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Gilani N, Mikheev A, Brinkmann IM, Kumbella M, Babb JS, Basukala D, Wetscherek A, Benkert T, Chandarana H, Sigmund EE. Spatial profiling of in vivo diffusion-weighted MRI parameters in the healthy human kidney. MAGMA 2024:10.1007/s10334-024-01159-6. [PMID: 38703246 DOI: 10.1007/s10334-024-01159-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 01/17/2024] [Accepted: 03/26/2024] [Indexed: 05/06/2024]
Abstract
OBJECTIVE Diffusion-weighted MRI is a technique that can infer microstructural and microcirculatory features from biological tissue, with particular application to renal tissue. There is extensive literature on diffusion tensor imaging (DTI) of anisotropy in the renal medulla, intravoxel incoherent motion (IVIM) measurements separating microstructural from microcirculation effects, and combinations of the two. However, interpretation of these features and adaptation of more specific models remains an ongoing challenge. One input to this process is a whole organ distillation of corticomedullary contrast of diffusion metrics, as has been explored for other renal biomarkers. MATERIALS AND METHODS In this work, we probe the spatial dependence of diffusion MRI metrics with concentrically layered segmentation in 11 healthy kidneys at 3 T. The metrics include those from DTI, IVIM, a combined approach titled "REnal Flow and Microstructure AnisotroPy (REFMAP)", and a multiply encoded model titled "FC-IVIM" providing estimates of fluid velocity and branching length. RESULTS Fractional anisotropy decreased from the inner kidney to the outer kidney with the strongest layer correlation in both parenchyma (including cortex and medulla) and medulla with Spearman correlation coefficients and p-values (r, p) of (0.42, <0.001) and (0.37, <0.001), respectively. Also, dynamic parameters derived from the three models significantly decreased with a high correlation from the inner to the outer parenchyma or medulla with (r, p) ranges of (0.46-0.55, <0.001). CONCLUSIONS These spatial trends might find implications for indirect assessments of kidney physiology and microstructure using diffusion MRI.
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Affiliation(s)
- Nima Gilani
- Department of Radiology, Center for Advanced Imaging Innovation and Research (CAI2R), Center for Biomedical Imaging, NYU Langone Health, New York, USA.
| | - Artem Mikheev
- Department of Radiology, Center for Advanced Imaging Innovation and Research (CAI2R), Center for Biomedical Imaging, NYU Langone Health, New York, USA
| | | | - Malika Kumbella
- Department of Radiology, Center for Advanced Imaging Innovation and Research (CAI2R), Center for Biomedical Imaging, NYU Langone Health, New York, USA
| | - James S Babb
- Department of Radiology, Center for Advanced Imaging Innovation and Research (CAI2R), Center for Biomedical Imaging, NYU Langone Health, New York, USA
| | - Dibash Basukala
- Department of Radiology, Center for Advanced Imaging Innovation and Research (CAI2R), Center for Biomedical Imaging, NYU Langone Health, New York, USA
| | - Andreas Wetscherek
- Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK
| | - Thomas Benkert
- MR Application Predevelopment, Siemens Healthcare GmbH, Erlangen, Germany
| | - Hersh Chandarana
- Department of Radiology, Center for Advanced Imaging Innovation and Research (CAI2R), Center for Biomedical Imaging, NYU Langone Health, New York, USA
| | - Eric E Sigmund
- Department of Radiology, Center for Advanced Imaging Innovation and Research (CAI2R), Center for Biomedical Imaging, NYU Langone Health, New York, USA
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Kaul I, Moore S, Barry E, Pareek G. Renal Imaging in Stone Disease: Which Modality to Choose? R I Med J (2013) 2023; 106:31-35. [PMID: 38015782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
Numerous imaging modalities are available to the provider when diagnosing or surveilling kidney stones. The decision to order one over the other can be nuanced and especially confusing to non-urologic practitioners. This manuscript reviews the main modalities used to image stones in the modern era - renal bladder ultrasound, Kidney Ureter Bladder plain film radiography (KUB), magnetic resonance imaging (MRI), and non-contrast computerized tomography (NCCT). While NCCT has become the most popular and familiar modality for most practitioners, particularly in the acute setting, ultrasound is a cost-effective technology that is adept at monitoring interval stone development in patients and evaluating for the presence of hydronephrosis. KUB and MRI also occupy unique niches in the management of urolithiasis. In the correct clinical setting, each of these modalities has a role in the acute workup and management of suspected nephrolithiasis.
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Affiliation(s)
- Iha Kaul
- Urology Resident, Division of Urology, Department of Surgery, Warren Alpert Medical School of Brown University
| | - Sarah Moore
- Urology Resident, Division of Urology, Department of Surgery, Warren Alpert Medical School of Brown University
| | - Emily Barry
- Urology Resident, Division of Urology, Department of Surgery, Warren Alpert Medical School of Brown University
| | - Gyan Pareek
- Chief of Urology, Division of Urology, Department of Surgery, Warren Alpert Medical School of Brown University
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DeFreitas MJ, Katsoufis CP, Infante JC, Granda ML, Abitbol CL, Fornoni A. The old becomes new: advances in imaging techniques to assess nephron mass in children. Pediatr Nephrol 2021; 36:517-525. [PMID: 31953750 DOI: 10.1007/s00467-020-04477-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 12/09/2019] [Accepted: 01/08/2020] [Indexed: 12/19/2022]
Abstract
Renal imaging is widely used in the assessment of surrogate markers of nephron mass correlated to renal function. Autopsy studies have tested the validity of various imaging modalities in accurately estimating "true" nephron mass. However, in vivo assessment of nephron mass has been largely limited to kidney volume determination by ultrasonography (US) in pediatric populations. Practical limitations and risks create challenges in incorporating more precise 3D volumetric imaging, like magnetic resonance imaging (MRI), and computed tomography (CT) technologies, compared to US for routine kidney volume assessment in children. Additionally, accounting for structural anomalies such as hydronephrosis when estimating renal parenchymal area in congenital anomalies of the kidney and urinary tract (CAKUT) is important, as it correlates with chronic kidney disease (CKD) progression. 3D imaging using CT and MRI has been shown to be superior to US, which has traditionally relied on 2D measurements to estimate kidney volume using the ellipsoid calculation. Recent innovations using 3D and contrast-enhanced US (CEUS) provide improved accuracy with low risk. Indexing kidney volume to body surface area in children is an important standard that may allow early detection of CKD progression in high-risk populations. This review highlights current understanding of various imaging modalities in assessing nephron mass, discusses applications and limitations, and describes recent advances in the field of imaging and kidney disease. Although renal imaging has been a long-standing, essential tool in assessing kidney disease, innovation and new applications of established technologies provide important tools in the study and management of kidney disease in children.
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Affiliation(s)
- Marissa J DeFreitas
- Division of Pediatric Nephrology, University of Miami Miller School of Medicine, P.O. Box 016960 (M714), Miami, FL, 33130, USA.
| | - Chryso P Katsoufis
- Division of Pediatric Nephrology, University of Miami Miller School of Medicine, P.O. Box 016960 (M714), Miami, FL, 33130, USA
| | - Juan C Infante
- Section of Pediatric Radiology, Department of Diagnostic Radiology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Michael L Granda
- Division of General Internal Medicine, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Carolyn L Abitbol
- Division of Pediatric Nephrology, University of Miami Miller School of Medicine, P.O. Box 016960 (M714), Miami, FL, 33130, USA
| | - Alessia Fornoni
- Katz Family Division of Nephrology and Hypertension, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
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Abstract
PURPOSE OF REVIEW In recent years, there has been renewed interest in the use of contrast-enhanced ultrasound (CEUS) in abdominal imaging and intervention. The goal of this article is to review the practical applications of CEUS in the kidney, including renal mass characterization, treatment monitoring during and after percutaneous ablation, and biopsy guidance. RECENT FINDINGS Current evidence suggests that CEUS allows accurate differentiation of solid and cystic renal masses and is an acceptable alternative to either computed tomography (CT) or magnetic resonance imaging (MRI) for characterization of indeterminate renal masses. CEUS is sensitive and specific for diagnosing residual or recurrent renal cell carcinoma (RCC) following percutaneous ablation. Furthermore, given its excellent spatial and temporal resolution, CEUS is well suited to demonstrate tumoral microvascularity associated with malignant renal masses and is an effective complement to conventional grayscale ultrasound (US) for percutaneous biopsy guidance. Currently underutilized, CEUS is an important problem-solving tool in renal imaging and intervention whose role will continue to expand in coming years.
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Alaini A, Malhotra D, Rondon-Berrios H, Argyropoulos CP, Khitan ZJ, Raj DSC, Rohrscheib M, Shapiro JI, Tzamaloukas AH. Establishing the presence or absence of chronic kidney disease: Uses and limitations of formulas estimating the glomerular filtration rate. World J Methodol 2017; 7:73-92. [PMID: 29026688 PMCID: PMC5618145 DOI: 10.5662/wjm.v7.i3.73] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 05/17/2017] [Accepted: 05/30/2017] [Indexed: 02/06/2023] Open
Abstract
The development of formulas estimating glomerular filtration rate (eGFR) from serum creatinine and cystatin C and accounting for certain variables affecting the production rate of these biomarkers, including ethnicity, gender and age, has led to the current scheme of diagnosing and staging chronic kidney disease (CKD), which is based on eGFR values and albuminuria. This scheme has been applied extensively in various populations and has led to the current estimates of prevalence of CKD. In addition, this scheme is applied in clinical studies evaluating the risks of CKD and the efficacy of various interventions directed towards improving its course. Disagreements between creatinine-based and cystatin-based eGFR values and between eGFR values and measured GFR have been reported in various cohorts. These disagreements are the consequence of variations in the rate of production and in factors, other than GFR, affecting the rate of removal of creatinine and cystatin C. The disagreements create limitations for all eGFR formulas developed so far. The main limitations are low sensitivity in detecting early CKD in several subjects, e.g., those with hyperfiltration, and poor prediction of the course of CKD. Research efforts in CKD are currently directed towards identification of biomarkers that are better indices of GFR than the current biomarkers and, particularly, biomarkers of early renal tissue injury.
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Affiliation(s)
- Ahmed Alaini
- Division of Nephrology, Department of Medicine, University of New Mexico School of Medicine, Albuquerque, NM 87131, United States
| | - Deepak Malhotra
- Division of Nephrology, Department of Medicine, University of Toledo School of Medicine, Toledo, OH 43614-5809, United States
| | - Helbert Rondon-Berrios
- Renal and Electrolyte Division, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA 15260, United States
| | - Christos P Argyropoulos
- Division of Nephrology, Department of Medicine, University of New Mexico School of Medicine, Albuquerque, NM 87131, United States
| | - Zeid J Khitan
- Division of Nephrology, Department of Medicine, Joan C. Edwards School of Medicine, Huntington, WV 25701, United States
| | - Dominic S C Raj
- Division of Nephrology, Department of Medicine, George Washington University, Washington, DC 20037, United States
| | - Mark Rohrscheib
- Division of Nephrology, Department of Medicine, University of New Mexico School of Medicine, Albuquerque, NM 87131, United States
| | - Joseph I Shapiro
- Marshall University Joan C. Edwards School of Medicine, Huntington, WV 25701, United States
| | - Antonios H Tzamaloukas
- Nephrology Section, Medicine Service, Raymond G. Murphy VA Medical Center, Albuquerque, NM 87108, United States
- Department of Medicine, University of New Mexico School of Medicine, Albuquerque, NM 87108, United States
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Winfree S, Khan S, Micanovic R, Eadon MT, Kelly KJ, Sutton TA, Phillips CL, Dunn KW, El-Achkar TM. Quantitative Three-Dimensional Tissue Cytometry to Study Kidney Tissue and Resident Immune Cells. J Am Soc Nephrol 2017; 28:2108-2118. [PMID: 28154201 DOI: 10.1681/asn.2016091027] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 12/29/2016] [Indexed: 12/11/2022] Open
Abstract
Analysis of the immune system in the kidney relies predominantly on flow cytometry. Although powerful, the process of tissue homogenization necessary for flow cytometry analysis introduces bias and results in the loss of morphologic landmarks needed to determine the spatial distribution of immune cells. An ideal approach would support three-dimensional (3D) tissue cytometry: an automated quantitation of immune cells and associated spatial parameters in 3D image volumes collected from intact kidney tissue. However, widespread application of this approach is limited by the lack of accessible software tools for digital analysis of large 3D microscopy data. Here, we describe Volumetric Tissue Exploration and Analysis (VTEA) image analysis software designed for efficient exploration and quantitative analysis of large, complex 3D microscopy datasets. In analyses of images collected from fixed kidney tissue, VTEA replicated the results of flow cytometry while providing detailed analysis of the spatial distribution of immune cells in different regions of the kidney and in relation to specific renal structures. Unbiased exploration with VTEA enabled us to discover a population of tubular epithelial cells that expresses CD11C, a marker typically expressed on dendritic cells. Finally, we show the use of VTEA for large-scale quantitation of immune cells in entire human kidney biopsies. In summary, we show that VTEA is a simple and effective tool that supports unique digital interrogation and analysis of kidney tissue from animal models or biobanked human kidney biopsies. We have made VTEA freely available to interested investigators via electronic download.
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Affiliation(s)
- Seth Winfree
- Division of Nephrology, Department of Medicine and
| | - Shehnaz Khan
- Division of Nephrology, Department of Medicine and
| | | | | | | | | | - Carrie L Phillips
- Department of Pathology, Indiana University School of Medicine, Indianapolis, Indiana; and
| | | | - Tarek M El-Achkar
- Division of Nephrology, Department of Medicine and .,Department of Medicine, Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana
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Lamin E, Smith ZL, Ramchandani P, Coronel M, Mucksavage P. Intrarenal Splenosis Diagnosed in an Incidentally Found Left Renal Mass. Urol Case Rep 2015; 3:132-4. [PMID: 26793528 PMCID: PMC4672665 DOI: 10.1016/j.eucr.2015.06.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 06/08/2015] [Accepted: 06/18/2015] [Indexed: 12/02/2022] Open
Abstract
Intrarenal splenosis is very rare and its management is not well established. We present a patient in whom an enhancing left renal mass was incidentally detected on a Computerized tomographic (CT) scan, concerning for renal cell carcinoma. However, the lesion was determined to represent intrarenal splenosis, confirmed by Technetium-99m (99mTc) sulfur colloid scan and percutaneous biopsy, which revealed splenic tissue. This multimodal approach to diagnosis of an unusual condition spared the patient an invasive procedure.
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Affiliation(s)
- Eliza Lamin
- Division of Urology, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Zachary L Smith
- Division of Urology, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Parvati Ramchandani
- Genitourinary Section, Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Misti Coronel
- Department of Pathology, Pennsylvania Hospital, Philadelphia, PA, USA
| | - Phillip Mucksavage
- Division of Urology, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
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Silva-Rodríguez J, Cortés J, Pardo-Montero J, Pérez-Fentes D, Herranz M, Ruibal Á, Aguiar P. In vivo quantification of renal function in mice using clinical gamma cameras. Phys Med 2015; 31:242-7. [PMID: 25726477 DOI: 10.1016/j.ejmp.2015.01.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Revised: 01/21/2015] [Accepted: 01/22/2015] [Indexed: 10/23/2022] Open
Abstract
INTRODUCTION In preclinical research, the growing number of transgenic models has led to the need for renal-function studies in mice. Many efforts have been made to develop dedicated SPECT systems for rodents, but their availability is limited due to high capital costs. The aim of this work is to demonstrate the feasibility of mouse renal imaging by using an inexpensive alternative based on clinical gamma-cameras. METHODS A healthy mouse was scanned 3 h after injection of 6 mCi of Dimercaptosuccinic acid (DMSA) labeled with 99mTc by using a single-head gamma-camera in conjunction with a dedicated pinhole collimator. List-mode data were binned to emulate multiple injections of 1 mCi, 0.1 mCi and 0.01 mCi of 99mTc-DMSA and 6-min ventral and dorsal planar images were acquired and SPECT imaging (60 projection images acquired over 60 min) was performed. An optimization of the protocols in terms of injected activity, time scan, renal cortex uniformity and cortex-to-pelvis contrast was carried out. RESULTS The appropriate protocols were an injected activity of 0.6 mCi, combined with duration of scanning of 1 min for planar and 60 min for SPECT imaging. Our results were validated through the relative quantification of renal function, which showed that both kidneys contributed equally to the total function. They showed that functional structures of the mouse kidneys can be visually distinguished as easily as in human studies. CONCLUSIONS Our findings showed the feasibility of conducting quantitative DMSA SPECT studies of anesthetized mice on clinical gamma cameras.
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Affiliation(s)
- Jesús Silva-Rodríguez
- L2A2, University of Santiago de Compostela, Santiago de Compostela, Spain; Molecular Imaging Group, IDIS Health Research Institute, Santiago de Compostela, Spain; Nuclear Medicine Dept, University Hospital of Santiago (CHUS), Santiago de Compostela, Spain
| | - Julia Cortés
- Molecular Imaging Group, IDIS Health Research Institute, Santiago de Compostela, Spain; Nuclear Medicine Dept, University Hospital of Santiago (CHUS), Santiago de Compostela, Spain
| | - Juan Pardo-Montero
- Molecular Imaging Group, IDIS Health Research Institute, Santiago de Compostela, Spain; Medical Physics Dept, University Hospital of Santiago (CHUS), Santiago de Compostela, Spain
| | - Daniel Pérez-Fentes
- Molecular Imaging Group, IDIS Health Research Institute, Santiago de Compostela, Spain; Urology Dept, University Hospital of Santiago (CHUS), Santiago de Compostela, Spain
| | - Michel Herranz
- Molecular Imaging Group, IDIS Health Research Institute, Santiago de Compostela, Spain; Nuclear Medicine Dept, University Hospital of Santiago (CHUS), Santiago de Compostela, Spain; Galaria Cyclotron Unit, Santiago de Compostela, Spain
| | - Álvaro Ruibal
- Molecular Imaging Group, IDIS Health Research Institute, Santiago de Compostela, Spain; Nuclear Medicine Dept, University Hospital of Santiago (CHUS), Santiago de Compostela, Spain; In-vivo Molecular Imaging Group, Dept. of Psychiatry, Radiology and Public Health, University of Santiago de Compostela (USC), Santiago de Compostela, Spain
| | - Pablo Aguiar
- Molecular Imaging Group, IDIS Health Research Institute, Santiago de Compostela, Spain; Nuclear Medicine Dept, University Hospital of Santiago (CHUS), Santiago de Compostela, Spain; In-vivo Molecular Imaging Group, Dept. of Psychiatry, Radiology and Public Health, University of Santiago de Compostela (USC), Santiago de Compostela, Spain.
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Abstract
Urinary tract infection (UTI) in an infant may be the first indication of an underlying renal disorder. Early recognition and initiation of adequate therapy for UTI is important to reduce the risk of long-term renal scarring. Ampicillin and gentamicin are traditionally the empiric treatment of choice; however, local antibiotic resistance patterns should be considered. Maternal antibiotics during pregnancy also increase the risk of resistant pathogens during neonatal UTI. Long-term management after the first UTI in infants remains controversial because of lack of specific studies in this age group and the risk-benefit issues for antibiotic prophylaxis between reduced recurrent disease and emergent antibiotic resistance.
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