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Zhou H, Si Y, Sun J, Deng J, Yang L, Tang Y, Qin W. Effectiveness of functional magnetic resonance imaging for early identification of chronic kidney disease: A systematic review and network meta-analysis. Eur J Radiol 2023; 160:110694. [PMID: 36642011 DOI: 10.1016/j.ejrad.2023.110694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 01/04/2023] [Accepted: 01/09/2023] [Indexed: 01/13/2023]
Abstract
PURPOSE The commonly used clinical indicators are not sensitive enough on detecting early chronic kidney disease (CKD), whether functional magnetic resonance imaging (fMRI) can be regarded as a new noninvasive method to identify early stages of CKD and even different stages remains unknown. We performed a network meta-analysis to explore the question. METHODS Five databases were searched to identify eligible articles from 2000 to 2022. The outcome indicators were imaging biomarkers of fMRI techniques, including apparent diffusion coefficient (ADC) by diffusion-weighted imaging (DWI), fractional anisotropy (FA) by diffusion tensor imaging (DTI), diffusion coefficient (D), pseudodiffusion coefficient (D*), and perfusion fraction (f) by intravoxel incoherent motion imaging (IVIM), and apparent relaxation rate (R2*) by blood oxygen level-dependent (BOLD). RESULTS A total of 21 articles with 1472 patients were included for analysis. Cortical FA, f, and R2* values in CKD stages 1-2 were found statistically different with healthy controls (mean difference (MD), -0.03, 95% confidence interval (CI) -0.05, -0.01; MD, -0.04, 95% CI -0.06, -0.02; MD, 2.22, 95% CI 0.87, 3.57, respectively), and cortical ADC values were significantly different among different CKD stages (stages 3 and 1-2: MD, -0.15, 95% CI -0.23, -0.06; stages 4-5 and 3: MD -0.27, 95% CI -0.39, -0.14). CONCLUSION The results indicated fMRI techniques had great efficacy in assessing early stages and different stages of CKD, among which DTI, IVIM, and BOLD exerted great superiority in differentiating early CKD patients from the general population, while DWI showed the advantage in distinguishing different CKD stages.
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Affiliation(s)
- Huan Zhou
- Division of Nephrology, Department of Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China; West China School of Medicine, Sichuan University, Chengdu, Sichuan, China.
| | - Yi Si
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
| | - Jiantong Sun
- West China School of Medicine, Sichuan University, Chengdu, Sichuan, China.
| | - Jiaxin Deng
- West China School of Medicine, Sichuan University, Chengdu, Sichuan, China.
| | - Ling Yang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
| | - Yi Tang
- Division of Nephrology, Department of Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China; West China School of Medicine, Sichuan University, Chengdu, Sichuan, China.
| | - Wei Qin
- Division of Nephrology, Department of Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China; West China School of Medicine, Sichuan University, Chengdu, Sichuan, China.
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Das CJ, Kubihal V, Kumar S, Agarwal SK, Dinda AK, Sreenivas V. Assessment of renal allograft rejection with diffusion tensor imaging. Br J Radiol 2023; 96:20220722. [PMID: 36607279 PMCID: PMC9975367 DOI: 10.1259/bjr.20220722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 11/07/2022] [Accepted: 12/12/2022] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVES To investigate the value of DTI in differentiation of renal allograft rejection from well-functioning stable allograft, using fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values. METHODS In this prospective study, 22 transplant recipients with well-functioning stable allograft (group A) and 20 patients with renal allograft rejection (group B + C) were recruited over a period of 19 months from January 2018 to July 2019. DTI-MRI was performed in all the patients, and FA and ADC values were measured in cortical and medullary regions of the transplanted kidney. On biopsy, graft rejection was classified as acute (group B) (n = 7) and chronic graft rejection (group C) (n = 13) based on the BANNF scoring system. Statistical analysis was performed using STATA v.14.0. RESULTS Statistically significant difference between group A and group B + C was noted for cortical (p < 0.001), and medullary (p = 0.003) FA values, and cortical (p = 0.020), and medullary (p = 0.046) ADC values. Cortical(p < 0.001) and Medullary(p = 0.020) FA values showed statistically significant difference between group A and group C, and cortical FA value(p = 0.012) also showed statistically significant difference between group B and group C. AUC (to differentiate between renal allograft rejection and well-functioning stable allograft) for cortical, and medullary FA values and cortical and medullary ADC values were 0.853(p < 0.001), 0.757(p = 0.004), 0.709(p = 0.021) and 0.736(p = 0.009), respectively. CONCLUSION AND ADVANCES IN KNOWLEDGE DTI is a promising functional MRI technique for the non-invasive assessment of renal allograft function. Diffusion parameters, such as FA and ADC values, can be useful in the differentiation of renal allograft rejection from well-functioning stable allograft.
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Affiliation(s)
- Chandan Jyoti Das
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Vijay Kubihal
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Sambuddha Kumar
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjay Kumar Agarwal
- Department of Nephrology, All India Institute of Medical Sciences, New Delhi, India
| | - Amit Kumar Dinda
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
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Borrelli P, Zacchia M, Cavaliere C, Basso L, Salvatore M, Capasso G, Aiello M. Diffusion tensor imaging for the study of early renal dysfunction in patients affected by bardet-biedl syndrome. Sci Rep 2021; 11:20855. [PMID: 34675323 PMCID: PMC8531379 DOI: 10.1038/s41598-021-00394-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 10/11/2021] [Indexed: 11/28/2022] Open
Abstract
Kidney structural abnormalities are common features of Bardet-Biedl syndrome (BBS) patients that lead to a progressive decline in renal function. Magnetic resonance diffusion tensor imaging (DTI) provides useful information on renal microstructures but it has not been applied to these patients. This study investigated using DTI to detect renal abnormalities in BBS patients with no overt renal dysfunction. Ten BBS subjects with estimated glomerular filtration rates over 60 ml/min/1.73m2 and 14 individuals matched for age, gender, body mass index and renal function were subjected to high-field DTI. Fractional anisotropy (FA), and mean, radial and axial diffusivity were evaluated from renal cortex and medulla. Moreover, the corticomedullary differentiation of each DTI parameter was compared between groups. Only cortical FA statistically differed between BBS patients and controls (p = 0.033), but all the medullary DTI parameters discriminated between the two groups with lower FA (p < 0.001) and axial diffusivity (p = 0.021) and higher mean diffusivity (p = 0.043) and radial diffusivity (p < 0.001) in BBS patients compared with controls. Corticomedullary differentiation values were significantly reduced in BBS patients. Thus, DTI is a valuable tool for investigating microstructural alterations in renal disorders when kidney functionality is preserved.
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Affiliation(s)
| | - Miriam Zacchia
- Department of Medical and Translational Sciences, University of Campania L. Vanvitelli, Naples, Italy
| | | | - Luca Basso
- IRCCS SDN, Via Emanuele Gianturco 113, 80131, Naples, Italy
| | | | - Giovambattista Capasso
- Department of Medical and Translational Sciences, University of Campania L. Vanvitelli, Naples, Italy.,Biogem, Research Institute for Molecular Biology and Genetics, Ariano Irpino, Italy
| | - Marco Aiello
- IRCCS SDN, Via Emanuele Gianturco 113, 80131, Naples, Italy
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Mani LY, Seif M, Nikles F, Tshering Vogel DW, Diserens G, Martirosian P, Burnier M, Vogt B, Vermathen P. Hip Position Acutely Affects Oxygenation and Perfusion of Kidney Grafts as Measured by Functional Magnetic Resonance Imaging Methods-The Bent Knee Study. Front Med (Lausanne) 2021; 8:697055. [PMID: 34447762 PMCID: PMC8384256 DOI: 10.3389/fmed.2021.697055] [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: 04/18/2021] [Accepted: 07/12/2021] [Indexed: 12/16/2022] Open
Abstract
Background: Kidney perfusion and oxygenation are two important determinants of kidney graft function. In kidney transplantation, repeated graft hypoperfusion may occur during hip flexion, for example in the sitting position, due to the progressive development of fibrotic tissue around iliac arteries. The aim of this study was to assess the changes in oxygenation and perfusion of kidney grafts during hip flexion and extension using a new functional magnetic resonance imaging (fMRI) protocol. Methods: Nineteen kidney graft recipients prospectively underwent MRI on a 3T scanner including diffusion-weighted, blood oxygenation level dependent (BOLD), and arterial spin labeling sequences in hip positions 0° and >90° before and after intravenous administration of 20 mg furosemide. Results: Unexpectedly, graft perfusion values were significantly higher in flexed compared to neutral hip position. Main diffusion-derived parameters were not affected by hip position. BOLD-derived cortico-medullary R2* ratio was significantly modified during hip flexion suggesting an intrarenal redistribution of the oxygenation in favor of the medulla and to the detriment of the cortex. Furthermore, the increase in medullary oxygenation induced by furosemide was significantly blunted during hip flexion (p < 0.001). Conclusion: Hip flexion has an acute impact on perfusion and tissue oxygenation in kidney grafts. Whether these position-dependent changes affect the long-term function and outcome of kidney transplants needs further investigation.
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Affiliation(s)
- Laila-Yasmin Mani
- Department of Nephrology and Hypertension, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Maryam Seif
- Departments of Biomedical Research and Radiology, University of Bern, Bern, Switzerland.,Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Florence Nikles
- Departments of Biomedical Research and Radiology, University of Bern, Bern, Switzerland
| | - Dechen W Tshering Vogel
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Gaëlle Diserens
- Departments of Biomedical Research and Radiology, University of Bern, Bern, Switzerland
| | - Petros Martirosian
- Section on Experimental Radiology, University of Tübingen, Tübingen, Germany
| | - Michel Burnier
- Service of Nephrology and Hypertension, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Bruno Vogt
- Department of Nephrology and Hypertension, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Peter Vermathen
- Departments of Biomedical Research and Radiology, University of Bern, Bern, Switzerland
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Diffusion tensor imaging of renal cortex in lupus nephritis. Jpn J Radiol 2021; 39:1069-1076. [PMID: 34125367 DOI: 10.1007/s11604-021-01154-0] [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: 04/20/2021] [Accepted: 06/08/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE To evaluate the diagnostic value of diffusion tensor imaging (DTI) of renal cortex in assessment of lupus nephritis (LN) and prediction of its pathological subtypes. METHODS Prospective study was performed upon 39 female patients with pathologically proven LN and 16 sex- and age-matched healthy controls. Patients and controls underwent DTI of kidney. Mean diffusivity (MD) and fractional anisotropy (FA) of renal cortex were calculated by two radiologists. LN patients were pathologically classified into either non-proliferative (n = 15) or proliferative (n = 24). RESULTS Mean MD of renal cortex in LN was significantly lower (p = 0.001) than that of controls with cut-off (2.16 and 2.2 X10-3mm2/s), area under curve (AUC) of (0.92, 0.94) and accuracy of (91%, 89%) for both observers. Mean FA of renal cortex in LN was significantly higher (p = 0.001) than that of controls with cut-off (0.20, 0.21), AUC of (0.86, 0.82) and accuracy of (86%, 84%) for both observers. Renal cortex MD and FA in non-proliferative LN were significantly different (p = 0.001) from that of proliferative LN for both observers. There was excellent inter-observer agreement of MD and FA (ICC = 0.96 and 0.81). CONCLUSION MD and FA of renal cortex may help to assess renal affection in LN patients and predict its pathological subtypes.
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Ko SF, Yip HK, Zhen YY, Hung CC, Lee CC, Huang CC, Ng SH, Chen YL, Lin JW. Renal Damages in Deoxycorticosterone Acetate-Salt Hypertensive Rats: Assessment with Diffusion Tensor Imaging and T2-mapping. Mol Imaging Biol 2021; 22:94-104. [PMID: 31065896 DOI: 10.1007/s11307-019-01364-z] [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] [Indexed: 12/22/2022]
Abstract
PURPOSE This study aimed to investigate the feasibility of diffusion tensor imaging (DTI) and T2-mapping to assess temporal renal damage in deoxycorticosterone acetate-salt (DOCA-salt) hypertensive rats and compare the results with histopathologic and immunohistochemical findings. PROCEDURES After baseline renal magnetic resonance imaging (MRI), 24 out of 30 uninephrectomized Sprague-Dawley rats with DOCA-salt-induced hypertension were divided equally into four groups. Group 1 had renal MRI at weeks 2, 4, 6, and 8, and groups 2, 3, and 4 had MRI at weeks 2, 4, and 6, respectively. The remaining 6 rats were used as sham controls. The renal cortex and outer and inner stripes of the outer medulla were examined over time using fractional anisotropy (FA), apparent diffusion coefficient (ADC), and T2-mapping, and the results were compared with baseline values. The degree of glomerular and tubular injury, endothelial cell thickening, hyaline arteriolosclerosis, macrophage infiltration, microcyst formation, and fibrosis in different zones at different time points in the DOCA-salt rats were compared with controls. RESULTS Compared with baseline values, DOCA-salt rats demonstrated a significant decrease in renal cortical FA from week 4 to week 8 (0.244 ± 0.015 vs 0.172 ± 0.014-0.150 ± 0.016, P = 0.018-0.002), corresponding to significantly more glomerular damage, arteriolosclerosis, macrophage infiltration, and fibrosis. The DOCA-salt rats had significantly increased cortical ADC and T2 values at weeks 6 and 8 (1.778 ± 0.051 × 10-3 mm2/s vs 1.872 ± 0.058-1.917 ± 0.066 × 10-3 mm2/s; 93.7 ± 4.9 ms vs 98.0 ± 2.9-100.7 ± 4.0 ms, respectively, all P < 0.05), consistent with excessively fluid-filled microcysts (aquaporin-2+). Despite DOCA-salt rats harbored markedly increased fibrosis in outer and inner stripes of the outer medulla at weeks 6 and 8, only nonsignificant decreases in FA were observed in comparison with the controls suggesting that only limited microstructural changes were present. CONCLUSIONS Renal cortical FA is useful for the early detection and monitoring of renal damage in DOCA-salt hypertensive rats.
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Affiliation(s)
- Sheung-Fat Ko
- Department of Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Sung District, Kaohsiung, 833, Taiwan.
| | - Hon-Kan Yip
- Department of Cardiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.,Center for Translational Researches in Biomedical Sciences, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yen-Yi Zhen
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chi-Chih Hung
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chen-Chang Lee
- Department of Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Sung District, Kaohsiung, 833, Taiwan
| | - Chung-Cheng Huang
- Department of Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Sung District, Kaohsiung, 833, Taiwan
| | - Shu-Hang Ng
- Department of Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Sung District, Kaohsiung, 833, Taiwan
| | - Yi-Ling Chen
- Department of Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Sung District, Kaohsiung, 833, Taiwan.,Center for Translational Researches in Biomedical Sciences, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Jui-Wei Lin
- Department of Pathology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
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Alnazer I, Bourdon P, Urruty T, Falou O, Khalil M, Shahin A, Fernandez-Maloigne C. Recent advances in medical image processing for the evaluation of chronic kidney disease. Med Image Anal 2021; 69:101960. [PMID: 33517241 DOI: 10.1016/j.media.2021.101960] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 11/18/2020] [Accepted: 12/31/2020] [Indexed: 12/31/2022]
Abstract
Assessment of renal function and structure accurately remains essential in the diagnosis and prognosis of Chronic Kidney Disease (CKD). Advanced imaging, including Magnetic Resonance Imaging (MRI), Ultrasound Elastography (UE), Computed Tomography (CT) and scintigraphy (PET, SPECT) offers the opportunity to non-invasively retrieve structural, functional and molecular information that could detect changes in renal tissue properties and functionality. Currently, the ability of artificial intelligence to turn conventional medical imaging into a full-automated diagnostic tool is widely investigated. In addition to the qualitative analysis performed on renal medical imaging, texture analysis was integrated with machine learning techniques as a quantification of renal tissue heterogeneity, providing a promising complementary tool in renal function decline prediction. Interestingly, deep learning holds the ability to be a novel approach of renal function diagnosis. This paper proposes a survey that covers both qualitative and quantitative analysis applied to novel medical imaging techniques to monitor the decline of renal function. First, we summarize the use of different medical imaging modalities to monitor CKD and then, we show the ability of Artificial Intelligence (AI) to guide renal function evaluation from segmentation to disease prediction, discussing how texture analysis and machine learning techniques have emerged in recent clinical researches in order to improve renal dysfunction monitoring and prediction. The paper gives a summary about the role of AI in renal segmentation.
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Affiliation(s)
- Israa Alnazer
- XLIM-ICONES, UMR CNRS 7252, Université de Poitiers, France; Laboratoire commune CNRS/SIEMENS I3M, Poitiers, France; AZM Center for Research in Biotechnology and its Applications, EDST, Lebanese University, Beirut, Lebanon.
| | - Pascal Bourdon
- XLIM-ICONES, UMR CNRS 7252, Université de Poitiers, France; Laboratoire commune CNRS/SIEMENS I3M, Poitiers, France
| | - Thierry Urruty
- XLIM-ICONES, UMR CNRS 7252, Université de Poitiers, France; Laboratoire commune CNRS/SIEMENS I3M, Poitiers, France
| | - Omar Falou
- AZM Center for Research in Biotechnology and its Applications, EDST, Lebanese University, Beirut, Lebanon; American University of Culture and Education, Koura, Lebanon; Lebanese University, Faculty of Science, Tripoli, Lebanon
| | - Mohamad Khalil
- AZM Center for Research in Biotechnology and its Applications, EDST, Lebanese University, Beirut, Lebanon
| | - Ahmad Shahin
- AZM Center for Research in Biotechnology and its Applications, EDST, Lebanese University, Beirut, Lebanon
| | - Christine Fernandez-Maloigne
- XLIM-ICONES, UMR CNRS 7252, Université de Poitiers, France; Laboratoire commune CNRS/SIEMENS I3M, Poitiers, France
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Renal Diffusion-Weighted Imaging (DWI) for Apparent Diffusion Coefficient (ADC), Intravoxel Incoherent Motion (IVIM), and Diffusion Tensor Imaging (DTI): Basic Concepts. Methods Mol Biol 2021; 2216:187-204. [PMID: 33476001 PMCID: PMC9703200 DOI: 10.1007/978-1-0716-0978-1_11] [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] [Indexed: 01/30/2023]
Abstract
The specialized function of the kidney is reflected in its unique structure, characterized by juxtaposition of disorganized and ordered elements, including renal glomerula, capillaries, and tubules. The key role of the kidney in blood filtration, and changes in filtration rate and blood flow associated with pathological conditions, make it possible to investigate kidney function using the motion of water molecules in renal tissue. Diffusion-weighted imaging (DWI) is a versatile modality that sensitizes observable signal to water motion, and can inform on the complexity of the tissue microstructure. Several DWI acquisition strategies are available, as are different analysis strategies, and models that attempt to capture not only simple diffusion effects, but also perfusion, compartmentalization, and anisotropy. This chapter introduces the basic concepts of DWI alongside common acquisition schemes and models, and gives an overview of specific DWI applications for animal models of renal disease.This chapter is based upon work from the COST Action PARENCHIMA, a community-driven network funded by the European Cooperation in Science and Technology (COST) program of the European Union, which aims to improve the reproducibility and standardization of renal MRI biomarkers. This introduction chapter is complemented by two separate chapters describing the experimental procedure and data analysis.
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Yu YM, Ni QQ, Wang ZJ, Chen ML, Zhang LJ. Multiparametric Functional Magnetic Resonance Imaging for Evaluating Renal Allograft Injury. Korean J Radiol 2020; 20:894-908. [PMID: 31132815 PMCID: PMC6536799 DOI: 10.3348/kjr.2018.0540] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 12/19/2018] [Indexed: 02/06/2023] Open
Abstract
Kidney transplantation is the treatment of choice for patients with end-stage renal disease, as it extends survival and increases quality of life in these patients. However, chronic allograft injury continues to be a major problem, and leads to eventual graft loss. Early detection of allograft injury is essential for guiding appropriate intervention to delay or prevent irreversible damage. Several advanced MRI techniques can offer some important information regarding functional changes such as perfusion, diffusion, structural complexity, as well as oxygenation and fibrosis. This review highlights the potential of multiparametric MRI for noninvasive and comprehensive assessment of renal allograft injury.
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Affiliation(s)
- Yuan Meng Yu
- Department of Medical Imaging, Jinling Hospital, Clinical School of Southern Medical University, Nanjing, China
| | - Qian Qian Ni
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Zhen Jane Wang
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Meng Lin Chen
- Medical Imaging Teaching and Research Office, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Long Jiang Zhang
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, China.
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Yu Z, Zhu H, Wu X, Chen Z, Zhang Z, Li J, Ye Q. Acute renal impairment characterization using diffusion magnetic resonance imaging: Validation by histology. NMR IN BIOMEDICINE 2019; 32:e4126. [PMID: 31290588 DOI: 10.1002/nbm.4126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 05/09/2019] [Accepted: 05/14/2019] [Indexed: 06/09/2023]
Abstract
Diffusion magnetic resonance imaging has been demonstrated to be a simple, noninvasive and accurate method for the detection of renal microstructure and microcirculation, which are closely linked to renal function. Moreover, serum endothelin-1 (ET-1) was also reported as a good indicator of early renal injury. The aim of this study was to evaluate the feasibility and capability of diffusion MRI and ET-1 to detect acute kidney injury by an operation simulating high-pressure renal pelvic perfusion, which is commonly used during ureteroscopic lithotripsy. Histological findings were used as a reference. Fourteen New Zealand rabbits in an experimental group and 14 in a control group were used in this study. Diffusion tensor imaging and intravoxel incoherent motion diffusion-weighted imaging were acquired by a 3.0 T MRI scanner. Significant corticomedullary differences were found in the values of the apparent diffusion coefficient (ADC), pure tissue diffusion, volume fraction of pseudo-diffusion (fp) and fractional anisotropy (FA) (P < 0.05 for all) in both preoperation and postoperation experimental groups. Compared with the control group, the values of cortical fpmean , medullary ADCmean and FAmean decreased significantly (P < 0.05) after the operation in the experimental group. Also, the change rate of medullary ADCmean in the experimental group was more pronounced than that in the control group (P = 0.018). No significant change was found in serum ET-1 concentration after surgery in either the experimental (P = 0.80) or control (P = 0.17) groups. In the experimental group, histological changes were observed in the medulla, while no visible change was found in the cortex. This study demonstrated the feasibility of diffusion MRI to detect the changes of renal microstructure and microcirculation in acute kidney injury, with the potential to evaluate renal function. Moreover, the sensitivity of diffusion MRI to acute kidney injury appears to be superior to that of serum ET-1.
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Affiliation(s)
- Zhixian Yu
- Department of Urology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Honghui Zhu
- Department of Urology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Xiuling Wu
- Department of Pathology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Zhongwei Chen
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Zhao Zhang
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Jiance Li
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Qiong Ye
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
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11
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Change in kidney volume after kidney transplantation in patients with autosomal polycystic kidney disease. PLoS One 2018; 13:e0209332. [PMID: 30589879 PMCID: PMC6307782 DOI: 10.1371/journal.pone.0209332] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 12/04/2018] [Indexed: 12/16/2022] Open
Abstract
Background The indication to bilateral nephrectomy in patients with autosomal dominant polycystic kidney scheduled for kidney transplantation is controversial. Indeed, the progressive enlargement of cysts may increase the risk of complications and the need for nephrectomy. However, very few studies investigated the change in kidney volume after kidney transplantation. Material and methods In this prospective cohort study, the change in native kidney volume in polycystic patients was evaluated with magnetic resonance imaging. Forty patients were included in the study. Kidney diameters and total kidney volume were evaluated with magnetic resonance imaging in patients who underwent simultaneous nephrectomy and kidney transplantation and in patients with kidney transplant alone, before transplantation and 1 year after transplantation. Results There was a significant reduction of kidney volume after transplantation, with a mean degree of kidney diameters reduction varying from 12.24% to 14.43%. Mean total kidney volume of the 55 kidney considered in the analysis significantly reduced from 1617.94 ± 833.42 ml to 1381.42 ± 1005.73 ml (P<0.05), with a mean rate of 16.44% of volume decrease. More than 80% of patients had a volume reduction in both groups. Conclusions Polycystic kidneys volume significantly reduces after kidney transplantation, and this would reduce the need for prophylactic bilateral nephrectomy in asymptomatic patients.
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Caroli A, Schneider M, Friedli I, Ljimani A, De Seigneux S, Boor P, Gullapudi L, Kazmi I, Mendichovszky IA, Notohamiprodjo M, Selby NM, Thoeny HC, Grenier N, Vallée JP. Diffusion-weighted magnetic resonance imaging to assess diffuse renal pathology: a systematic review and statement paper. Nephrol Dial Transplant 2018; 33:ii29-ii40. [PMID: 30137580 PMCID: PMC6106641 DOI: 10.1093/ndt/gfy163] [Citation(s) in RCA: 95] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 05/02/2018] [Indexed: 12/26/2022] Open
Abstract
Diffusion-weighted magnetic resonance imaging (DWI) is a non-invasive method sensitive to local water motion in the tissue. As a tool to probe the microstructure, including the presence and potentially the degree of renal fibrosis, DWI has the potential to become an effective imaging biomarker. The aim of this review is to discuss the current status of renal DWI in diffuse renal diseases. DWI biomarkers can be classified in the following three main categories: (i) the apparent diffusion coefficient-an overall measure of water diffusion and microcirculation in the tissue; (ii) true diffusion, pseudodiffusion and flowing fraction-providing separate information on diffusion and perfusion or tubular flow; and (iii) fractional anisotropy-measuring the microstructural orientation. An overview of human studies applying renal DWI in diffuse pathologies is given, demonstrating not only the feasibility and intra-study reproducibility of DWI but also highlighting the need for standardization of methods, additional validation and qualification. The current and future role of renal DWI in clinical practice is reviewed, emphasizing its potential as a surrogate and monitoring biomarker for interstitial fibrosis in chronic kidney disease, as well as a surrogate biomarker for the inflammation in acute kidney diseases that may impact patient selection for renal biopsy in acute graft rejection. As part of the international COST (European Cooperation in Science and Technology) action PARENCHIMA (Magnetic Resonance Imaging Biomarkers for Chronic Kidney Disease), aimed at eliminating the barriers to the clinical use of functional renal magnetic resonance imaging, this article provides practical recommendations for future design of clinical studies and the use of renal DWI in clinical practice.
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Affiliation(s)
- Anna Caroli
- Medical Imaging Unit, Bioengineering Department, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Bergamo, Italy
| | - Moritz Schneider
- Department of Radiology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany
- Comprehensive Pneumology Center, German Center for Lung Research, Munich, Germany
| | - Iris Friedli
- Division of Radiology, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
| | - Alexandra Ljimani
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Dusseldorf, Germany
| | - Sophie De Seigneux
- Service and Laboratory of Nephrology, Department of Internal Medicine Specialties and Department of Physiology and Metabolism, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
| | - Peter Boor
- Institute of Pathology and Division of Nephrology, RWTH University of Aachen, Aachen, Germany
| | - Latha Gullapudi
- Centre for Kidney Research and Innovation, University of Nottingham, Nottingham, UK
| | - Isma Kazmi
- Centre for Kidney Research and Innovation, University of Nottingham, Nottingham, UK
| | - Iosif A Mendichovszky
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke’s Hospital, Cambridge, UK
| | | | - Nicholas M Selby
- Centre for Kidney Research and Innovation, University of Nottingham, Nottingham, UK
| | - Harriet C Thoeny
- Department of Diagnostic, Pediatric, and Interventional Radiology, Inselspital University Hospital, Bern, Switzerland
| | - Nicolas Grenier
- Service d'Imagerie Diagnostique et Interventionnelle de l'Adulte, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Jean-Paul Vallée
- Division of Radiology, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
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Scintigraphic texture analysis for assessment of renal allograft function. Pol J Radiol 2018; 83:e1-e10. [PMID: 30038672 PMCID: PMC6047088 DOI: 10.5114/pjr.2018.74956] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 07/18/2017] [Indexed: 12/27/2022] Open
Abstract
Purpose Early detection and monitoring of kidney function during the post-transplantation period is one of the most important issues for improving the accuracy of an initial diagnosis. The aim of this study was to evaluate texture analysis (TA) in scintigraphic imaging to detect changes in kidney status after transplantation. Material and methods Scintigraphic images were used for TA from a total of 94 kidney allografts (39 rejected and 55 non-rejected). Images corresponding to the frames at the 2nd, 5th, and 20th minute of the study were used to determine the optimum time point for analysis of differences in texture features between the rejected and non-rejected allografts. Results Linear discriminant analysis indicated the best performance at the fifth minute frame for classification of the rejected and non-rejected allografts with receiver operating characteristic curve (Az) of 0.982, corresponding to 91.89% sensitivity, 96.49% specificity, and 94.68% accuracy. Also, TA can differentiate acute tubular necrosis from acute rejection with Az of 0.953 corresponding to 88% sensitivity, 92.31% specificity, and 90.62% accuracy at the 5th minute frame. The best correlation between texture feature and kidney function was achieved at the 20th minute frame (r = -0.396) for glomerular filtration rate. Conclusions TA has good potential for the characterisation of kidney failure after transplantation and can improve clinical diagnosis.
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Razek AAKA, Al-Adlany MAAA, Alhadidy AM, Atwa MA, Abdou NEA. Diffusion tensor imaging of the renal cortex in diabetic patients: correlation with urinary and serum biomarkers. Abdom Radiol (NY) 2017; 42:1493-1500. [PMID: 28044190 DOI: 10.1007/s00261-016-1021-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE To demonstrate role of diffusion tensor imaging of the kidney in diabetic patients and to correlate renal fractional anisotropy (FA) and apparent diffusion coefficient (ADC) of the renal cortex with urinary and serum biomarkers of diabetes. MATERIAL AND METHODS Prospective study was conducted upon 42 diabetic patients (28 males, 14 females; mean age = 33 years) and 17 age- and sex-matched volunteers. Diabetic patients were micro-normoalbuminuric (n = 27) and macroalbuminuric (n = 15). Patients and volunteers underwent diffusion tensor imaging of the kidney. The FA and ADC of the renal cortex were calculated from 3 regions of interests of both kidneys. RESULTS The mean FA and ADC of the renal cortex in diabetic patients (0.36 ± 0.10 and 1.74 ± 0.16 × 10-3 mm2/s) was significantly different (p = 0.001) from that of volunteers (0.26 ± 0.02 and 1.88 ± 0.03 × 10-3 mm2/s). The cut-off renal FA and ADC used to differentiate diabetic patients from volunteers were 0.28 and 1.89 × 10-3 mm2/s with AUC of 0.791 and 0.773 and accuracy of 71% and 76%. The FA and ADC calculated in the renal cortex in patients with macroalbuminuria (0.43 ± 0.10 and 1.63 ± 0.19 × 10-3 mm2/s) was significantly different (p = 0.001) from that of patients with micro-normoalbuminuria (0.35 ± 0.12 and 1.80 ± 0.18 × 10-3 mm2/s). The FA and ADC of the renal cortex in diabetic patients correlated with urinary albumin (r = 0.530; p = 0.001, r = -0.421; p = 0.006), urinary NAG (r = 0.376; p = 0.014, r = -0.245; p = 0.01), urinary TGF-β1 (r = 0.287; p = 0.065, r = -0.214; p = 0.175), and serum creatinine (r = 0.381; p = 0.013, r = -0.349; p = 0.023). CONCLUSION The FA and ADC of the renal cortex may help in differentiation of diabetic kidney from volunteers and prediction of the presence of macroalbuminuria in diabetic patients and correlated with some of the urinary and serum biomarkers of diabetes.
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Affiliation(s)
| | | | | | - Mohammed Ali Atwa
- Department of Clinical Pathology, Mansoura Faculty of Medicine, Mansoura, Egypt
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Kjølby B, Khan A, Chuhutin A, Pedersen L, Jensen J, Jakobsen S, Zeidler D, Sangill R, Nyengaard J, Jespersen S, Hansen B. Fast diffusion kurtosis imaging of fibrotic mouse kidneys. NMR IN BIOMEDICINE 2016; 29:1709-1719. [PMID: 27731906 PMCID: PMC5123986 DOI: 10.1002/nbm.3623] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 07/25/2016] [Accepted: 08/17/2016] [Indexed: 05/16/2023]
Abstract
Diffusion kurtosis imaging (DKI) is sensitive to tissue microstructure and may therefore be useful in the diagnosis and monitoring of disease in brain and body organs. Generally, diffusion magnetic resonance imaging (dMRI) in the body is challenging because of the heterogeneous body composition, which can cause image artefacts as a result of chemical shifts and susceptibility differences. In addition, the abdomen possesses physiological factors (e.g. breathing, heartbeat, blood flow) which may severely reduce image quality, especially when echo planar imaging is employed, as is typical in dMRI. Collectively, these challenging measurement conditions impede the use and exploration of DKI in the body. This impediment is further exacerbated by the traditionally large amount of data required for DKI and the low signal-to-noise ratio at the b-values needed to effectively probe the kurtosis regime. Recently introduced fast DKI techniques reduce the challenge of DKI in the body by decreasing the data requirement substantially, so that, for example, triggering and breath-hold techniques may be applied for the entire DKI acquisition without causing unfeasible scan times. One common pathological condition for which body DKI may be of immediate clinical value is kidney fibrosis, which causes progressive changes in organ microstructure. With its sensitivity to microstructure, DKI is an obvious candidate for a non-invasive evaluation method. We present preclinical evidence indicating that the rapidly obtainable tensor-derived mean kurtosis ( W̅) distinguishes moderately fibrotic kidneys from healthy controls. The presence and degree of fibrosis are confirmed by histology, which also indicates fibrosis as the main driver behind the DKI differences observed between groups. We therefore conclude that fast kurtosis is a likely candidate for an MRI-based method for the detection and monitoring of renal fibrosis. We provide protocol recommendations for fast renal DKI in humans based on a b-value optimisation performed using data acquired at 3 T in normal human kidney.
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Affiliation(s)
- B.F. Kjølby
- Center of Functionally Integrative Neuroscience (CFIN) and MINDLab, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - A.R. Khan
- Center of Functionally Integrative Neuroscience (CFIN) and MINDLab, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - A. Chuhutin
- Center of Functionally Integrative Neuroscience (CFIN) and MINDLab, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - L. Pedersen
- Research Laboratory for Biochemical Pathology, Aarhus University Hospital, Department of Clinical Medicine, Aarhus, Denmark
| | - J.B. Jensen
- The PET centre, Aarhus University Hospital, Aarhus, Denmark
| | - S. Jakobsen
- The PET centre, Aarhus University Hospital, Aarhus, Denmark
| | - D. Zeidler
- Center of Functionally Integrative Neuroscience (CFIN) and MINDLab, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - R. Sangill
- Center of Functionally Integrative Neuroscience (CFIN) and MINDLab, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - J.R Nyengaard
- Stereology and Electron Microscopy Laboratory, Centre for Stochastic Geometry and Advanced Bioimaging, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - S.N. Jespersen
- Center of Functionally Integrative Neuroscience (CFIN) and MINDLab, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Physics and Astronomy, Aarhus University, Aarhus, Denmark
| | - B. Hansen
- Center of Functionally Integrative Neuroscience (CFIN) and MINDLab, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Corresponding Author: Brian Hansen, CFIN, Aarhus University, Building 10G, 5th Floor, Nørrebrogade 44, DK-8000 Århus C, Denmark,
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