Assessment of the kidneys: magnetic resonance angiography, perfusion and diffusion

Dynamic contrast-enhanced MRI promotes early detection of toxin-induced acute kidney injury

Acute kidney injury (AKI) is a common cause of morbidity and mortality in hospitalized patients. Nevertheless, there is limited ability to diagnose AKI in its earliest stages through the collection of structural and functional information. Magnetic resonance imaging (MRI) is increasingly being used to provide structural and functional data that characterize the injured kidney. Dynamic contrast-enhanced (DCE) MRI is an imaging modality with robust spatial and temporal resolution; however, its ability to detect changes in kidney function following AKI has not been determined. We hypothesized that DCE MRI would detect a prolongation in contrast transit time following toxin-induced AKI earlier than commonly used serum and tissue biomarkers. To test our hypothesis, we injected mice with either vehicle or cisplatin (30 mg/kg) and performed DCE MRI at multiple time points. We found that commonly used kidney injury biomarkers, including creatinine, blood urea nitrogen, and neutrophil gelatinase-associated lipocalin, did not rise until day 2 following cisplatin. Tissue levels of the proinflammatory cytokines and chemokines, tumor necrosis factor-α, interleukin (IL)-1β, IL-1α, IL-6, C-C motif chemokine ligand 2, and C-X-C motif chemokine ligand 2 similarly did not upregulate until day 2 following cisplatin. However, the time to peak intensity of contrast in the renal collecting system was already prolonged at day 1 following cisplatin compared with vehicle-treated mice. This intensity change mirrored changes in kidney injury as measured by histological analysis and in transporter expression in the proximal tubule. Taken together, DCE MRI is a promising preclinical imaging modality that is useful for assessing functional capacity of the kidney in the earliest stages following AKI.

The Performance of Noncontrast Magnetic Resonance Angiography in Detecting Renal Artery Stenosis as Compared With Contrast Enhanced Magnetic Resonance Angiography Using Conventional Angiography as a Reference

OBJECTIVE

The aims of this study were to evaluate the performance of noncontrast magnetic resonance angiography (NC MRA) for detecting renal artery stenosis (RAS) as compared with contrast-enhanced magnetic resonance angiography (CE MRA) and to evaluate the clinical feasibility, technical success rate, and performance of NC MRA for detecting RAS as compared with CE MRA.

METHODS

Thirty-six subjects who underwent NC MRA and/or CE MRA were enrolled. Feasibility, technical success rate, and image quality scores were compared. Diagnostic ability was calculated using conventional angiography as a reference.

RESULTS

Noncontrast MRA had higher feasibility and technical success rates than CE MRA did (100% and 97.2% vs 83.3% and 90%, respectively). Noncontrast MRA yielded significantly better image quality in motion artifact (P = 0.016). The diagnostic ability for detecting RAS is without significant difference between NC MRA and CE MRA.

CONCLUSION

Although NC MRA and CE MRA demonstrated comparable ability in diagnosing RAS, NC MRA achieved better technical success rates, feasibility, and image quality in motion artifacts than CE MRA did.

Quantitative high-resolution renal perfusion imaging using 3-dimensional through-time radial generalized autocalibrating partially parallel acquisition

OBJECTIVES

Dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) examinations of the kidneys provide quantitative information on renal perfusion and filtration. However, these examinations are often difficult to implement because of respiratory motion and their need for a high spatiotemporal resolution and 3-dimensional coverage. Here, we present a free-breathing quantitative renal DCE-MRI examination acquired with a highly accelerated stack-of-stars trajectory and reconstructed with 3-dimensional (3D) through-time radial generalized autocalibrating partially parallel acquisition (GRAPPA), using half and quarter doses of gadolinium contrast.

MATERIALS AND METHODS

Data were acquired in 10 asymptomatic volunteers using a stack-of-stars trajectory that was undersampled in-plane by a factor of 12.6 with respect to Nyquist sampling criterion and using partial Fourier of 6/8 in the partition direction. Data had a high temporal (2.1-2.9 seconds per frame) and spatial (approximately 2.2 mm) resolution with full 3D coverage of both kidneys (350-370 mm × 79-92 mm). Images were successfully reconstructed with 3D through-time radial GRAPPA, and interframe respiratory motion was compensated by using an algorithm developed to automatically use images from multiple points of enhancement as references for registration. Quantitative pharmacokinetic analysis was performed using a separable dual-compartment model.

RESULTS

Region-of-interest (ROI) pharmacokinetic analysis provided estimates (mean (SD)) of quantitative renal parameters after a half dose: 218.1 (57.1) mL/min per 100 mL; plasma mean transit time, 4.8 (2.2) seconds; renal filtration, 28.7 (10.0) mL/min per 100 mL; and tubular mean transit time, 131.1 (60.2) seconds in 10 kidneys. The ROI pharmacokinetic analysis provided estimates (mean (SD)) of quantitative renal parameters after a quarter dose: 218.1 (57.1) mL/min per 100 mL; plasma mean transit time, 4.8 (2.2) seconds; renal filtration, 28.7 (10.0) mL/min per 100 mL; and tubular mean transit time, 131.1 (60.2) seconds in the 10 kidneys. Three-dimensional pixelwise parameter maps were also evaluated.

CONCLUSIONS

Highly undersampled data were successfully reconstructed with 3D through-time radial GRAPPA to achieve a high-resolution 3-dimensional renal DCE-MRI examination. The acquisition was completely free breathing, and the images were registered to compensate for respiratory motion. This allowed for an accurate high-resolution 3D quantitative renal functional mapping of perfusion and filtration parameters.

New magnetic resonance imaging methods in nephrology

Established as a method to study anatomic changes, such as renal tumors or atherosclerotic vascular disease, magnetic resonance imaging (MRI) to interrogate renal function has only recently begun to come of age. In this review, we briefly introduce some of the most important MRI techniques for renal functional imaging, and then review current findings on their use for diagnosis and monitoring of major kidney diseases. Specific applications include renovascular disease, diabetic nephropathy, renal transplants, renal masses, acute kidney injury, and pediatric anomalies. With this review, we hope to encourage more collaboration between nephrologists and radiologists to accelerate the development and application of modern MRI tools in nephrology clinics.

Review of Journal of Cardiovascular Magnetic Resonance 2012

There were 90 articles published in the Journal of Cardiovascular Magnetic Resonance (JCMR) in 2012, which is an 8% increase in the number of articles since 2011. The quality of the submissions continues to increase. The editors are delighted to report that the 2011 JCMR Impact Factor (which is published in June 2012) has risen to 4.44, up from 3.72 for 2010 (as published in June 2011), a 20% increase. The 2011 impact factor means that the JCMR papers that were published in 2009 and 2010 were cited on average 4.44 times in 2011. The impact factor undergoes natural variation according to citation rates of papers in the 2 years following publication, and is significantly influenced by highly cited papers such as official reports. However, the progress of the journal's impact over the last 5 years has been impressive. Our acceptance rate is approximately 25%, and has been falling as the number of articles being submitted has been increasing. In accordance with Open-Access publishing, the JCMR articles go on-line as they are accepted with no collating of the articles into sections or special thematic issues. For this reason, the Editors have felt that it is useful once per calendar year to summarize the papers for the readership into broad areas of interest or theme, so that areas of interest can be reviewed in a single article in relation to each other and other recent JCMR articles. The papers are presented in broad themes and set in context with related literature and previously published JCMR papers to guide continuity of thought in the journal. We hope that you find the open-access system increases wider reading and citation of your papers, and that you will continue to send your quality manuscripts to JCMR for publication.

Review of Journal of Cardiovascular Magnetic Resonance 2011

There were 83 articles published in the Journal of Cardiovascular Magnetic Resonance (JCMR) in 2011, which is an 11% increase in the number of articles since 2010. The quality of the submissions continues to increase. The editors had been delighted with the 2010 JCMR Impact Factor of 4.33, although this fell modestly to 3.72 for 2011. The impact factor undergoes natural variation according to citation rates of papers in the 2 years following publication, and is significantly influenced by highly cited papers such as official reports. However, we remain very pleased with the progress of the journal's impact over the last 5 years. Our acceptance rate is approximately 25%, and has been falling as the number of articles being submitted has been increasing. In accordance with Open-Access publishing, the JCMR articles go on-line as they are accepted with no collating of the articles into sections or special thematic issues. For this reason, the Editors feel it is useful to summarize the papers for the readership into broad areas of interest or theme, which we feel would be useful, so that areas of interest from the previous year can be reviewed in a single article in relation to each other and other recent JCMR articles. The papers are presented in broad themes and set in context with related literature and previously published JCMR papers to guide continuity of thought in the journal. We hope that you find the open-access system increases wider reading and citation of your papers, and that you will continue to send your quality manuscripts to JCMR for publication.

Management of acute kidney injury

Acute kidney injury is common in hospitalized children and is associated with siginficant morbidity and mortality especially in critically ill children. A complete evaluation is necessary for all children with AKI as early recognition and treatment is paramount. Apart from clinical evaluation, urinalysis, biochemical investigations and imaging studies helps in the diagnosis of the specific cause of AKI and assessing its severity. Attention should be given to assessment of volume status and fluid administration because volume depletion is a common and modifiable risk factor for AKI. Prevention or prompt management of complications like fliud overload, hyperkalemia and metabolic acidosis improves outcomes. Immediate initiation of renal replacement therapy (RRT) is indicated in the presence of life threatening changes in fluid, electrolyte and acid-base balance. Other measures like treating the underlying cause of AKI, adapting dosage of drugs to renal function, treatment of infections and providing adequate nutrition is important. Children with AKI should be followed up as they are at risk for development of chronic kidney disease.