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Jiang B, Yu Y, Wan J, Xu R, Ma J, Tian Y, Hu L, Wu P, Hu C, Zhu M. The Use of Diffusion Tensor Imaging in the Identification of Acute Rejection and Chronic Allograft Nephropathy After Renal Transplantation. J Magn Reson Imaging 2024; 59:2082-2088. [PMID: 37807929 DOI: 10.1002/jmri.29042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 09/20/2023] [Accepted: 09/20/2023] [Indexed: 10/10/2023] Open
Abstract
BACKGROUND Identifying the cause of renal allograft dysfunction is important for the clinical management of kidney transplant recipients. PURPOSE To evaluate the diagnostic efficiency of diffusion tensor imaging (DTI) for identifying allografts with acute rejection (AR) and chronic allograft nephropathy (CAN). STUDY TYPE Prospective. SUBJECTS Seventy-seven renal transplant patients (aged 42.5 ± 9.5 years), including 29 patients with well-functioning stable allografts (Control group), 25 patients diagnosed with acute rejection (AR group), and 23 patients diagnosed with chronic allograft nephropathy (CAN group). FIELD STRENGTH/SEQUENCE 1.5 T/T2-weighted imaging and DTI. ASSESSMENT The serum creatinine, proteinuria, pathologic results, and fractional anisotropy (FA) values were obtained and compared among the three groups. STATISTICAL TEST One-way analysis of variance; correlation analysis; independent-sample t-test; intraclass correlation coefficients and receiver operating characteristic curves. Statistical significance was set to a P-value <0.05. RESULTS The AR and CAN groups presented with significantly elevated serum creatinine as compared with the Control group (191.8 ± 181.0 and 163.1 ± 115.8 μmol/L vs. 82.3 ± 20.9 μmol/L). FA decreased in AR group (cortical/medullary: 0.13 ± 0.02/0.31 ± 0.07) and CAN group (cortical/medullary: 0.11 ± 0.02/0.27 ± 0.06), compared with the Control group (cortical/medullary: 0.15 ± 0.02/0.35 ± 0.05). Cortical FA in the AR group was higher than in the CAN group. The area under the curve (AUC) for identifying AR from normal allografts was 0.756 and 0.744 by cortical FA and medullary FA, respectively. The AUC of cortical FA and medullary FA for differentiating CAN from normal allografts was 0.907 and 0.830, respectively. The AUC of cortical FA and medullary FA for distinguishing AR and CAN from normal allografts was 0.828 and 0.785, respectively. Cortical FA was able to distinguish between AR and CAN with an AUC of 0.728. DATA CONCLUSION DTI was able to detect patients with dysfunctional allografts. Cortical FA can further distinguish between AR and CAN. EVIDENCE LEVEL 2 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Bin Jiang
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yixing Yu
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Jiayi Wan
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Rui Xu
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Jiali Ma
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yangyang Tian
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Linkun Hu
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Peng Wu
- Philips Healthcare, Shanghai, China
| | - Chunhong Hu
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Mo Zhu
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China
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Tong X, He H, Ning Z, Shen R, Du C, Zeng X, Wang Q, He ZX, Xu D, Zhao X. Characterization of kidneys in patients with systemic sclerosis by multi-parametric magnetic resonance quantitative imaging. Magn Reson Imaging 2024; 109:203-210. [PMID: 38513788 DOI: 10.1016/j.mri.2024.03.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 03/09/2024] [Accepted: 03/18/2024] [Indexed: 03/23/2024]
Abstract
PURPOSE To determine the usefulness of multiparametric magnetic resonance (MR) quantitative imaging in characterizing the kidneys in systemic sclerosis (SSc) patients. MATERIAL AND METHODS Forty-six SSc patients (47.9 ± 12.8 years, 40 females) and 22 age- and sex- matched healthy volunteers (46.1 ± 13.8 years, 20 females) were recruited and underwent renal MR imaging by acquiring blood oxygen level dependent and saturated multi-delay renal arterial spin labeling (SAMURAI) sequences. The T2* value, T1 value, renal blood flow (RBF), arterial bolus arrival time (aBAT), and tissue bolus arrival time (tBAT) of renal cortex were measured and compared among diffuse cutaneous SSc (dcSSc) and limited cutaneous SSc (lcSSc) groups and healthy controls using One-way ANOVA and analyzed by logistic regression. RESULTS Compared to healthy volunteers, SSc patients with normal estimated glomerular filtration rate (n = 40) had significantly lower T2* value (P = 0.026) in the left renal cortex, longer T1 value (right: P = 0.015; left: P = 0.023), lower RBF (right: P < 0.001; left: P < 0.001), and shorter tBAT (right: P < 0.001; left: P = 0.005) in both right and left renal cortex after adjusting for demographics. The dcSSc patients (n = 23) had significantly lower RBF in both right (226.7 ± 65.2 mL/100 g/min vs. 278.2 ± 73.5 mL/100 g/min, P = 0.022) and left (194.5 ± 71.5 mL/100 g/min vs. 252.7 ± 84.4 mL/100 g/min, P = 0.020) renal cortex compared to the lcSSc patients (n = 23) after adjusting for demographics, but the significance of the difference was attenuated after further adjusting for modified Rodnan skin score and digital ulcers. CONCLUSION Multi-parametric MR quantitative imaging, particularly multi-delay ASL perfusion imaging, is a useful technique for characterizing the kidneys and classification of SSc patients.
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Affiliation(s)
- Xinyu Tong
- Department of Nuclear Medicine, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Huilin He
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Key Laboratory of Rheumatology & Clinical Immunology, Ministry of Education, Beijing, China
| | - Zihan Ning
- Center for Biomedical Imaging Research, School of Biomedical Engineering, Tsinghua University, Beijing, China
| | - Rui Shen
- Center for Biomedical Imaging Research, School of Biomedical Engineering, Tsinghua University, Beijing, China
| | - Chenlin Du
- Center for Biomedical Imaging Research, School of Biomedical Engineering, Tsinghua University, Beijing, China
| | - Xiaofeng Zeng
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Key Laboratory of Rheumatology & Clinical Immunology, Ministry of Education, Beijing, China
| | - Qian Wang
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Key Laboratory of Rheumatology & Clinical Immunology, Ministry of Education, Beijing, China
| | - Zuo-Xiang He
- Department of Nuclear Medicine, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China.
| | - Dong Xu
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Key Laboratory of Rheumatology & Clinical Immunology, Ministry of Education, Beijing, China.
| | - Xihai Zhao
- Center for Biomedical Imaging Research, School of Biomedical Engineering, Tsinghua University, Beijing, China.
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Bane O, Lewis SC, Lim RP, Carney BW, Shah A, Fananapazir G. Contemporary and Emerging MRI Strategies for Assessing Kidney Allograft Complications: Arterial Stenosis and Parenchymal Injury, From the AJR Special Series on Imaging of Fibrosis. AJR Am J Roentgenol 2024; 222:e2329418. [PMID: 37315018 PMCID: PMC11006565 DOI: 10.2214/ajr.23.29418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
MRI plays an important role in the evaluation of kidney allografts for vascular complications as well as parenchymal insults. Transplant renal artery stenosis, the most common vascular complication of kidney transplant, can be evaluated by MRA using gadolinium and nongadolinium contrast agents as well as by unenhanced MRA techniques. Parenchymal injury occurs through a variety of pathways, including graft rejection, acute tubular injury, BK polyomavirus infection, drug-induced interstitial nephritis, and pyelonephritis. Investigational MRI techniques have sought to differentiate among these causes of dysfunction as well as to assess the degree of interstitial fibrosis or tubular atrophy (IFTA)-the common end pathway for all of these processes-which is currently evaluated by invasively obtained core biopsies. Some of these MRI sequences have shown promise in not only assessing the cause of parenchymal injury but also assessing IFTA noninvasively. This review describes current clinically used MRI techniques and previews promising investigational MRI techniques for assessing complications of kidney grafts.
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Affiliation(s)
- Octavia Bane
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Sara C Lewis
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Ruth P Lim
- Department of Radiology and Department of Surgery, University of Melbourne, Austin Health, Melbourne, Australia
| | - Benjamin W Carney
- Department of Radiology, University of California Davis Medical Center, 4860 Y St, Ste 3100, Sacramento, CA 95816
| | - Amar Shah
- Department of Radiology, Mayo Clinic Arizona, Phoenix, AZ
| | - Ghaneh Fananapazir
- Department of Radiology, University of California Davis Medical Center, 4860 Y St, Ste 3100, Sacramento, CA 95816
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Zhao D, Wang W, Niu YY, Ren XH, Shen AJ, Xiang YS, Xie HY, Wu LH, Yu C, Zhang YY. Amide Proton Transfer-Weighted Magnetic Resonance Imaging for Application in Renal Fibrosis: A Radiological-Pathological-Based Analysis. Am J Nephrol 2024; 55:334-344. [PMID: 38228096 DOI: 10.1159/000536232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 01/04/2024] [Indexed: 01/18/2024]
Abstract
INTRODUCTION Renal fibrosis (RF), being the most important pathological change in the progression of CKD, is currently assessed by the evaluation of a biopsy. This present study aimed to apply a novel functional MRI (fMRI) protocol named amide proton transfer (APT) weighting to evaluate RF noninvasively. METHODS Male Sprague-Dawley (SD) rats were initially subjected to bilateral kidney ischemia/reperfusion injury (IRI), unilateral ureteral obstruction, and sham operation, respectively. All rats underwent APT mapping on the 7th and 14th days after operation. Besides, 26 patients underwent renal biopsy at the Nephrology Department of Shanghai Tongji Hospital between July 2022 and May 2023. Patients underwent APT and apparent diffusion coefficient (ADC) mappings within 1 week before biopsy. MRI results of both patients and rats were calculated by comparing with gold standard histology for fibrosis assessment. RESULTS In animal models, the cortical APT (cAPT) and medullary APT (mAPT) values were positively correlated with the degree of RF. Compared to the sham group, IRI group showed significantly increased cAPT and mAPT values on the 7th and 14th days after surgery, but no group differences were found in ADC values. Similar results were found in human patients. Cortical/medullary APT values were significantly increased in patients with moderate-to-severe fibrosis than in patients with mild fibrosis. ROC curve analysis indicated that APT value displayed a better diagnostic value for RF. Furthermore, combination of cADC and cAPT improved fibrosis detection by imaging variables alone (p < 0.1). CONCLUSION APT values had better diagnostic capability at early stage of RF compared to ADC values, and the addition of APT imaging to conventional ADC will significantly improve the diagnostic performance for predicting kidney fibrosis.
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Affiliation(s)
- Dan Zhao
- Department of Nephrology, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, China,
| | - Wei Wang
- Department of Radiology, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yang-Yang Niu
- Department of Nephrology, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xi-Hui Ren
- Department of Radiology, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Ai-Jun Shen
- Department of Radiology, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yong-Sheng Xiang
- Department of Radiology, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Hong-Yan Xie
- Department of Nephrology, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Le-Hao Wu
- Department of Nephrology, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Chen Yu
- Department of Nephrology, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Ying-Ying Zhang
- Department of Nephrology, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, China
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Bane O, Seeliger E, Cox E, Stabinska J, Bechler E, Lewis S, Hickson LJ, Francis S, Sigmund E, Niendorf T. Renal MRI: From Nephron to NMR Signal. J Magn Reson Imaging 2023; 58:1660-1679. [PMID: 37243378 PMCID: PMC11025392 DOI: 10.1002/jmri.28828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 05/11/2023] [Accepted: 05/12/2023] [Indexed: 05/28/2023] Open
Abstract
Renal diseases pose a significant socio-economic burden on healthcare systems. The development of better diagnostics and prognostics is well-recognized as a key strategy to resolve these challenges. Central to these developments are MRI biomarkers, due to their potential for monitoring of early pathophysiological changes, renal disease progression or treatment effects. The surge in renal MRI involves major cross-domain initiatives, large clinical studies, and educational programs. In parallel with these translational efforts, the need for greater (patho)physiological specificity remains, to enable engagement with clinical nephrologists and increase the associated health impact. The ISMRM 2022 Member Initiated Symposium (MIS) on renal MRI spotlighted this issue with the goal of inspiring more solutions from the ISMRM community. This work is a summary of the MIS presentations devoted to: 1) educating imaging scientists and clinicians on renal (patho)physiology and demands from clinical nephrologists, 2) elucidating the connection of MRI parameters with renal physiology, 3) presenting the current state of leading MR surrogates in assessing renal structure and functions as well as their next generation of innovation, and 4) describing the potential of these imaging markers for providing clinically meaningful renal characterization to guide or supplement clinical decision making. We hope to continue momentum of recent years and introduce new entrants to the development process, connecting (patho)physiology with (bio)physics, and conceiving new clinical applications. We envision this process to benefit from cross-disciplinary collaboration and analogous efforts in other body organs, but also to maximally leverage the unique opportunities of renal physiology. LEVEL OF EVIDENCE: 1 TECHNICAL EFFICACY STAGE: 2.
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Affiliation(s)
- Octavia Bane
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
- Icahn School of Medicine at Mount Sinai, BioMedical Engineering and Imaging Institute, New York City, New York, USA
| | - Erdmann Seeliger
- Institute of Translational Physiology, Charité-University Medicine Berlin, Berlin, Germany
| | - Eleanor Cox
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, UK
| | - Julia Stabinska
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Maryland, USA
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Eric Bechler
- Department of Diagnostic and Interventional Radiology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Sara Lewis
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - LaTonya J Hickson
- Division of Nephrology and Hypertension, Mayo Clinic, Jacksonville, Florida, USA
| | - Sue Francis
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, UK
| | - Eric Sigmund
- Bernard and Irene Schwartz Center for Biomedical Imaging Center for Advanced Imaging Innovation and Research (CAI2R), New York University Langone Health, New York City, New York, USA
| | - Thoralf Niendorf
- Berlin Ultrahigh Field Facility (B.U.F.F.), Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany
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Francis ST, Selby NM, Taal MW. Magnetic Resonance Imaging to Evaluate Kidney Structure, Function, and Pathology: Moving Toward Clinical Application. Am J Kidney Dis 2023; 82:491-504. [PMID: 37187282 DOI: 10.1053/j.ajkd.2023.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 02/20/2023] [Indexed: 05/17/2023]
Abstract
Recent advances in multiparametric magnetic resonance imaging (MRI) allow multiple quantitative measures to assess kidney morphology, tissue microstructure, oxygenation, kidney blood flow, and perfusion to be collected in a single scan session. Animal and clinical studies have investigated the relationship between the different MRI measures and biological processes, although their interpretation can be complex due to variations in study design and generally small participant numbers. However, emerging themes include the apparent diffusion coefficient derived from diffusion-weighted imaging, T1 and T2 mapping parameters, and cortical perfusion being consistently associated with kidney damage and predicting kidney function decline. Blood oxygen level-dependent (BOLD) MRI has shown inconsistent associations with kidney damage markers but has been predictive of kidney function decline in several studies. Therefore, multiparametric MRI of the kidneys has the potential to address the limitations of existing diagnostic methods to provide a noninvasive, noncontrast, and radiation-free method to assess whole kidney structure and function. Barriers to be overcome to facilitate widespread clinical application include improved understanding of biological factors that impact MRI measures, development of a larger evidence base for clinical utility, standardization of MRI protocols, automation of data analysis, determining optimal combination of MRI measures, and health economic evaluation.
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Affiliation(s)
- Susan T Francis
- Sir Peter Mansfield Imaging Centre, School of Physics & Astronomy, University of Nottingham, Nottingham; NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, University of Nottingham, Nottingham
| | - Nicholas M Selby
- Centre for Kidney Research and Innovation, Academic Unit for Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham; Department of Renal Medicine, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, United Kingdom
| | - Maarten W Taal
- Centre for Kidney Research and Innovation, Academic Unit for Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham; Department of Renal Medicine, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, United Kingdom.
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Hua C, Qiu L, Zhou L, Zhuang Y, Cai T, Xu B, Hao S, Fang X, Wang L, Jiang H. Value of multiparametric magnetic resonance imaging for evaluating chronic kidney disease and renal fibrosis. Eur Radiol 2023; 33:5211-5221. [PMID: 37148348 DOI: 10.1007/s00330-023-09674-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 01/12/2023] [Accepted: 02/13/2023] [Indexed: 05/08/2023]
Abstract
OBJECTIVES To identify optimized MRI markers for evaluating chronic kidney disease (CKD) and renal interstitial fibrosis (IF). MATERIALS AND METHODS This prospective study included 43 patients with CKD and 20 controls. The CKD group was divided into mild and moderate-to-severe subgroups based on pathological results. Scanned sequences included T1 mapping, R2* mapping, intravoxel incoherent motion imaging, and diffusion-weighted imaging. One-way analyses of variance were used to compare MRI parameters among groups. Correlations of MRI parameters with estimated glomerular filtration rate (eGFR) and renal IF were analyzed using age as covariates. The support vector machine (SVM) model was used to evaluate the diagnostic efficacy of multiparametric MRI. RESULTS Compared to control values, renal cortical apparent diffusion coefficient (cADC), medullary ADC (mADC), cortical pure diffusion coefficient (cDt), medullary Dt (mDt), cortical shifted apparent diffusion coefficient (csADC), and medullary sADC (msADC) values gradually decreased in the mild and moderate-to-severe groups, while cortical T1 (cT1) and medullary T1 (mT1) values gradually increased. Values of cADC, mADC, cDt, mDt, cT1, mT1, csADC, and msADC were significantly associated with eGFR and IF (p < 0.001). The SVM model indicated that multiparametric MRI combining cT1 and csADC can distinguish patients with CKD from controls with high accuracy (0.84), sensitivity (0.70), and specificity (0.92) (AUC: 0.96). Multiparametric MRI combining cT1 and cADC exhibited high accuracy (0.91), sensitivity (0.95), and specificity (0.81) for evaluating IF severity (AUC: 0.96). CONCLUSION Multiparametric MRI combining T1 mapping and diffusion imaging may be of clinical utility in non-invasive assessment of CKD and IF. CLINICAL RELEVANCE STATEMENT This study shows that multiparametric MRI combining T1 mapping and diffusion imaging may be clinically useful in the non-invasive assessment of chronic kidney disease (CKD) and interstitial fibrosis; this could provide information for risk stratification, diagnosis, treatment, and prognosis. KEY POINTS • Optimized MRI markers for evaluating chronic kidney disease and renal interstitial fibrosis were investigated. • Renal cortex/medullary T1 values increased as interstitial fibrosis increased; cortical shifted apparent diffusion coefficient (csADC) correlated significantly with eGFR and interstitial fibrosis. • Support vector machine (SVM) combining cortical T1 (cT1) and csADC/cADC effectively identifies chronic kidney disease and accurately predicts renal interstitial fibrosis.
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Affiliation(s)
- Chenchen Hua
- Diagnostic Radiology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, No. 299 Qingyang Road, Wuxi, China
- Department of Diagnostic Radiology, The Affiliated Wuxi Children's Hospital of Nanjing Medical University, No. 299 Qingyang Road, Wuxi, China
| | - Lu Qiu
- Department of Diagnostic Radiology, The Affiliated Wuxi Children's Hospital of Nanjing Medical University, No. 299 Qingyang Road, Wuxi, China
| | - Leting Zhou
- Department of Nephrology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, No. 299 Qingyang Road, Wuxi, China
| | - Yi Zhuang
- Department of Diagnostic Radiology, The Affiliated Wuxi Children's Hospital of Nanjing Medical University, No. 299 Qingyang Road, Wuxi, China
| | - Ting Cai
- Department of Nephrology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, No. 299 Qingyang Road, Wuxi, China
| | - Bin Xu
- Diagnostic Radiology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, No. 299 Qingyang Road, Wuxi, China
| | - Shaowei Hao
- Siemens Healthineers Digital Technology (Shanghai) CO., Ltd, Shanghai, China
| | - Xiangming Fang
- Diagnostic Radiology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, No. 299 Qingyang Road, Wuxi, China
| | - Liang Wang
- Department of Nephrology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, No. 299 Qingyang Road, Wuxi, China.
| | - Haoxiang Jiang
- Department of Diagnostic Radiology, The Affiliated Wuxi Children's Hospital of Nanjing Medical University, No. 299 Qingyang Road, Wuxi, China.
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Friedli I, Baid-Agrawal S, Unwin R, Morell A, Johansson L, Hockings PD. Magnetic Resonance Imaging in Clinical Trials of Diabetic Kidney Disease. J Clin Med 2023; 12:4625. [PMID: 37510740 PMCID: PMC10380287 DOI: 10.3390/jcm12144625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 06/28/2023] [Accepted: 07/04/2023] [Indexed: 07/30/2023] Open
Abstract
Chronic kidney disease (CKD) associated with diabetes mellitus (DM) (known as diabetic kidney disease, DKD) is a serious and growing healthcare problem worldwide. In DM patients, DKD is generally diagnosed based on the presence of albuminuria and a reduced glomerular filtration rate. Diagnosis rarely includes an invasive kidney biopsy, although DKD has some characteristic histological features, and kidney fibrosis and nephron loss cause disease progression that eventually ends in kidney failure. Alternative sensitive and reliable non-invasive biomarkers are needed for DKD (and CKD in general) to improve timely diagnosis and aid disease monitoring without the need for a kidney biopsy. Such biomarkers may also serve as endpoints in clinical trials of new treatments. Non-invasive magnetic resonance imaging (MRI), particularly multiparametric MRI, may achieve these goals. In this article, we review emerging data on MRI techniques and their scientific, clinical, and economic value in DKD/CKD for diagnosis, assessment of disease pathogenesis and progression, and as potential biomarkers for clinical trial use that may also increase our understanding of the efficacy and mode(s) of action of potential DKD therapeutic interventions. We also consider how multi-site MRI studies are conducted and the challenges that should be addressed to increase wider application of MRI in DKD.
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Affiliation(s)
- Iris Friedli
- Antaros Medical, BioVenture Hub, 43183 Mölndal, Sweden
| | - Seema Baid-Agrawal
- Transplant Center, Sahlgrenska University Hospital, University of Gothenburg, 41345 Gothenburg, Sweden
| | - Robert Unwin
- AstraZeneca R&D BioPharmaceuticals, Translational Science and Experimental Medicine, Early Cardiovascular, Renal & Metabolic Diseases (CVRM), Granta Park, Cambridge CB21 6GH, UK
| | - Arvid Morell
- Antaros Medical, BioVenture Hub, 43183 Mölndal, Sweden
| | | | - Paul D Hockings
- Antaros Medical, BioVenture Hub, 43183 Mölndal, Sweden
- MedTech West, Chalmers University of Technology, 41345 Gothenburg, Sweden
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Chen J, Zhang Z, Liu J, Li C, Yin M, Nie L, Song B. Multiparametric Magnetic Resonance Imaging of the Kidneys: Effects of Regional, Side, and Hydration Variations on Functional Quantifications. J Magn Reson Imaging 2023; 57:1576-1586. [PMID: 36219465 PMCID: PMC10079549 DOI: 10.1002/jmri.28477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 09/28/2022] [Accepted: 09/29/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND To standardize renal functional magnetic resonance imaging (MRI), it is important to understand the influence of side-to-side variation, regional variation within the organ, and hydration states in MRI and to search for variables that are not affected by those variations. PURPOSE To assess MRI-based biomarkers for characterizing the kidney in healthy volunteers while considering variations in anatomic factors and hydration states. STUDY TYPE Prospective. SUBJECTS Twenty-five healthy volunteers (15 females and 10 males, median age 25 years). FIELD STRENGTH/SEQUENCE 3.0 T intravoxel incoherent motion diffusion-weighted imaging, arterial spinning labeling imaging, blood oxygenation level dependent imaging, and three-dimensional MR elastography. ASSESSMENT Functional variables were measured before and after water challenge. Regions of interest were manually drawn by two investigators (JC and ZZ, with 8- and 5-year experiences in abdominal radiology) in the cortex, the medulla, and the entire kidney. The medulla/cortex ratio was calculated. STATISTICAL TESTS Paired t-test or Wilcoxon signed rank test; interobserver correlation coefficient; repeatability coefficients; Spearman's correlation; significance level: P < 0.05. RESULTS Diffusion parameters were only subject to regional variation. R2*, RBF, and renal stiffness (RS) showed regional variation, side variation, and dependence on hydration states. For each side and hydration state, the cortex showed significantly higher standard apparent diffusion coefficient (sADC), higher true diffusion (D), lower R2*, and lower RS than the medulla. For each region at baseline, the left kidney showed significantly higher R2*, higher RS, and lower renal blood flow (RBF) than the right kidney. For each region and side, RS and RBF increased significantly while R2* decreased significantly after water intake. After introducing the intrinsic regional difference, significantly higher medulla/cortex ratio of RS remained after water intake except for RS@90 Hz in the right kidney. DATA CONCLUSION Renal multiparametric MRI quantifications were affected by regional variation, side variation, and hydration states. LEVEL OF EVIDENCE 2 TECHNICAL EFFICACY: Stage 1.
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Affiliation(s)
- Jie Chen
- Department of Radiology, Sichuan University West China Hospital, Chengdu, China
| | - Zhen Zhang
- Department of Radiology, Sichuan University West China Hospital, Chengdu, China
| | - Juan Liu
- Department of Radiology, Sichuan University West China Hospital, Chengdu, China
| | - Chengjie Li
- Department of Radiology, Chongqing Southeast Hospital, Chongqing, China
| | - Meng Yin
- Department of Radiology, Mayo Clinic, USA
| | - Lisha Nie
- GE Healthcare, MR Research China, Beijing, China
| | - Bin Song
- Department of Radiology, Sichuan University West China Hospital, Chengdu, China
- Department of Radiology, Sanya People’s Hospital, Sanya, China
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10
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Laothamatas I, Al Mubarak H, Reddy A, Wax R, Badani K, Taouli B, Bane O, Lewis S. Multiparametric MRI of Solid Renal Masses: Principles and Applications of Advanced Quantitative and Functional Methods for Tumor Diagnosis and Characterization. J Magn Reson Imaging 2023. [PMID: 37052601 DOI: 10.1002/jmri.28718] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/23/2023] [Accepted: 03/23/2023] [Indexed: 04/14/2023] Open
Abstract
Solid renal masses (SRMs) are increasingly detected and encompass both benign and malignant masses, with renal cell carcinoma (RCC) being the most common malignant SRM. Most patients with SRMs will undergo management without a priori pathologic confirmation. There is an unmet need to noninvasively diagnose and characterize RCCs, as significant variability in clinical behavior is observed and a wide range of differing management options exist. Cross-sectional imaging modalities, including magnetic resonance imaging (MRI), are increasingly used for SRM characterization. Multiparametric (mp) MRI techniques can provide insight into tumor biology by probing different physiologic/pathophysiologic processes noninvasively. These include sequences that probe tissue microstructure, including intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) and T1 relaxometry; oxygen metabolism (blood oxygen level dependent [BOLD-MRI]); as well as vascular flow and perfusion (dynamic contrast-enhanced MRI [DCE-MRI] and arterial spin labeling [ASL]). In this review, we will discuss each mpMRI method in terms of its principles, roles, and discuss the results of human studies for SRM assessment. Future validation of these methods may help to enable a personalized management approach for patients with SRM in the emerging era of precision medicine. EVIDENCE LEVEL: 5. TECHNICAL EFFICACY: 2.
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Affiliation(s)
- Indira Laothamatas
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Haitham Al Mubarak
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Arthi Reddy
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Rebecca Wax
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ketan Badani
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Bachir Taouli
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Octavia Bane
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Sara Lewis
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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11
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Recent Developments in the Evaluation and Management of Cardiorenal Syndrome: A Comprehensive Review. Curr Probl Cardiol 2023; 48:101509. [PMID: 36402213 DOI: 10.1016/j.cpcardiol.2022.101509] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 11/11/2022] [Indexed: 11/18/2022]
Abstract
Cardiorenal syndrome (CRS) is an increasingly recognized diagnostic entity associated with high morbidity and mortality among acutely ill heart failure (HF) patients with acute and/ or chronic kidney diseases (CKD). While traditionally viewed as a state of decline in glomerular filtration rate (GFR) due to decreased renal perfusion, mainly due to therapeutic interventions to relieve congestive in HF, recent insights into the underlying pathophysiologic mechanisms of CRS led to a broader definition and further classification of CRS into 5 distinct types. In this comprehensive review, we discuss the classification of CRS, highlighting the underlying common pathogenetic pathways of heart failure and kidney injury, including increased congestion, neurohormonal dysregulation, oxidative stress as well as inflammation, and cytokine storm that are particularly evident in COVID-19 patients with multiorgan failure and also in those with other disorders including sepsis, systemic lupus erythematosus and amyloidosis. In this review we also present the recent advances in the diagnostic strategies of CRS including cardiac and renal biomarkers as well as advanced cardiac and renal imaging techniques that are available to aid in the diagnosis as well as in the prognostication of this disorder. Finally, we discuss the various therapeutic options available to-date, including fluid optimization, hemofiltration, renal replacement therapy as well as the role of SGLT2 inhibitors in light of recent data from RCTs. It is important to note that, CRS population are either excluded or underrepresented, at best, in major RCTs and therefore, therapeutic recommendations are largely extrapolated from HF and CKD clinical trials.
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12
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Echeverria‐Chasco R, Martin‐Moreno PL, Garcia‐Fernandez N, Vidorreta M, Aramendia‐Vidaurreta V, Cano D, Villanueva A, Bastarrika G, Fernández‐Seara MA. Multiparametric renal magnetic resonance imaging: A reproducibility study in renal allografts with stable function. NMR IN BIOMEDICINE 2023; 36:e4832. [PMID: 36115029 PMCID: PMC10078573 DOI: 10.1002/nbm.4832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 09/13/2022] [Accepted: 09/15/2022] [Indexed: 06/15/2023]
Abstract
Monitoring renal allograft function after transplantation is key for the early detection of allograft impairment, which in turn can contribute to preventing the loss of the allograft. Multiparametric renal MRI (mpMRI) is a promising noninvasive technique to assess and characterize renal physiopathology; however, few studies have employed mpMRI in renal allografts with stable function (maintained function over a long time period). The purposes of the current study were to evaluate the reproducibility of mpMRI in transplant patients and to characterize normal values of the measured parameters, and to estimate the labeling efficiency of Pseudo-Continuous Arterial Spin Labeling (PCASL) in the infrarenal aorta using numerical simulations considering experimental measurements of aortic blood flow profiles. The subjects were 20 transplant patients with stable kidney function, maintained over 1 year. The MRI protocol consisted of PCASL, intravoxel incoherent motion, and T1 inversion recovery. Phase contrast was used to measure aortic blood flow. Renal blood flow (RBF), diffusion coefficient (D), pseudo-diffusion coefficient (D*), flowing fraction ( f ), and T1 maps were calculated and mean values were measured in the cortex and medulla. The labeling efficiency of PCASL was estimated from simulation of Bloch equations. Reproducibility was assessed with the within-subject coefficient of variation, intraclass correlation coefficient, and Bland-Altman analysis. Correlations were evaluated using the Pearson correlation coefficient. The significance level was p less than 0.05. Cortical reproducibility was very good for T1, D, and RBF, moderate for f , and low for D*, while medullary reproducibility was good for T1 and D. Significant correlations in the cortex between RBF and f (r = 0.66), RBF and eGFR (r = 0.64), and D* and eGFR (r = -0.57) were found. Normal values of the measured parameters employing the mpMRI protocol in kidney transplant patients with stable function were characterized and the results showed good reproducibility of the techniques.
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Affiliation(s)
- Rebeca Echeverria‐Chasco
- Department of RadiologyClínica Universidad de NavarraPamplonaSpain
- IdiSNA, Instituto de Investigación Sanitaria de NavarraPamplonaSpain
| | - Paloma L. Martin‐Moreno
- IdiSNA, Instituto de Investigación Sanitaria de NavarraPamplonaSpain
- Department of NephrologyClínica Universidad de NavarraPamplonaSpain
| | - Nuria Garcia‐Fernandez
- IdiSNA, Instituto de Investigación Sanitaria de NavarraPamplonaSpain
- Department of NephrologyClínica Universidad de NavarraPamplonaSpain
| | | | - Verónica Aramendia‐Vidaurreta
- Department of RadiologyClínica Universidad de NavarraPamplonaSpain
- IdiSNA, Instituto de Investigación Sanitaria de NavarraPamplonaSpain
| | - David Cano
- Department of RadiologyClínica Universidad de NavarraPamplonaSpain
| | - Arantxa Villanueva
- IdiSNA, Instituto de Investigación Sanitaria de NavarraPamplonaSpain
- Electrical Electronics and Communications Engineering Department and Smart Cities InstitutePublic University of NavarrePamplonaSpain
| | - Gorka Bastarrika
- Department of RadiologyClínica Universidad de NavarraPamplonaSpain
- IdiSNA, Instituto de Investigación Sanitaria de NavarraPamplonaSpain
| | - Maria A. Fernández‐Seara
- Department of RadiologyClínica Universidad de NavarraPamplonaSpain
- IdiSNA, Instituto de Investigación Sanitaria de NavarraPamplonaSpain
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13
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Liu F, Hu W, Sun Y, Shen Y, Zhou W, Dai Y, Gu L, Zhang M, Zhou Y. Exploration of Interstitial Fibrosis in Chronic Kidney Disease by Diffusion‐Relaxation Correlation Spectrum
MR
Imaging: A Preliminary Study. J Magn Reson Imaging 2022. [DOI: 10.1002/jmri.28535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 11/07/2022] [Accepted: 11/08/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Fang Liu
- Department of Radiology Renji Hospital, School of Medicine, Shanghai Jiao Tong University Shanghai China
| | - Wentao Hu
- Central Research Institute, United Imaging Healthcare Shanghai China
| | - Yawen Sun
- Department of Radiology Renji Hospital, School of Medicine, Shanghai Jiao Tong University Shanghai China
| | - Yiwei Shen
- Department of Nephrology Renji Hospital, School of Medicine, Shanghai Jiao Tong University Shanghai China
| | - Wenyan Zhou
- Department of Nephrology Renji Hospital, School of Medicine, Shanghai Jiao Tong University Shanghai China
| | - Yongming Dai
- Central Research Institute, United Imaging Healthcare Shanghai China
| | - Leyi Gu
- Department of Nephrology Renji Hospital, School of Medicine, Shanghai Jiao Tong University Shanghai China
| | - Minfang Zhang
- Department of Nephrology Renji Hospital, School of Medicine, Shanghai Jiao Tong University Shanghai China
| | - Yan Zhou
- Department of Radiology Renji Hospital, School of Medicine, Shanghai Jiao Tong University Shanghai China
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14
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Ruiz-Ortega M, Lamas S, Ortiz A. Antifibrotic Agents for the Management of CKD: A Review. Am J Kidney Dis 2022; 80:251-263. [PMID: 34999158 DOI: 10.1053/j.ajkd.2021.11.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 11/18/2021] [Indexed: 01/27/2023]
Abstract
Kidney fibrosis is a hallmark of chronic kidney disease (CKD) and a potential therapeutic target. However, there are conceptual and practical challenges to directly targeting kidney fibrosis. Whether fibrosis is mainly a cause or a consequence of CKD progression has been disputed. It is unclear whether specifically targeting fibrosis is feasible in clinical practice because most drugs that decrease fibrosis in preclinical models target additional and often multiple pathogenic pathways (eg, renin-angiotensin-aldosterone system blockade). Moreover, tools to assess whole-kidney fibrosis in routine clinical practice are lacking. Pirfenidone, a drug used for idiopathic pulmonary fibrosis, is undergoing a phase 2 trial for kidney fibrosis. Other drugs in use or being tested for idiopathic pulmonary fibrosis (eg, nintedanib, PRM-151, epigallocatechin gallate) are also potential candidates to treat kidney fibrosis. Novel therapeutic approaches may include antagomirs (eg, lademirsen) or drugs targeting interleukin 11 or NKD2 (WNT signaling pathway inhibitor). Reversing the dysfunctional tubular cell metabolism that leads to kidney fibrosis offers additional therapeutic opportunities. However, any future drug targeting fibrosis of the kidneys should demonstrate added benefit to a standard of care that combines renin-angiotensin system with mineralocorticoid receptor (eg, finerenone) blockade or with sodium/glucose cotransporter 2 inhibitors.
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Affiliation(s)
- Marta Ruiz-Ortega
- Molecular and Cellular Biology in Renal and Vascular Pathology, Madrid, Spain; Instituto de Investigación Sanitaria-Fundación Jiménez Díaz-Universidad Autónoma Madrid; Red de Investigación Renal, Madrid, Spain
| | - Santiago Lamas
- Instituto de Investigación Sanitaria-Fundación Jiménez Díaz-Universidad Autónoma Madrid; Red de Investigación Renal, Madrid, Spain; Program of Physiological and Pathological Processes, Centro de Biología Molecular "Severo Ochoa", Madrid, Spain
| | - Alberto Ortiz
- Nephrology and Hypertension, Madrid, Spain; Instituto de Investigación Sanitaria-Fundación Jiménez Díaz-Universidad Autónoma Madrid; Red de Investigación Renal, Madrid, Spain.
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15
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Abstract
PURPOSE OF REVIEW Fibrosis is an important biomarker of chronic kidney injury, and a powerful predictor of renal outcome. Currently, the only method for measuring fibrotic burden is histologic analysis, which requires a kidney biopsy in humans, or kidney removal in animal models. These requirements have not only hindered our ability to manage patients effectively, but have also prevented a full understanding of renal fibrosis pathogenesis, and slowed the translation of new antifibrotic agents. The development of noninvasive fibrosis imaging tools could thus transform both clinical care and renal fibrosis research. RECENT FINDINGS Conventional imaging modalities have historically failed to image fibrosis successfully. However, recent exciting technological advances have greatly enhanced their capabilities. New techniques, for example, may allow imaging of the physical consequences of scarring, as surrogate measures of renal fibrosis. Similarly, other groups have developed ways to directly image extracellular matrix, either with the use of contrast-enhanced probes, or using matrix components as endogenous contrast agents. SUMMARY New developments in imaging technology have the potential to transform our ability to visualize renal fibrosis and to monitor its progression. In doing so, these advances could have major implications for kidney disease care, the development of new antiscarring agents, and our understanding of renal fibrosis in general.
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16
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Wang R, Lin Z, Yang X, Zhao K, Wang S, Sui X, Su T, Wang X. Noninvasive Evaluation of Renal Hypoxia by Multiparametric Functional MRI in Early Diabetic Kidney Disease. J Magn Reson Imaging 2021; 55:518-527. [PMID: 34184356 DOI: 10.1002/jmri.27814] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 06/16/2021] [Accepted: 06/18/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Renal hypoxia, which caused by a mismatch between oxygen delivery and oxygen demand, may be the primary pathophysiological pathway driving diabetic kidney disease (DKD). Blood oxygenation level-dependent (BOLD) magnetic resonance imaging (MRI) could detect hypoxia, but can be limited in distinguishing increased oxygen consumption or decreased blood supply. PURPOSE To explore multiparametric functional MRI in evaluating mechanism of the hypoxia changes in early stage of DKD. STUDY TYPE Prospective. ANIMAL MODEL Thirty-five New Zealand White rabbits were divided into control group (n = 5) and alloxan-induced diabetes mellitus (DM) groups (DM3 group: n = 15, DM7 group: n = 15). FIELD STRENGTH/SEQUENCE 3 T MRI/BOLD, arterial spin labeling (ASL), and asymmetric spin-echo (ASE). ASSESSMENT The renal oxygenation level (R2*), renal blood flow (RBF), and oxygen extraction fraction (OEF) were evaluated by BOLD, ASL, and ASE MRI, respectively. The regions of interest were manually drawn including cortex, outer stripes of outer medulla (OS), and inner stripes of outer medulla (IS). STATISTICAL TESTS Analysis of variance, independent-sample t-test, and paired-sample t-test were applied for comparisons among groups, between groups, and within the same group. P < 0.05 was considered statistically significant. RESULTS All renal regions of DM3 group at Day 3 after DM induction showed significantly higher R2* and OEF values compared to baseline. The RBF values showed no statistically significant difference (P = 0.62, 0.76, 0.09 in cortex, OS, and IS, respectively). For DM7 group at Day 7, R2*, OEF, and RBF values showed no statistically significant difference compared to baseline (P = 0.06, 0.05, 0.06 of R2*; 0.70, 0.64, 0.68 of OEF; and 0.33, 0.58, 0.48 of RBF in cortex, OS, and IS, respectively). DATA CONCLUSION BOLD MRI could detect renal hypoxia in early stage of DKD rabbit model, which was mainly revealed by increased oxygen consumption, but not affected by renal blood flow change. LEVEL OF EVIDENCE 2 Technical Efficacy Stage: 1.
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Affiliation(s)
- Rui Wang
- Department of Radiology, Peking University First Hospital, Beijing, China
| | - Zhiyong Lin
- Department of Radiology, Peking University First Hospital, Beijing, China
| | - Xuedong Yang
- Department of Radiology, China Academy of Chinese Medical Sciences Guanganmen Hospital, Beijing, China
| | - Kai Zhao
- Department of Radiology, Peking University First Hospital, Beijing, China
| | - Suxia Wang
- Renal Pathology Center, Peking University First Hospital, Peking University Institute of Nephrology, Beijing, China
| | - Xueqing Sui
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Tao Su
- Department of Nephrology, Peking University First Hospital, Beijing, China
| | - Xiaoying Wang
- Department of Radiology, Peking University First Hospital, Beijing, China
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17
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Katagiri D, Wang F, Gore JC, Harris RC, Takahashi T. Clinical and experimental approaches for imaging of acute kidney injury. Clin Exp Nephrol 2021; 25:685-699. [PMID: 33835326 PMCID: PMC8154759 DOI: 10.1007/s10157-021-02055-2] [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: 11/23/2020] [Accepted: 03/17/2021] [Indexed: 12/23/2022]
Abstract
Complex molecular cell dynamics in acute kidney injury and its heterogeneous etiologies in patient populations in clinical settings have revealed the potential advantages and disadvantages of emerging novel damage biomarkers. Imaging techniques have been developed over the past decade to further our understanding about diseased organs, including the kidneys. Understanding the compositional, structural, and functional changes in damaged kidneys via several imaging modalities would enable a more comprehensive analysis of acute kidney injury, including its risks, diagnosis, and prognosis. This review summarizes recent imaging studies for acute kidney injury and discusses their potential utility in clinical settings.
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Affiliation(s)
- Daisuke Katagiri
- Division of Nephrology and Hypertension, Vanderbilt University Medical Center, S-3223 MCN, Nashville, TN, 37232, USA. .,Department of Nephrology, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan.
| | - Feng Wang
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, TN, USA.,Vanderbilt In Vivo Mouse Kidney Imaging Core, Vanderbilt University Medical Center, Nashville, TN, USA
| | - John C Gore
- Vanderbilt In Vivo Mouse Kidney Imaging Core, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Raymond C Harris
- Division of Nephrology and Hypertension, Vanderbilt University Medical Center, S-3223 MCN, Nashville, TN, 37232, USA
| | - Takamune Takahashi
- Division of Nephrology and Hypertension, Vanderbilt University Medical Center, S-3223 MCN, Nashville, TN, 37232, USA. .,Vanderbilt In Vivo Mouse Kidney Imaging Core, Vanderbilt University Medical Center, Nashville, TN, USA.
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18
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Nassar MK, Khedr D, Abu-Elfadl HG, E Abdulgalil A, Abdalbary M, Moustafa FEH, Sayed Ahmed N, Shemies RS. Diffusion Tensor Imaging in early prediction of renal fibrosis in patients with renal disease: Functional and histopathological correlations. Int J Clin Pract 2021; 75:e13918. [PMID: 33295069 DOI: 10.1111/ijcp.13918] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 12/06/2020] [Indexed: 12/15/2022] Open
Abstract
AIM Renal fibrosis (RF) is a well-known marker of chronic kidney disease (CKD) progression. However, renal biopsy is an available tool for evaluation of RF, non-invasive tools are needed not only to detect but also to monitor the progression of fibrosis. The aim of this study is to evaluate the role of diffusion tensor imaging (DTI) in the assessment of renal dysfunction and RF in patients with renal disease. METHODS Fifty-six patients with renal disorders and 22 healthy controls were recruited. All participants underwent DTI. Renal biopsy was performed for all patients. Mean renal medullary and cortical fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values were compared between patients and healthy controls and correlated to serum creatinine (SCr), estimated glomerular filtration rate (eGFR), 24-h urinary protein (24h-UPRO) and renal histopathological scores. RESULTS Cortical FA values were significantly higher (P = .001), while cortical ADC values were significantly lower in the patients' group (P = .002). Cortical FA values positively correlated to SCr (P = .006) and negatively correlated to eGFR (P = .03), while cortical ADC negatively correlated to percentage of sclerotic glomeruli, atrophic tubules and interstitial fibrosis (P = .001 for all variables). Medullary ADC negatively correlated to tubular atrophy (P = .02). The diagnostic performance of DTI for detecting RF was supported by ROC curve. Multiple linear regression analysis revealed that the mean cortex ADC was significantly decreased by 0.199 mg/dL for patients with >50% glomerulosclerosis in renal biopsy. CONCLUSION DTI appears to represent a valuable tool for the non-invasive assessment of renal dysfunction and renal fibrosis.
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Affiliation(s)
- Mohammed K Nassar
- Mansoura Nephrology and Dialysis Unit, Mansoura University, Mansoura, Egypt
| | - Doaa Khedr
- Department of diagnostic radiology, Mansoura University, Mansoura, Egypt
| | - Hend G Abu-Elfadl
- Department of diagnostic radiology, Mansoura University, Mansoura, Egypt
| | - Ahmed E Abdulgalil
- Mansoura Nephrology and Dialysis Unit, Mansoura University, Mansoura, Egypt
| | - Mohamed Abdalbary
- Mansoura Nephrology and Dialysis Unit, Mansoura University, Mansoura, Egypt
| | | | - Nagy Sayed Ahmed
- Mansoura Nephrology and Dialysis Unit, Mansoura University, Mansoura, Egypt
| | - Rasha S Shemies
- Mansoura Nephrology and Dialysis Unit, Mansoura University, Mansoura, Egypt
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19
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Yu YM, Wang W, Wen J, Zhang Y, Lu GM, Zhang LJ. Detection of renal allograft fibrosis with MRI: arterial spin labeling outperforms reduced field-of-view IVIM. Eur Radiol 2021; 31:6696-6707. [PMID: 33738596 DOI: 10.1007/s00330-021-07818-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 01/27/2021] [Accepted: 02/19/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To compare the value of reduced field-of-view (FOV) intravoxel incoherent motion (IVIM) diffusion-weighted imaging (DWI) and arterial spin labeling (ASL) for assessing renal allograft fibrosis and predicting long-term dysfunction. METHODS This prospective study included 175 renal transplant recipients undergoing reduced FOV IVIM DWI, ASL, and biopsies. Renal allograft fibrosis was categorized into ci0, ci1, ci2, and ci3 fibrosis according to biopsy results. A total of 83 participants followed for a median of 39 (IQR, 21-42) months were dichotomized into stable and impaired allograft function groups based on follow-up estimated glomerular filtration rate. Total apparent diffusion coefficient (ADCT), pure diffusion ADC, pseudo-perfusion ADC, perfusion fraction f from IVIM DWI, and renal blood flow (RBF) from ASL were calculated and compared. The area under the receiver operating characteristic curve (AUC) was calculated to assess the diagnostic and predictive performances. RESULTS RBF was different in ci0 vs ci1 (147.9 ± 46.3 vs 126.0 ± 49.4 ml/min/100 g, p = .02) and ci2 vs ci3 (92.9 ± 46.9 vs 70.8 ± 37.8 ml/min/100 g, p = .03). RBF in the stable group was higher than that in the impaired group (144.73 ± 49.33 vs 102.19 ± 47.58 ml/min/100 g, p < .001). AUCs in distinguishing renal allograft fibrosis and predicting long-term allograft dysfunction for RBF were higher than cortical ADCT (ci0 vs ci1-3, 0.76 vs 0.59, p < .001; ci0-1 vs ci2-3, 0.79 vs 0.68, p = .01; ci0-2 vs ci3, 0.79 vs 0.68, p = .01; 0.76 vs 0.60, p = .04, respectively). CONCLUSION Compared to reduced FOV IVIM DWI, ASL was a more promising technique for noninvasively distinguishing renal allograft fibrosis degree and predicting long-term allograft dysfunction. KEY POINTS • Compared to total ADC from rFOV IVIM DWI, RBF from ASL can distinguish no fibrosis (ci0) vs mild fibrosis (ci1) (p = .02) and moderate fibrosis (ci2) vs severe fibrosis (ci3) (p = .04). • RBF had superior performance than diffusion parameters in discriminating fibrosis (no fibrosis [ci0] vs fibrosis [ci1-3], mild fibrosis [ci0-1] vs moderate to severe fibrosis [ci2-3], non-severe [ci0-2] vs severe [ci3] fibrosis; AUC = 0.76 vs 0.59, p < .001; 0.79 vs 0.68, p = .01; 0.79 vs 0.68, p = .01). • Compared to reduced FOV IVIM DWI, ASL was a more promising technique for noninvasively predicting long-term allograft dysfunction (AUC = 0.76 vs 0.60, p = .04).
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Affiliation(s)
- Yuan Meng Yu
- Department of Medical Imaging, Jinling Hospital, Clinical School of Southern Medical University, Nanjing, 210002, Jiangsu, China.,Department of MRI, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, No. 157 Jinbi Road, Kunming, 650032, Yunnan, China
| | - Wei Wang
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing Medical University, 305 East Zhong Shan Road, Nanjing, 210002, China.,Department of Nephrology, Shanghai General Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Jiqiu Wen
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing Medical University, 305 East Zhong Shan Road, Nanjing, 210002, China
| | - Yong Zhang
- MR Research, GE Healthcare, Shanghai, 201203, China
| | - Guang Ming Lu
- Department of Medical Imaging, Jinling Hospital, Clinical School of Southern Medical University, Nanjing, 210002, Jiangsu, China.,Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China
| | - Long Jiang Zhang
- Department of Medical Imaging, Jinling Hospital, Clinical School of Southern Medical University, Nanjing, 210002, Jiangsu, China. .,Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China.
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20
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Zhang J, Yu Y, Liu X, Tang X, Xu F, Zhang M, Xie G, Zhang L, Li X, Liu ZH. Evaluation of Renal Fibrosis by Mapping Histology and Magnetic Resonance Imaging. KIDNEY DISEASES 2021; 7:131-142. [PMID: 33824869 DOI: 10.1159/000513332] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 11/24/2020] [Indexed: 12/15/2022]
Abstract
Background Renal fibrosis is a key driver of progression in chronic kidney disease (CKD). Recent advances in diagnostic imaging techniques have shown promising results for the noninvasive assessment of renal fibrosis. However, the specificity and accuracy of these techniques are controversial because they indirectly assess renal fibrosis. This limits fibrosis assessment by imaging in CKD for clinical practice. To validate magnetic resonance imaging (MRI) assessment for fibrosis, we derived representative models by mapping histology-proven renal fibrosis and imaging in CKD. Methods Ninety-seven adult Chinese CKD participants with histology were studied. The kidney cortex interstitial extracellular matrix volume was calculated by the Aperio ScanScope system using Masson's trichrome slices. The kidney cortex microcirculation was quantitatively assessed by peritubular capillary density using CD34 staining. The imaging techniques included intravoxel incoherent motion diffusion-weighted imaging and magnetic resonance elastography (MRE) imaging. Relevant analyses were performed to evaluate the correlations between MRI parameters and histology variables. Multiple linear regression models were used to describe the relationships between a response variable and other variables. The best-fit lines, which minimize the sum of squared residuals of the multiple linear regression models, were generated. Results MRE values were negatively associated with the interstitial extracellular matrix volume (Rho = -0.397, p < 0.001). The best mapping model of extracellular matrix volume with the MRE value and estimated glomerular filtration rate (eGFR) we obtained was as follows: Interstitial extracellular matrix volume = 218.504 - 14.651 × In(MRE) - 18.499 × In(eGFR). DWI-fraction values were positively associated with peritubular capillary density (Rho = 0.472, p < 0.001). The best mapping model of peritubular capillary density with DWI-fraction value and eGFR was as follows: Peritubular capillaries density = 17.914 + 9.403 × (DWI - fraction) + 0.112 × (eGFR). Conclusions The study provides histological evidence to support that MRI can effectively evaluate fibrosis in the kidney. These findings picture the graphs of the mapping model from imaging and eGFR into fibrosis, which has significant value for clinical implementation.
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Affiliation(s)
- Jiong Zhang
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Second Military Medical University, Nanjing, China
| | - Yuanmeng Yu
- Department of Medical Imaging, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | | | - Xiong Tang
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Second Military Medical University, Nanjing, China
| | - Feng Xu
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Second Military Medical University, Nanjing, China
| | - Mingchao Zhang
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Second Military Medical University, Nanjing, China
| | - Guotong Xie
- Ping An Healthcare Technology, Ping An Health Cloud Company Limited, Ping An International Smart City Technology Co., Ltd., Beijing, China
| | - Longjiang Zhang
- Department of Medical Imaging, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Xiang Li
- Ping An Health Technology, Beijing, China
| | - Zhi-Hong Liu
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Second Military Medical University, Nanjing, China
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21
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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: 27] [Impact Index Per Article: 9.0] [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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22
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Kidney Transplantation and Diagnostic Imaging: The Early Days and Future Advancements of Transplant Surgery. Diagnostics (Basel) 2020; 11:diagnostics11010047. [PMID: 33396860 PMCID: PMC7823312 DOI: 10.3390/diagnostics11010047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 12/27/2020] [Accepted: 12/28/2020] [Indexed: 12/23/2022] Open
Abstract
The first steps for modern organ transplantation were taken by Emerich Ullmann (Vienne, Austria) in 1902, with a dog-to-dog kidney transplant, and ultimate success was achieved by Joseph Murray in 1954, with the Boston twin brothers. In the same time period, the ground-breaking work of Wilhelm C. Röntgen (1895) and Maria Sklodowska-Curie (1903), on X-rays and radioactivity, enabled the introduction of diagnostic imaging. In the years thereafter, kidney transplantation and diagnostic imaging followed a synergistic path for their development, with key discoveries in transplant rejection pathways, immunosuppressive therapies, and the integration of diagnostic imaging in transplant programs. The first image of a transplanted kidney, a urogram with intravenous contrast, was shown to the public in 1956, and the first recommendations for transplantation diagnostic imaging were published in 1958. Transplant surgeons were eager to use innovative diagnostic modalities, with renal scintigraphy in the 1960s, as well as ultrasound and computed tomography in the 1970s. The use of innovative diagnostic modalities has had a great impact on the reduction of post-operative complications in kidney transplantation, making it one of the key factors for successful transplantation. For the new generation of transplant surgeons, the historical alignment between transplant surgery and diagnostic imaging can be a motivator for future innovations.
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23
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de Boer A, Pieters TT, Harteveld AA, Blankestijn PJ, Bos C, Froeling M, Goldschmeding R, Hoogduin HJM, Joles JA, Petri BJ, Verhaar MC, Leiner T, Nguyen TQ, van Zuilen AD. Validation of multiparametric MRI by histopathology after nephrectomy: a case study. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2020; 34:377-387. [PMID: 32954447 PMCID: PMC8154819 DOI: 10.1007/s10334-020-00887-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 07/23/2020] [Accepted: 09/01/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Renal multiparametric MRI (mpMRI) is a promising tool to monitor renal allograft health to enable timely treatment of chronic allograft nephropathy. This study aims to validate mpMRI by whole-kidney histology following transplantectomy. MATERIALS AND METHODS A patient with kidney transplant failure underwent mpMRI prior to transplantectomy. The mpMRI included blood oxygenation level-dependent (BOLD) MRI, T1 and T2 mapping, diffusion-weighted imaging (DWI), 2D phase contrast (2DPC) and arterial spin labeling (ASL). Parenchymal mpMRI measures were compared to normative values obtained in 19 healthy controls. Differences were expressed in standard deviations (SD) of normative values. The mpMRI measures were compared qualitatively to histology. RESULTS The mpMRI showed a heterogeneous parenchyma consistent with extensive interstitial hemorrhage on histology. A global increase in T1 (+ 3.0 SD) and restricted diffusivity (- 3.6 SD) were consistent with inflammation and fibrosis. Decreased T2 (- 1.8 SD) indicated fibrosis or hemorrhage. ASL showed diminished cortical perfusion (- 2.9 SD) with patent proximal arteries. 2DPC revealed a 69% decrease in renal perfusion. Histological evaluation showed a dense inflammatory infiltrate and fibrotic changes, consistent with mpMRI results. Most interlobular arteries were obliterated while proximal arteries were patent, consistent with ASL findings. DISCUSSION mpMRI findings correlated well with histology both globally as well as locally.
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Affiliation(s)
- Anneloes de Boer
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
| | - Tobias T Pieters
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Anita A Harteveld
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Peter J Blankestijn
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Clemens Bos
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Martijn Froeling
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Roel Goldschmeding
- Department of Pathology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Hans J M Hoogduin
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Jaap A Joles
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Bart-Jeroen Petri
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Marianne C Verhaar
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Tim Leiner
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Tri Q Nguyen
- Department of Pathology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Arjan D van Zuilen
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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24
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Bane O, Said D, Weiss A, Stocker D, Kennedy P, Hectors SJ, Khaim R, Salem F, Delaney V, Menon MC, Markl M, Lewis S, Taouli B. 4D flow MRI for the assessment of renal transplant dysfunction: initial results. Eur Radiol 2020; 31:909-919. [PMID: 32870395 DOI: 10.1007/s00330-020-07208-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 07/07/2020] [Accepted: 08/19/2020] [Indexed: 12/26/2022]
Abstract
OBJECTIVES (1) Determine inter-observer reproducibility and test-retest repeatability of 4D flow parameters in renal allograft vessels; (2) determine if 4D flow measurements in the renal artery (RA) and renal vein (RV) can distinguish between functional and dysfunctional allografts; (3) correlate haemodynamic parameters with estimated glomerular filtration rate (eGFR), perfusion measured with dynamic contrast-enhanced MRI (DCE-MRI) and histopathology. METHODS Twenty-five prospectively recruited renal transplant patients (stable function/chronic renal allograft dysfunction, 12/13) underwent 4D flow MRI at 1.5 T. 4D flow coronal oblique acquisitions were performed in the transplant renal artery (RA) (velocity encoding parameter, VENC = 120 cm/s) and renal vein (RV) (VENC = 45 cm/s). Test-retest repeatability (n = 3) and inter-observer reproducibility (n = 10) were assessed by Cohen's kappa, coefficient of variation (CoV) and Bland-Altman statistics. Haemodynamic parameters were compared between patients and correlated to the estimated glomerular filtration rate, DCE-MRI parameters (n = 10) and histopathology from allograft biopsies (n = 15). RESULTS For inter-observer reproducibility, kappa was > 0.99 and 0.62 and CoV of flow was 12.6% and 7.8% for RA and RV, respectively. For test-retest repeatability, kappa was > 0.99 and 0.5 and CoV of flow was 27.3% and 59.4%, for RA and RV, respectively. RA (p = 0.039) and RV (p = 0.019) flow were both significantly reduced in dysfunctional allografts. Both identified chronic allograft dysfunction with good diagnostic performance (RA: AUC = 0.76, p = 0.036; RV: AUC = 0.8, p = 0.018). RA flow correlated negatively with histopathologic interstitial fibrosis score ci (ρ = - 0.6, p = 0.03). CONCLUSIONS 4D flow parameters had better repeatability in the RA than in the RV. RA and RV flow can identify chronic renal allograft dysfunction, with RA flow correlating with histopathologic interstitial fibrosis score. KEY POINTS • Inter-observer reproducibility of 4D flow measurements was acceptable in both the transplant renal artery and vein, but test-retest repeatability was better in the renal artery than in the renal vein. • Blood flow measurements obtained with 4D flow MRI in the renal artery and renal vein are significantly reduced in dysfunctional renal transplants. • Renal transplant artery flow correlated negatively with histopathologic interstitial fibrosis score.
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Affiliation(s)
- Octavia Bane
- Department of Radiology, Icahn School of Medicine at Mount Sinai (ISMMS), 1470 Madison Avenue, New York, NY, 10029, USA.,BioMedical Engineering and Imaging Institute, ISMMS, New York, NY, USA
| | - Daniela Said
- Department of Radiology, Icahn School of Medicine at Mount Sinai (ISMMS), 1470 Madison Avenue, New York, NY, 10029, USA.,BioMedical Engineering and Imaging Institute, ISMMS, New York, NY, USA
| | - Amanda Weiss
- Department of Radiology, Icahn School of Medicine at Mount Sinai (ISMMS), 1470 Madison Avenue, New York, NY, 10029, USA.,BioMedical Engineering and Imaging Institute, ISMMS, New York, NY, USA
| | - Daniel Stocker
- Department of Radiology, Icahn School of Medicine at Mount Sinai (ISMMS), 1470 Madison Avenue, New York, NY, 10029, USA.,BioMedical Engineering and Imaging Institute, ISMMS, New York, NY, USA
| | - Paul Kennedy
- Department of Radiology, Icahn School of Medicine at Mount Sinai (ISMMS), 1470 Madison Avenue, New York, NY, 10029, USA.,BioMedical Engineering and Imaging Institute, ISMMS, New York, NY, USA
| | - Stefanie J Hectors
- Department of Radiology, Icahn School of Medicine at Mount Sinai (ISMMS), 1470 Madison Avenue, New York, NY, 10029, USA.,BioMedical Engineering and Imaging Institute, ISMMS, New York, NY, USA.,Department of Radiology, Weill Cornell Medicine, New York, New York, NY, USA
| | - Rafael Khaim
- Division of Renal Medicine, Recanati Miller Transplantation Institute, ISMMS, New York, NY, USA
| | - Fadi Salem
- Department of Pathology, ISMMS, New York, NY, USA
| | - Veronica Delaney
- Division of Renal Medicine, Recanati Miller Transplantation Institute, ISMMS, New York, NY, USA
| | - Madhav C Menon
- Division of Renal Medicine, Recanati Miller Transplantation Institute, ISMMS, New York, NY, USA
| | - Michael Markl
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, IL, USA
| | - Sara Lewis
- Department of Radiology, Icahn School of Medicine at Mount Sinai (ISMMS), 1470 Madison Avenue, New York, NY, 10029, USA.,BioMedical Engineering and Imaging Institute, ISMMS, New York, NY, USA
| | - Bachir Taouli
- Department of Radiology, Icahn School of Medicine at Mount Sinai (ISMMS), 1470 Madison Avenue, New York, NY, 10029, USA. .,BioMedical Engineering and Imaging Institute, ISMMS, New York, NY, USA.
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25
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Liang P, Xu C, Tripathi P, Li J, Li A, Hu D, Kamel I, Li Z. One-stop assessment of renal function and renal artery in hypertensive patients with suspected renal dysfunction: non-enhanced MRI using spatial labeling with multiple inversion pulses. Eur Radiol 2020; 31:94-103. [PMID: 32749582 DOI: 10.1007/s00330-020-07088-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 04/01/2020] [Accepted: 07/20/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To assess whether spatial labeling with multiple inversion pulses (SLEEK) sequence can be employed as a one-stop assessment method for evaluating renal function and displaying renal artery in hypertensive patients with suspected renal dysfunction. METHODS A total of 78 patients with suspected hypertensive renal damage were enrolled in this retrospective study. All patients underwent MRI examinations, and both SLEEK and DWI sequences were performed simultaneously. According to estimated glomerular filtration rate (eGFR), patients were divided into three groups (Group 1, eGFR> 90; Group 2, eGFR = 60-90; Group 3, eGFR< 60). Twenty-two of these patients also underwent CT angiography (CTA) examination. Comparison between CTA, DWI, and eGFR was performed to assess the value of SLEEK in evaluating renal function and displaying renal artery. RESULTS The performance of SLEEK to display renal artery was highly consistent with the results of CTA (kappa = 0.713). The corticomedullary contrast ratio positively correlated with eGFR (p = 0.004, r = 0.322) and was significantly higher in SLEEK images than in DWI images in all three groups (p < 0.001). There was no significant difference in corticomedullary contrast ratio in SLEEK images between Group 1 and Group 2 (p = 0.285). However, the minimal renal cortical thickness, which significantly correlated with eGFR (p < 0.001, r = 0.866), was significantly different between Group 1 and Group 2 (p < 0.001). ROC analysis showed good diagnostic performance when differentiating patients with eGFR> 60 from those with eGFR< 60. CONCLUSIONS The SLEEK sequence could evaluate simultaneously renal function through corticomedullary differentiation and renal arteries, enabling one-stop assessment in hypertensive patients with suspected renal dysfunction. KEY POINTS • Spatial labeling with multiple inversion pulses (SLEEK) improves renal corticomedullary differentiation in hypertensive patients with renal dysfunction compared with DWI. • SLEEK clearly displays renal artery in hypertensive patients with renal dysfunction. • SLEEK could be utilized as a one-stop assessment method for evaluating renal function and renal artery in hypertensive patients.
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Affiliation(s)
- Ping Liang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Chuou Xu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Pratik Tripathi
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jiali Li
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Anqin Li
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Daoyu Hu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Ihab Kamel
- Russell H. Morgan Department of Radiology and Radiological Science, the Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Zhen Li
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
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26
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Adams LC, Bressem KK, Scheibl S, Nunninger M, Gentsch A, Fahlenkamp UL, Eckardt KU, Hamm B, Makowski MR. Multiparametric Assessment of Changes in Renal Tissue after Kidney Transplantation with Quantitative MR Relaxometry and Diffusion-Tensor Imaging at 3 T. J Clin Med 2020; 9:jcm9051551. [PMID: 32455558 PMCID: PMC7290480 DOI: 10.3390/jcm9051551] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 05/15/2020] [Accepted: 05/18/2020] [Indexed: 12/17/2022] Open
Abstract
Background: Magnetic resonance relaxometry (MRR) offers highly reproducible pixel-wise parametric maps of T1 and T2 relaxation times, reflecting specific tissue properties, while diffusion-tensor imaging (DTI) is a promising technique for the characterization of microstructural changes, depending on the directionality of molecular motion. Both MMR and DTI may be used for non-invasive assessment of parenchymal changes caused by kidney injury or graft dysfunction. Methods: We examined 46 patients with kidney transplantation and 16 healthy controls, using T1/T2 relaxometry and DTI at 3 T. Twenty-two early transplants and 24 late transplants were included. Seven of the patients had prior renal biopsy (all of them dysfunctional allografts; 6/7 with tubular atrophy and 7/7 with interstitial fibrosis). Results: Compared to healthy controls, T1 and T2 relaxation times in the renal parenchyma were increased after transplantation, with the highest T1/T2 values in early transplants (T1: 1700 ± 53 ms/T2: 83 ± 6 ms compared to T1: 1514 ± 29 ms/T2: 78 ± 4 ms in controls). Medullary and cortical ADC/FA values were decreased in early transplants and highest in controls, with medullary FA values showing the most pronounced difference. Cortical renal T1, mean medullary FA and corticomedullary differentiation (CMD) values correlated best with renal function as measured by eGFR (cortical T1: r = −0.63, p < 0.001; medullary FA: r = 0.67, p < 0.001; FA CMD: r = 0.62, p < 0.001). Mean medullary FA proved to be a significant predictor for tubular atrophy (p < 0.001), while cortical T1 appeared as a significant predictor of interstitial fibrosis (p = 0.003). Conclusion: Cortical T1, medullary FA, and FA CMD might serve as new imaging biomarkers of renal function and histopathologic microstructure.
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Affiliation(s)
- Lisa C. Adams
- Department of Radiology, Charité, Charitéplatz 1, 10117 Berlin, Germany; (S.S.); (M.N.); (U.L.F.); (B.H.)
- Correspondence: (L.C.A.); (K.K.B.); Tel.: +49-30627376 (L.C.A.)
| | - Keno K. Bressem
- Department of Radiology, Charité, Hindenburgdamm 30, 12203 Berlin, Germany
- Correspondence: (L.C.A.); (K.K.B.); Tel.: +49-30627376 (L.C.A.)
| | - Sonja Scheibl
- Department of Radiology, Charité, Charitéplatz 1, 10117 Berlin, Germany; (S.S.); (M.N.); (U.L.F.); (B.H.)
| | - Max Nunninger
- Department of Radiology, Charité, Charitéplatz 1, 10117 Berlin, Germany; (S.S.); (M.N.); (U.L.F.); (B.H.)
| | - Andre Gentsch
- Department of Nephrology, Charité, Charitéplatz 1, 10117 Berlin, Germany; (A.G.); (K.-U.E.)
| | - Ute L. Fahlenkamp
- Department of Radiology, Charité, Charitéplatz 1, 10117 Berlin, Germany; (S.S.); (M.N.); (U.L.F.); (B.H.)
| | - Kai-Uwe Eckardt
- Department of Nephrology, Charité, Charitéplatz 1, 10117 Berlin, Germany; (A.G.); (K.-U.E.)
| | - Bernd Hamm
- Department of Radiology, Charité, Charitéplatz 1, 10117 Berlin, Germany; (S.S.); (M.N.); (U.L.F.); (B.H.)
| | - Marcus R. Makowski
- Department of Radiology, Charité, Charitéplatz 1, 10117 Berlin, Germany; (S.S.); (M.N.); (U.L.F.); (B.H.)
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, School of Medicine, 81675 Munich, Germany
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27
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Pajenda S, Rasul S, Hacker M, Wagner L, Geist BK. Dynamic 2-deoxy-2[18F] fluoro-D-glucose PET/MRI in human renal allotransplant patients undergoing acute kidney injury. Sci Rep 2020; 10:8270. [PMID: 32427878 PMCID: PMC7237443 DOI: 10.1038/s41598-020-65267-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 04/29/2020] [Indexed: 12/11/2022] Open
Abstract
Patients after solid organ kidney transplantation (KTX) often suffer from acute kidney injury (AKI). Parameters as serum creatinine indicate a loss of kidney function, although no distinction of the cause and prognosis can be made. Imaging tools measuring kidney function have not been widely in clinical use. In this observational study we evaluated 2-deoxy-2[18F] fluoro-D-glucose (FDG) PET/MRI in thirteen patients after KTX with AKI as a functional assessment of the graft. Twenty-four healthy volunteers served as control. General kidney performance (GKP), initial flow (IF) and renal response function (RF) were calculated by standardized uptake values (SUV) and time activity curves (TAC). The GKP measured for the total kidney and medulla was significantly higher in healthy patients compared to patients after KTX (p = 0.0002 and p = 0.0004, respectively), but no difference was found for the GKP of the cortex (p = 0.59). The IF in KTX patients correlated with renal recovery, defined as change in serum creatinine 10 days after PET/MRI (r = 0.80, p = 0.001). With regard to the RF, a negative correlation for tubular damage was found (r = -0.74, p = 0.004). In conclusion, parameters obtained from FDG PET/MRI showed a possible predictive feature for renal recovery in KTX patients undergoing AKI.
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Affiliation(s)
- Sahra Pajenda
- Department of Medicine III, Division of Nephrology and Dialysis, Medical University of Vienna. Waehringer Guertel 18-20, 1090, Vienna, Austria.
| | - Sazan Rasul
- Department of Biomedical Imaging and Image- Guided Therapy, Division of Nuclear Medicine, Medical University of Vienna. Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Marcus Hacker
- Department of Biomedical Imaging and Image- Guided Therapy, Division of Nuclear Medicine, Medical University of Vienna. Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Ludwig Wagner
- Department of Medicine III, Division of Nephrology and Dialysis, Medical University of Vienna. Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Barbara Katharina Geist
- Department of Biomedical Imaging and Image- Guided Therapy, Division of Nuclear Medicine, Medical University of Vienna. Waehringer Guertel 18-20, 1090, Vienna, Austria
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28
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de Boer A, Harteveld AA, Stemkens B, Blankestijn PJ, Bos C, Franklin SL, Froeling M, Joles JA, Verhaar MC, van den Berg N, Hoogduin H, Leiner T. Multiparametric Renal MRI: An Intrasubject Test-Retest Repeatability Study. J Magn Reson Imaging 2020; 53:859-873. [PMID: 32297700 PMCID: PMC7891585 DOI: 10.1002/jmri.27167] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 03/30/2020] [Accepted: 03/31/2020] [Indexed: 12/13/2022] Open
Abstract
Background Renal multiparametric magnetic resonance imaging (MRI) is a promising tool for diagnosis, prognosis, and treatment monitoring in kidney disease. Purpose To determine intrasubject test–retest repeatability of renal MRI measurements. Study Type Prospective. Population Nineteen healthy subjects aged over 40 years. Field Strength/Sequences T1 and T2 mapping, R2* mapping or blood oxygenation level‐dependent (BOLD) MRI, diffusion tensor imaging (DTI), and intravoxel incoherent motion (IVIM) diffusion‐weighted imaging (DWI), 2D phase contrast, arterial spin labelling (ASL), dynamic contrast enhanced (DCE) MRI, and quantitative Dixon for fat quantification at 3T. Assessment Subjects were scanned twice with ~1 week between visits. Total scan time was ~1 hour. Postprocessing included motion correction, semiautomated segmentation of cortex and medulla, and fitting of the appropriate signal model. Statistical Test To assess the repeatability, a Bland–Altman analysis was performed and coefficients of variation (CoVs), repeatability coefficients, and intraclass correlation coefficients were calculated. Results CoVs for relaxometry (T1, T2, R2*/BOLD) were below 6.1%, with the lowest CoVs for T2 maps and highest for R2*/BOLD. CoVs for all diffusion analyses were below 7.2%, except for perfusion fraction (FP), with CoVs ranging from 18–24%. The CoV for renal sinus fat volume and percentage were both around 9%. Perfusion measurements were most repeatable with ASL (cortical perfusion only) and 2D phase contrast with CoVs of 10% and 13%, respectively. DCE perfusion had a CoV of 16%, while single kidney glomerular filtration rate (GFR) had a CoV of 13%. Repeatability coefficients (RCs) ranged from 7.7–87% (lowest/highest values for medullary mean diffusivity and cortical FP, respectively) and intraclass correlation coefficients (ICCs) ranged from −0.01 to 0.98 (lowest/highest values for cortical FP and renal sinus fat volume, respectively). Data Conclusion CoVs of most MRI measures of renal function and structure (with the exception of FP and perfusion as measured by DCE) were below 13%, which is comparable to standard clinical tests in nephrology. Level of Evidence 2 Technical Efficacy Stage 1
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Affiliation(s)
- Anneloes de Boer
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Anita A Harteveld
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Bjorn Stemkens
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Peter J Blankestijn
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Clemens Bos
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Suzanne L Franklin
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Department of Radiology, C.J. Gorter Center for High Field MRI, Leiden University Medical Center, Leiden, The Netherlands
| | - Martijn Froeling
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Jaap A Joles
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Marianne C Verhaar
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Nico van den Berg
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Hans Hoogduin
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Tim Leiner
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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