box 8126, St Louis, MO 63110 , USA
| | - Aubrey R Morrison
- Renal Division, Department of Internal Medicine , Washington University School of Medicine , 660 South Euclid, Box 8126, St Louis, MO 63110 , USA
| |
Collapse
|