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Abstract
As a sign of chronic kidney disease (CKD) progression, renal fibrosis is an irreversible and alarming pathological change. The accurate diagnosis of renal fibrosis depends on the widely used renal biopsy, but this diagnostic modality is invasive and can easily lead to sampling error. With the development of imaging techniques, an increasing number of noninvasive imaging techniques, such as multipara meter magnetic resonance imaging (MRI) and ultrasound elastography, have gained attention in assessing kidney fibrosis. Depending on their ability to detect changes in tissue stiffness and diffusion of water molecules, ultrasound elastography and some MRI techniques can indirectly assess the degree of fibrosis. The worsening of renal tissue oxygenation and perfusion measured by blood oxygenation level-dependent MRI and arterial spin labeling MRI separately is also an indirect reflection of renal fibrosis. Objective and quantitative indices of fibrosis may be available in the future by using novel techniques, such as photoacoustic imaging and fluorescence microscopy. However, these imaging techniques are susceptible to interference or may not be convenient. Due to the lack of sufficient specificity and sensitivity, these imaging techniques are neither widely accepted nor proposed by clinicians. These obstructions must be overcome by conducting technology research and more prospective studies. In this review, we emphasize the recent advancement of these noninvasive imaging techniques and provide clinicians a continuously updated perspective on the assessment of kidney fibrosis.
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Affiliation(s)
- Buchun Jiang
- Department of Nephrology, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, National Children’s Regional Medical Center, Hangzhou, China
| | - Fei Liu
- Department of Nephrology, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, National Children’s Regional Medical Center, Hangzhou, China
| | - Haidong Fu
- Department of Nephrology, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, National Children’s Regional Medical Center, Hangzhou, China,CONTACT Haidong Fu
| | - Jianhua Mao
- Department of Nephrology, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, National Children’s Regional Medical Center, Hangzhou, China,Jianhua Mao The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, National Children’s Regional Medical Center, 3333 Bingsheng Rd, Hangzhou, Zhejiang310052, China
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Tao Q, Zhang D, Zhang Q, Liu C, Ye S, Feng Y, Liu R. Mitochondrial targeted ROS Scavenger based on nitroxide for Treatment and MRI imaging of Acute Kidney Injury. Free Radic Res 2022; 56:303-315. [PMID: 35746859 DOI: 10.1080/10715762.2022.2093724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Overproduction of reactive oxygen species (ROS) during oxidative stress is a hallmark of acute kidney injure (AKI), which induced the damage to the renal cells and mitochondrial injury. PURPOSE In this contribution, we prepared mitochondrial targeted nitroxide, which linked 3-carboxy-2,2,5,5-tetramethylpyrrolidine 1-oxyl (carboxy-PROXYL) with (2-aminoethyl)triphenylphosphonium bromide (TPP), named TPP-PROXYL to eliminate the ROS in situ and image the oxidative stress reaction by MRI. METHODS 2,7-Dichlorodihydrofluorescein diacetate (DCFH-DA) staining, mitochondrial membrane potential assay (JC-1) staining and transmission electron microscope (TEM) experiments were processed to verify that TPP-PROXYL could target mitochondria, scavenge the ROS, and prevent damage to mitochondria in live cells. Contrast enhanced MRI also been used to monitor these redox reaction in AKI model. RESULTS TPP-PROXYL demonstrated excellent ROS T1-weighted magnetic resonance imaging (MRI) enhancement in vitro and in vivo, with r1 value about 0.190 mM-1·s-1. In vivo AKI treatment experiments proved that TPP-PROXYL could improve the survival rate of mice and inhibit kidney damage. Moreover, the great ROS scavenging capability and the renal damage reduction during AKI treatment of TPP-PROXYL was verified via MR imaging technology. CONCLUSION Collectively, this research provides TPP-PROXYL would serve as a powerful platform to realize ROS scavenging, treatment and MR imaging of AKI.
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Affiliation(s)
- Quan Tao
- School of Biomedical Engineering, Southern Medical University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Medical Image Processing, Southern Medical University, Guangzhou, China.,Guangdong Province Engineering Laboratory for Medical Imaging and Diagnostic Technology, Southern Medical University, Guangzhou, China.,Key Laboratory of Mental Health of the Ministry of Education & Guangdong-Hong Kong-Macao Greater Bay Area Center for Brain Science and Brain-Inspired Intelligence, Southern Medical University, Guangzhou, China
| | - Di Zhang
- School of Biomedical Engineering, Southern Medical University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Medical Image Processing, Southern Medical University, Guangzhou, China.,Guangdong Province Engineering Laboratory for Medical Imaging and Diagnostic Technology, Southern Medical University, Guangzhou, China.,Key Laboratory of Mental Health of the Ministry of Education & Guangdong-Hong Kong-Macao Greater Bay Area Center for Brain Science and Brain-Inspired Intelligence, Southern Medical University, Guangzhou, China
| | - Qianqian Zhang
- School of Biomedical Engineering, Southern Medical University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Medical Image Processing, Southern Medical University, Guangzhou, China.,Guangdong Province Engineering Laboratory for Medical Imaging and Diagnostic Technology, Southern Medical University, Guangzhou, China.,Key Laboratory of Mental Health of the Ministry of Education & Guangdong-Hong Kong-Macao Greater Bay Area Center for Brain Science and Brain-Inspired Intelligence, Southern Medical University, Guangzhou, China
| | - Chuang Liu
- School of Biomedical Engineering, Southern Medical University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Medical Image Processing, Southern Medical University, Guangzhou, China.,Guangdong Province Engineering Laboratory for Medical Imaging and Diagnostic Technology, Southern Medical University, Guangzhou, China.,Key Laboratory of Mental Health of the Ministry of Education & Guangdong-Hong Kong-Macao Greater Bay Area Center for Brain Science and Brain-Inspired Intelligence, Southern Medical University, Guangzhou, China
| | - Sheng Ye
- School of Biomedical Engineering, Southern Medical University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Medical Image Processing, Southern Medical University, Guangzhou, China.,Guangdong Province Engineering Laboratory for Medical Imaging and Diagnostic Technology, Southern Medical University, Guangzhou, China.,Key Laboratory of Mental Health of the Ministry of Education & Guangdong-Hong Kong-Macao Greater Bay Area Center for Brain Science and Brain-Inspired Intelligence, Southern Medical University, Guangzhou, China
| | - Yanqiu Feng
- School of Biomedical Engineering, Southern Medical University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Medical Image Processing, Southern Medical University, Guangzhou, China.,Guangdong Province Engineering Laboratory for Medical Imaging and Diagnostic Technology, Southern Medical University, Guangzhou, China.,Key Laboratory of Mental Health of the Ministry of Education & Guangdong-Hong Kong-Macao Greater Bay Area Center for Brain Science and Brain-Inspired Intelligence, Southern Medical University, Guangzhou, China
| | - Ruiyuan Liu
- School of Biomedical Engineering, Southern Medical University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Medical Image Processing, Southern Medical University, Guangzhou, China.,Guangdong Province Engineering Laboratory for Medical Imaging and Diagnostic Technology, Southern Medical University, Guangzhou, China.,Key Laboratory of Mental Health of the Ministry of Education & Guangdong-Hong Kong-Macao Greater Bay Area Center for Brain Science and Brain-Inspired Intelligence, Southern Medical University, Guangzhou, China
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Comparison of multiparametric magnetic resonance imaging sequences with laboratory parameters for prognosticating renal function in chronic kidney disease. Sci Rep 2021; 11:22129. [PMID: 34764322 PMCID: PMC8586015 DOI: 10.1038/s41598-021-01147-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 10/11/2021] [Indexed: 11/12/2022] Open
Abstract
Magnetic resonance imaging (MRI) is playing an increasingly important role in evaluating chronic kidney disease (CKD). It has the potential to be used not only for evaluation of physiological and pathological states, but also for prediction of disease course. Although different MRI sequences have been employed in renal disease, there are few studies that have compared the different sequences. We compared several multiparametric MRI sequences, and compared their results with the estimated glomerular filtration rate. Principal component analysis showed a similarity between T1 values and tissue perfusion (arterial spin labelling), and between fractional anisotropy (diffusion tensor imaging) and apparent diffusion coefficient values (diffusion-weighted imaging). In multiple regression analysis, only T2* values, derived from the blood oxygenation level-dependent (BOLD) MRI sequence, were associated with estimated glomerular filtration rate slope after adjusting for degree of proteinuria, a classic prognostic factor for CKD. In receiver operating characteristic curve analysis, T2* values were a good predictor of rapid deterioration, regardless of the degree of proteinuria. This suggests further study of the use of BOLD-derived T2* values in the workup of CKD, especially to predict the disease course.
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Zhao F, Zhou X, Messina E, Hu L, Holahan MA, Swaminath G, Hines CDG. Robust arterial spin labeling MRI measurement of pharmacologically induced perfusion change in rat kidneys. NMR IN BIOMEDICINE 2021; 34:e4566. [PMID: 34096123 DOI: 10.1002/nbm.4566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 04/29/2021] [Accepted: 05/12/2021] [Indexed: 06/12/2023]
Abstract
Kidney diseases such as acute kidney injury, diabetic nephropathy and chronic kidney disease (CKD) are related to dysfunctions of the microvasculature in the kidney causing a decrease in renal blood perfusion (RBP). Pharmacological intervention to improve the function of the microvasculature is a viable strategy for the potential treatment of these diseases. The measurement of RBP is a reliable biomarker to evaluate the efficacy of pharmacological agents' actions on the microvasculature, and measurement of RBP responses to different pharmacological agents can also help elucidate the mechanism of hemodynamic regulation in the kidney. Magnetic resonance imaging (MRI) with flow-sensitive alternating inversion recovery (FAIR) arterial spin labeling (ASL) has been used to measure RBP in humans and animals. However, artifacts caused by respiratory and peristaltic motions limit the potential of FAIR ASL in drug discovery and kidney research. In this study, the combined anesthesia protocol of inactin with a low dose of isoflurane was used to fully suppress peristalsis in rats, which were ventilated with an MRI-synchronized ventilator. FAIR ASL data were acquired in eight axial slices using a single-shot, gradient-echo, echo-planar imaging (EPI) sequence. The artifacts in the FAIR ASL RBP measurement due to respiratory and peristaltic motions were substantially eliminated. The RBP responses to fenoldopam and L-NAME were measured, and the increase and decrease in RBP caused by fenoldopam and L-NAME, respectively, were robustly observed. To further validate FAIR ASL, the renal blood flow (RBF) responses to the same agents were measured by an invasive perivascular flow probe method. The pharmacological agent-induced responses in RBP and RBF are similar. This indicates that FAIR ASL has the sensitivity to measure pharmacologically induced changes in RBP. FAIR ASL with multislice EPI can be a valuable tool for supporting drug discovery, and for elucidating the mechanism of hemodynamic regulation in kidneys.
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Affiliation(s)
| | | | | | - Lufei Hu
- Merck & Co. Inc., Kenilworth, New Jersey, USA
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Zhang J, Chen J, Chen Q, Chen J, Luo K, Pan L, Zhang Y, Dou W, Xing W. Can R 2 ' mapping evaluate hypoxia in renal ischemia reperfusion injury quantitatively? An experimental study. Magn Reson Med 2021; 86:974-983. [PMID: 33724527 DOI: 10.1002/mrm.28696] [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: 08/28/2020] [Revised: 12/31/2020] [Accepted: 01/04/2021] [Indexed: 11/09/2022]
Abstract
PURPOSE To explore if R2 ' mapping can assess renal hypoxia in rabbits with ischemia reperfusion injury (IRI). METHODS Forty rabbits were randomly divided into 4 groups according to the clipping time: the sham group and 45 min, 60 min, and 75 min for the mild, moderate, and severe groups (with n = 10 each group), respectively. Intravenous furosemide (FU) was administered 24 h after IRI. All rabbits were performed 5 times (IRIpre , IRI24h , FU5min , FU12min , and FU24min ) with a 3.0 Tesla MR. The R2 ' values and the hypoxic scores were then recorded. The repeated measurement analysis of variance and Spearman correlation analysis was used for statistical analysis. RESULTS Compared to the baseline, the medullary R2 ' values increased significantly 24 h after the IRI (baseline 19.31 ± 1.21 s-1 , mild group 20.05 ± 1.26 s-1 , moderate group 25.38 ± 1.38 s-1 , and severe group 25.79 ± 1.10 s-1 ; each P < .001). FU led to a significant decrease in the medullary R2 ' value (sham group 11.17 ± 4.33 s-1 , mild group 7.80 ± 0.74 s-1 , moderate group 3.92 ± 0.28 s-1 , and severe group 3.82 ± 0.23 s-1 ; each P < .05). Quantitative hypoxic scores revealed significant differences among the 4 groups in the outer medulla (P < .001 each). The medullary R2 ' differences (before and after intravenous FU) were significantly correlated with the hypoxic scores, respectively (P < .001). CONCLUSION R2 ' mapping can evaluate the renal hypoxia in the procession of IRI in rabbits and might serve as a quantitative biomarker for IRI.
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Affiliation(s)
- Jinggang Zhang
- Department of Radiology, Third Affiliated Hospital of Soochow University, Changzhou, People's Republic of China
| | - Jie Chen
- Department of Radiology, Third Affiliated Hospital of Soochow University, Changzhou, People's Republic of China
| | - Qin Chen
- Department of Radiology, Third Affiliated Hospital of Soochow University, Changzhou, People's Republic of China
| | - Jing Chen
- Department of Radiology, Third Affiliated Hospital of Soochow University, Changzhou, People's Republic of China
| | - Kai Luo
- Department of Radiology, Third Affiliated Hospital of Soochow University, Changzhou, People's Republic of China
| | - Liang Pan
- Department of Radiology, Third Affiliated Hospital of Soochow University, Changzhou, People's Republic of China
| | - Yongcheng Zhang
- Department of Radiology, Third Affiliated Hospital of Soochow University, Changzhou, People's Republic of China
| | - Weiqiang Dou
- MR research China, GE Healthcare, Beijing, People's Republic of China
| | - Wei Xing
- Department of Radiology, Third Affiliated Hospital of Soochow University, Changzhou, People's Republic of China
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Early detection of subclinical pathology in patients with stable kidney graft function by arterial spin labeling. Eur Radiol 2020; 31:2687-2695. [PMID: 33151395 DOI: 10.1007/s00330-020-07369-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 08/24/2020] [Accepted: 10/02/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVES To evaluate the utility of arterial spin labeling (ASL) for the identification of kidney allografts with underlying pathologies, particularly those with stable graft function. METHODS A total of 75 patients, including 18 stable grafts with normal histology (normal group), 21 stable grafts with biopsy-proven pathology (subclinical pathology group), and 36 with unstable graft function (unstable graft group), were prospectively examined by ASL magnetic resonance imaging. Receiver operating characteristic curves were generated to calculate the area under the curve (AUC), sensitivity, and specificity. RESULTS Patient demographics among the 3 groups were comparable. Compared with the normal group, kidney allograft cortical ASL values decreased in the subclinical pathology group and the unstable graft group (204.7 ± 44.9 ml/min/100 g vs 152.5 ± 38.9 ml/min/100 g vs 92.3 ± 37.4 ml/min/100 g, p < 0.001). The AUC, sensitivity, and specificity for discriminating allografts with pathologic changes from normal allografts were 0.92 (95% CI, 0.83-0.97), 71.9%, and 100% respectively by cortical ASL and 0.82 (95% CI, 0.72-0.90), 54.4%, and 100% respectively by serum creatinine. The cortical ASL identified allografts with subclinical pathology among patients with stable graft function with an AUC of 0.80 (95% CI, 0.64-0.91), sensitivity of 57.1%, and specificity of 88.9%. Combined use of proteinuria and cortical ASL could improve the sensitivity and specificity to 76.2% and 100% respectively for distinguishing the subclinical pathology group from the normal group. CONCLUSIONS Cortical ASL is useful for the identification of allografts with underlying pathologies. More importantly, ASL showed promise as a non-invasive tool for the clinical translation of identifying kidney allografts with subclinical pathology. KEY POINTS • Cortical ASL values were decreased in kidney allografts with subclinical pathologic changes as compared with normal allografts (152.5 ± 38.9 ml/min/100 g vs 204.7 ± 44.9 ml/min/100 g, p < 0.001). • Cortical ASL differentiated allografts with pathologic changes and subclinical pathology group from normal group with an AUC of 0.92 (95% CI, 0.83-0.97) and 0.80 (95% CI, 0.64-0.91) respectively. • Cortical ASL discriminated allografts with underlying pathologic changes from normal allografts with a specificity of 100%, and combined use of proteinuria and cortical ASL values could also achieve 100% specificity for discriminating allografts with subclinical pathology from normal allografts.
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Neumann W, Pusch TP, Siegfarth M, Schad LR, Stallkamp JL. CT and MRI compatibility of flexible 3D-printed materials for soft actuators and robots used in image-guided interventions. Med Phys 2019; 46:5488-5498. [PMID: 31587313 DOI: 10.1002/mp.13852] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 08/12/2019] [Accepted: 09/26/2019] [Indexed: 01/09/2023] Open
Abstract
PURPOSE Three-dimensional (3D) printing allows for the fabrication of medical devices with complex geometries, such as soft actuators and robots that can be used in image-guided interventions. This study investigates flexible and rigid 3D-printing materials in terms of their impact on multimodal medical imaging. METHODS The generation of artifacts in clinical computer tomography (CT) and magnetic resonance (MR) imaging was evaluated for six flexible and three rigid materials, each with a cubical and a cylindrical geometry, and for one exemplary flexible fluidic actuator. Additionally, CT Hounsfield units (HU) were quantified for various parameter sets iterating peak voltage, x-ray tube current, slice thickness, and convolution kernel. RESULTS We found the image artifacts caused by the materials to be negligible in both CT and MR images. The HU values mainly depended on the elemental composition of the materials and applied peak voltage was ranging between 80 and 140 kVp. Flexible, nonsilicone-based materials were ranged between 51 and 114 HU. The voltage dependency was less than 29 HU. Flexible, silicone-based materials were ranged between 60 and 365 HU. The voltage-dependent influence was as large as 172 HU. Rigid materials ranged between -69 and 132 HU. The voltage-dependent influence was <33 HU. CONCLUSIONS All tested materials may be employed for devices placed in the field of view during CT and MR imaging as no significant artifacts were measured. Moreover, the material selection in CT could be based on the desired visibility of the material depending on the application. Given the wide availability of the tested materials, we expect our results to have a positive impact on the development of devices and robots for image-guided interventions.
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Affiliation(s)
- Wiebke Neumann
- Computer Assisted Clinical Medicine, Medical Faculty Mannheim, Heidelberg University, 68167, Mannheim, Germany
| | - Tim P Pusch
- Fraunhofer Institute for Manufacturing Engineering and Automation, Project Group for Automation in Medicine and Biotechnology, 68167, Mannheim, Germany
| | - Marius Siegfarth
- Fraunhofer Institute for Manufacturing Engineering and Automation, Project Group for Automation in Medicine and Biotechnology, 68167, Mannheim, Germany
| | - Lothar R Schad
- Computer Assisted Clinical Medicine, Medical Faculty Mannheim, Heidelberg University, 68167, Mannheim, Germany
| | - Jan L Stallkamp
- Fraunhofer Institute for Manufacturing Engineering and Automation, Project Group for Automation in Medicine and Biotechnology, 68167, Mannheim, Germany.,Medical Faculty Mannheim, Heidelberg University, 68167, Mannheim, Germany
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Chacon-Caldera J, Maunder A, Rao M, Norquay G, Rodgers OI, Clemence M, Puddu C, Schad LR, Wild JM. Dissolved hyperpolarized xenon-129 MRI in human kidneys. Magn Reson Med 2019; 83:262-270. [PMID: 31400040 PMCID: PMC6852523 DOI: 10.1002/mrm.27923] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 06/13/2019] [Accepted: 07/08/2019] [Indexed: 12/24/2022]
Abstract
Purpose To assess the feasibility of using dissolved hyperpolarized xenon‐129 (129Xe) MRI to study renal physiology in humans at 3 T. Methods Using a flexible transceiver RF coil, dynamic and spatially resolved 129Xe spectroscopy was performed in the abdomen after inhalation of hyperpolarized 129Xe gas with 3 healthy male volunteers. A transmit‐only receive‐only RF coil array was purpose‐built to focus RF excitation and enhance sensitivity for dynamic imaging of 129Xe uptake in the kidneys using spoiled gradient echo and balanced steady‐state sequences. Results Using spatially resolved spectroscopy, different magnitudes of signal from 129Xe dissolved in red blood cells and tissue/plasma could be identified in the kidneys and the aorta. The spectra from both kidneys showed peaks with similar amplitudes and chemical shift values. Imaging with the purpose‐built coil array was shown to provide more than a 3‐fold higher SNR in the kidneys when compared with surrounding tissues, while further physiological information from the dissolved 129Xe in the lungs and in transit to the kidneys was provided with the transceiver coil. The signal of dissolved hyperpolarized 129Xe could be imaged with both tested sequences for about 40 seconds after inhalation. Conclusion The uptake of 129Xe dissolved in the human kidneys was measured with spectroscopic and imaging experiments, demonstrating the potential of hyperpolarized 129Xe MR as a novel, noninvasive technique to image human kidney tissue perfusion.
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Affiliation(s)
- Jorge Chacon-Caldera
- Computer Assisted Clinical Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,POLARIS, Unit of Academic Radiology, University of Sheffield, Sheffield, United Kingdom
| | - Adam Maunder
- POLARIS, Unit of Academic Radiology, University of Sheffield, Sheffield, United Kingdom
| | - Madhwesha Rao
- POLARIS, Unit of Academic Radiology, University of Sheffield, Sheffield, United Kingdom
| | - Graham Norquay
- POLARIS, Unit of Academic Radiology, University of Sheffield, Sheffield, United Kingdom
| | - Oliver I Rodgers
- POLARIS, Unit of Academic Radiology, University of Sheffield, Sheffield, United Kingdom
| | | | - Claudio Puddu
- POLARIS, Unit of Academic Radiology, University of Sheffield, Sheffield, United Kingdom
| | - Lothar R Schad
- Computer Assisted Clinical Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Jim M Wild
- POLARIS, Unit of Academic Radiology, University of Sheffield, Sheffield, United Kingdom
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Martirosian P, Pohmann R, Schraml C, Schwartz M, Kuestner T, Schwenzer NF, Scheffler K, Nikolaou K, Schick F. Spatial-temporal perfusion patterns of the human liver assessed by pseudo-continuous arterial spin labeling MRI. Z Med Phys 2018; 29:173-183. [PMID: 30266458 DOI: 10.1016/j.zemedi.2018.08.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 07/18/2018] [Accepted: 08/27/2018] [Indexed: 01/14/2023]
Abstract
PURPOSE To investigate the capabilities of a modern pseudo-continuous arterial spin labeling (PCASL) technique for non-invasive assessment of the temporal and spatial distribution of the liver perfusion in healthy volunteers on a clinical MR system at 3T. MATERIALS AND METHODS A 2D-PCASL multi-slice echo planar imaging sequence was adapted to the specific conditions in liver: a) labeling by PCASL was optimized to the flow characteristics in the portal vein, b) background suppression was applied for reduction of motion related artifacts, c) post labeling delays (PLDs) were varied over a large range (0.7-3.5s) in order to get better insight in the temporal and spatial distribution of tagged blood in the liver, and d) a special timed-breathing protocol was used allowing for recording of 16 to 18 label-control image pairs and a reference M0 image for each of 4 to 6 slices within approx. 5min for one PLD. RESULTS Measurements with multiple PLDs showed dominating perfusion signal in macroscopic blood vessels for PLDs up to 1.5 s, whereas pure liver parenchyma revealed maximum perfusion signal for a PLD of approx. 2 s, and detectable signal up to PLDs of 3.5 s. Data fitting to a perfusion model for liver provided a mean global perfusion of 153±15ml/100g/min and a mean transit time of 1938±332ms in liver parenchyma. Measurements with a single PLD of 2 s demonstrated that portal-venous and arterial perfusion components can be measured separately by two measurements with two different positions of the labeling plane (one for labeling of the global hepatopetal blood flow and one for selective labeling of the portal blood flow only). Relative contribution of blood from the hepatic artery to the global liver perfusion, the hepatic perfusion index (HPI), amounted to approx. 23%. CONCLUSION Modern and adapted protocols for assessment of liver perfusion by PCASL have the potential to provide perfusion and blood transit time maps in reasonable acquisition time.
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Affiliation(s)
- Petros Martirosian
- Section on Experimental Radiology, University Hospital of Tübingen, Tübingen, Germany.
| | - Rolf Pohmann
- Department of High-field Magnetic Resonance, Max Planck Institute for Biological Cybernetics, Tübingen, Germany
| | - Christina Schraml
- Department of Diagnostic and Interventional Radiology, University Hospital of Tübingen, Tübingen, Germany
| | - Martin Schwartz
- Section on Experimental Radiology, University Hospital of Tübingen, Tübingen, Germany; Institute of Signal Processing and System Theory, University of Stuttgart, Stuttgart, Germany
| | - Thomas Kuestner
- Section on Experimental Radiology, University Hospital of Tübingen, Tübingen, Germany; Institute of Signal Processing and System Theory, University of Stuttgart, Stuttgart, Germany
| | - Nina Franziska Schwenzer
- Department of Diagnostic and Interventional Radiology, University Hospital of Tübingen, Tübingen, Germany
| | - Klaus Scheffler
- Department of High-field Magnetic Resonance, Max Planck Institute for Biological Cybernetics, Tübingen, Germany; Department of Biomedical Magnetic Resonance, University Hospital of Tübingen, Tübingen, Germany
| | - Konstantin Nikolaou
- Department of Diagnostic and Interventional Radiology, University Hospital of Tübingen, Tübingen, Germany
| | - Fritz Schick
- Section on Experimental Radiology, University Hospital of Tübingen, Tübingen, Germany
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Zhou JY, Wang YC, Zeng CH, Ju SH. Renal Functional MRI and Its Application. J Magn Reson Imaging 2018; 48:863-881. [PMID: 30102436 DOI: 10.1002/jmri.26180] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 04/10/2018] [Indexed: 12/11/2022] Open
Abstract
Renal function varies according to the nature and stage of diseases. Renal functional magnetic resonance imaging (fMRI), a technique considered superior to the most common method used to estimate the glomerular filtration rate, allows for noninvasive, accurate measurements of renal structures and functions in both animals and humans. It has become increasingly prevalent in research and clinical applications. In recent years, renal fMRI has developed rapidly with progress in MRI hardware and emerging postprocessing algorithms. Function-related imaging markers can be acquired via renal fMRI, encompassing water molecular diffusion, perfusion, and oxygenation. This review focuses on the progression and challenges of the main renal fMRI methods, including dynamic contrast-enhanced MRI, blood oxygen level-dependent MRI, diffusion-weighted imaging, diffusion tensor imaging, arterial spin labeling, fat fraction imaging, and their recent clinical applications. LEVEL OF EVIDENCE 5 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018;48:863-881.
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Affiliation(s)
- Jia-Ying Zhou
- Jiangsu Key Laboratory of Molecular and Functional Imaging, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, China
| | - Yuan-Cheng Wang
- Jiangsu Key Laboratory of Molecular and Functional Imaging, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, China
| | - Chu-Hui Zeng
- Jiangsu Key Laboratory of Molecular and Functional Imaging, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, China
| | - Sheng-Hong Ju
- Jiangsu Key Laboratory of Molecular and Functional Imaging, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, China
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Liu J, Han Z, Chen G, Li Y, Zhang J, Xu J, van Zijl PCM, Zhang S, Liu G. CEST MRI of sepsis-induced acute kidney injury. NMR IN BIOMEDICINE 2018; 31:e3942. [PMID: 29897643 DOI: 10.1002/nbm.3942] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 04/15/2018] [Accepted: 04/23/2018] [Indexed: 06/08/2023]
Abstract
Sepsis-induced acute kidney injury (SAKI) is a major complication of kidney disease associated with increased mortality and faster progression. Therefore, the development of imaging biomarkers to detect septic AKI is of great clinical interest. In this study, we aimed to characterize the endogenous chemical exchange saturation transfer (CEST) MRI contrast in the lipopolysaccharide (LPS)-induced SAKI mouse model and to investigate the use of CEST MRI for detecting such injury. We used a SAKI mouse model that was generated by i.p. injection of 10 mg/kg LPS. The resulting kidney injury was confirmed by the elevation of serum creatinine and histology. MRI assessments were performed 24 h after LPS injection, including CEST MRI at different B1 strengths (1, 1.8 and 3 μT), T1 mapping, T2 mapping and conventional magnetization transfer contrast (MTC) MRI. The CEST MRI results were analyzed using Z-spectra, in which the normalized water signal saturation (Ssat /S0 ) is measured as a function of saturation frequency. Substantial decreases in CEST contrast were observed at both 3.5 and - 3.5 ppm frequency offset from water at all B1 powers, with the most significant difference obtained at a B1 of 1.8 μT. The average Ssat /S0 differences between injured and normal kidneys were 0.07 (0.55 ± 0.04 versus 0.62 ± 0.04, P = 0.0028) and 0.07 (0.50 ± 0.04 versus 0.57 ± 0.03, P = 0.0008) for 3.5 and - 3.5 ppm, respectively. In contrast, the T1 and T2 relaxation times and MTC contrast in the injured kidneys did not show a significant change compared with the normal control. Our results showed that CEST MRI is more sensitive to the pathological changes in injured kidneys than the changes in T1 , T2 and MTC effect, indicating its potential clinical utility for molecular imaging of renal diseases.
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Affiliation(s)
- Jing Liu
- Graduate College, Southern Medical University, Guangzhou, Guangdong, China
- Department of Radiology, Guangdong Provincial People's Hospital/Guangdong General Hospital, Guangzhou, Guangdong, China
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Zheng Han
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Guoli Chen
- Department of Pathology and Laboratory Medicine, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Yuguo Li
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jia Zhang
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jiadi Xu
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Peter C M van Zijl
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Shuixing Zhang
- Graduate College, Southern Medical University, Guangzhou, Guangdong, China
- Department of Radiology, Guangdong Provincial People's Hospital/Guangdong General Hospital, Guangzhou, Guangdong, China
- Department of Radiology, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Guanshu Liu
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, USA
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12
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Greite R, Thorenz A, Chen R, Jang MS, Rong S, Brownstein MJ, Tewes S, Wang L, Baniassad B, Kirsch T, Bräsen JH, Lichtinghagen R, Meier M, Haller H, Hueper K, Gueler F. Renal ischemia-reperfusion injury causes hypertension and renal perfusion impairment in the CD1 mice which promotes progressive renal fibrosis. Am J Physiol Renal Physiol 2018; 314:F881-F892. [DOI: 10.1152/ajprenal.00519.2016] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Renal ischemia-reperfusion injury (IRI) is a severe complication of major surgery and a risk factor for increased morbidity and mortality. Here, we investigated mechanisms that might contribute to IRI-induced progression to chronic kidney disease (CKD). Acute kidney injury (AKI) was induced by unilateral IRI for 35 min in CD1 and C57BL/6 (B6) mice. Unilateral IRI was used to overcome early mortality. Renal morphology, NGAL upregulation, and neutrophil infiltration as well as peritubular capillary density were studied by immunohistochemistry. The composition of leukocyte infiltrates in the kidney after IRI was investigated by flow cytometry. Systemic blood pressure was measured with a tail cuff, and renal perfusion was quantified by functional magnetic resonance imaging (fMRI). Mesangial matrix expansion was assessed by silver staining. Following IRI, CD1 and B6 mice developed similar morphological signs of AKI and increases in NGAL expression, but neutrophil infiltration was greater in CD1 than B6 mice. IRI induced an increase in systemic blood pressure of 20 mmHg in CD1, but not in B6 mice; and CD1 mice also had a greater loss of renal perfusion and kidney volume than B6 mice ( P < 0.05). CD1 mice developed substantial interstitial fibrosis and decreased peritubular capillary (PTC) density by day 14 while B6 mice showed only mild renal scarring and almost normal PTC. Our results show that after IRI, CD1 mice develop more inflammation, hypertension, and later mesangial matrix expansion than B6 mice do. Subsequently, CD1 animals suffer from CKD due to impaired renal perfusion and pronounced permanent loss of peritubular capillaries.
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Affiliation(s)
- Robert Greite
- Nephrology, Hannover Medical School, Hannover, Germany
| | - Anja Thorenz
- Nephrology, Hannover Medical School, Hannover, Germany
| | - Rongjun Chen
- Nephrology, Hannover Medical School, Hannover, Germany
| | - Mi-Sun Jang
- Nephrology, Hannover Medical School, Hannover, Germany
| | - Song Rong
- Nephrology, Hannover Medical School, Hannover, Germany
- The Transplantation Center of the Affiliated Hospital, Zunyi Medical College, Zunyi, China
| | | | - Susanne Tewes
- Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Li Wang
- Nephrology, Hannover Medical School, Hannover, Germany
| | | | | | | | | | - Martin Meier
- Imaging Center, Institute of Laboratory Animal Sciences, Hannover Medical School, Hannover, Germany
| | | | - Katja Hueper
- Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Faikah Gueler
- Nephrology, Hannover Medical School, Hannover, Germany
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13
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Moore JK, Chen J, Pan H, Gaut JP, Jain S, Wickline SA. Quantification of vascular damage in acute kidney injury with fluorine magnetic resonance imaging and spectroscopy. Magn Reson Med 2017; 79:3144-3153. [PMID: 29148253 DOI: 10.1002/mrm.26985] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 10/02/2017] [Accepted: 10/03/2017] [Indexed: 12/28/2022]
Abstract
PURPOSE To design a fluorine MRI/MR spectroscopy approach to quantify renal vascular damage after ischemia-reperfusion injury, and the therapeutic response to antithrombin nanoparticles (NPs) to protect kidney function. METHODS A total of 53 rats underwent 45 min of bilateral renal artery occlusion and were treated at reperfusion with either plain perfluorocarbon NPs or NPs functionalized with a direct thrombin inhibitor (PPACK:phenyalanine-proline-arginine-chloromethylketone). Three hours after reperfusion, kidneys underwent ex vivo fluorine MRI/MR spectroscopy at 4.7 T to quantify the extent and volume of trapped NPs, as an index of vascular damage and ischemia-reperfusion injury. Microscopic evaluation of structural damage and NP trapping in non-reperfused renal segments was performed. Serum creatinine was quantified serially over 7 days. RESULTS The damaged renal cortico-medullary junction trapped a significant volume of NPs (P = 0.04), which correlated linearly (r = 0.64) with the severity of kidney injury 3 h after reperfusion. Despite global large vessel reperfusion, non-reperfusion in medullary peritubular capillaries was confirmed by MRI and microscopy, indicative of continuing hypoxia due to vascular compromise. Treatment of animals with PPACK NPs after acute kidney injury did not accelerate kidney functional recovery. CONCLUSIONS Quantification of ischemia-reperfusion injury after acute kidney injury with fluorine MRI/MR spectroscopy of perfluorocarbon NPs objectively depicts the extent and severity of vascular injury and its linear relationship to renal dysfunction. The lack of kidney function improvement after early posttreatment thrombin inhibition confirms the rapid onset of ischemia-reperfusion injury as a consequence of vascular damage and non-reperfusion. The prolongation of medullary ischemia renders cortico-medullary tubular structures susceptible to continued necrosis despite restoration of large vessel flow, which suggests limitations to acute interventions after acute kidney injury, designed to interdict renal tubular damage. Magn Reson Med 79:3144-3153, 2018. © 2017 International Society for Magnetic Resonance in Medicine.
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Affiliation(s)
- Jeremy K Moore
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Junjie Chen
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Hua Pan
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Joseph P Gaut
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA.,Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Sanjay Jain
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Samuel A Wickline
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA.,Department of Biomedical Engineering, Washington University, St. Louis, Missouri, USA.,Department of Cardiovascular Science, University of South Florida, Tampa, Florida, USA.,Department of Molecular Pharmacology and Physiology, University of South Florida, Tampa, Florida, USA
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14
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Longo DL, Cutrin JC, Michelotti F, Irrera P, Aime S. Noninvasive evaluation of renal pH homeostasis after ischemia reperfusion injury by CEST-MRI. NMR IN BIOMEDICINE 2017; 30:e3720. [PMID: 28370530 DOI: 10.1002/nbm.3720] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 02/06/2017] [Accepted: 02/06/2017] [Indexed: 06/07/2023]
Abstract
Acute kidney injury (AKI) in mice caused by sustained ischemia followed by reperfusion is associated with acute tubular necrosis and renal dysfunctional blood flow. Although the principal role of the kidney is the maintenance of acid-base balance, current imaging approaches are unable to assess this important parameter, and clinical biomarkers are not robust enough in evaluating the severity of kidney damage. Therefore, novel noninvasive imaging approaches are needed to assess the acid-base homeostasis in vivo. This study investigates the usefulness of MRI-chemical exchange saturation transfer (CEST) pH imaging (through iopamidol injection) in characterizing moderate and severe AKI in mice following unilateral ischemia reperfusion injury. Moderate (20 min) and severe (40 min) ischemia were induced in Balb/C mice, which were imaged at several time points thereafter (Days 0, 1, 2, 7). A significant increase of renal pH values was observed as early as one day after the ischemia reperfusion damage for both moderate and severe ischemia. MRI-CEST pH imaging distinguished the evolution of moderate from severe AKI. A recovery of normal renal pH values was observed for moderate AKI, whereas a persisting renal pH increase was observed for severe AKI on Day 7. Renal filtration fraction was significantly lower for clamped kidneys (0.54-0.57) in comparison to contralateral kidneys (0.84-0.86) following impairment of glomerular filtration. The severe AKI group showed a reduced filtration fraction even after 7 days (0.38 for the clamped kidneys). Notably, renal pH values were significantly correlated with the histopathological score. In conclusion, MRI-CEST pH mapping is a valid tool for the noninvasive evaluation of both acid-base balance and renal filtration in patients with ischemia reperfusion injury.
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Affiliation(s)
- Dario Livio Longo
- Istituto di Biostrutture e Bioimmagini (CNR), c/o Centro di Biotecnologie Molecolari, Torino, Italy
- Dipartimento di Biotecnologie Molecolari e Scienze per la Salute, Università degli Studi di Torino, Torino, Italy
| | - Juan Carlos Cutrin
- Dipartimento di Biotecnologie Molecolari e Scienze per la Salute, Università degli Studi di Torino, Torino, Italy
| | - Filippo Michelotti
- Dipartimento di Biotecnologie Molecolari e Scienze per la Salute, Università degli Studi di Torino, Torino, Italy
| | - Pietro Irrera
- Dipartimento di Biotecnologie Molecolari e Scienze per la Salute, Università degli Studi di Torino, Torino, Italy
| | - Silvio Aime
- Dipartimento di Biotecnologie Molecolari e Scienze per la Salute, Università degli Studi di Torino, Torino, Italy
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