Functional magnetic resonance imaging of human renal allografts during the post-transplant period: preliminary observations

Ferumoxytol Is Not Retained in Kidney Allografts in Patients Undergoing Acute Rejection

PURPOSE

To evaluate whether ultrasmall superparamagnetic iron oxide nanoparticle (USPIO)-enhanced magnetic resonance imaging (MRI) can detect allograft rejection in pediatric kidney transplant patients.

PROCEDURES

The USPIO ferumoxytol has a long blood half-life and is phagocytosed by macrophages. In an IRB-approved single-center prospective clinical trial, 26 pediatric patients and adolescents (age 10-26 years) with acute allograft rejection (n = 5), non-rejecting allografts (n = 13), and normal native kidneys (n = 8) underwent multi-echo T2* fast spoiled gradient-echo (FSPGR) MRI after intravenous injection (p.i.) of 5 mg Fe/kg ferumoxytol. T2* relaxation times at 4 h p.i. (perfusion phase) and more than 20 h p.i. (macrophage phase) were compared with biopsy results. The presence of rejection was assessed using the Banff criteria, and the prevalence of macrophages on CD163 immunostains was determined based on a semi-quantitative scoring system. MRI and histology data were compared among patient groups using t tests, analysis of variance, and regression analyses with a significance threshold of p < 0.05.

RESULTS

At 4 h p.i., mean T2* values were 6.6 ± 1.5 ms for native kidneys and 3.9 ms for one allograft undergoing acute immune rejection. Surprisingly, at 20-24 h p.i., one rejecting allograft showed significantly prolonged T2* relaxation times (37.0 ms) compared to native kidneys (6.3 ± 1.7 ms) and non-rejecting allografts (7.6 ± 0.1 ms). Likewise, three additional rejecting allografts showed significantly prolonged T2* relaxation times compared to non-rejecting allografts at later post-contrast time points, 25-97 h p.i. (p = 0.008). Histological analysis revealed edema and compressed microvessels in biopsies of rejecting allografts. Allografts with and without rejection showed insignificant differences in macrophage content on histopathology (p = 0.44).

CONCLUSION

After ferumoxytol administration, renal allografts undergoing acute rejection show prolonged T2* values compared to non-rejecting allografts. Since histology revealed no significant differences in macrophage content, the increasing T2* value is likely due to the combined effect of reduced perfusion and increased edema in rejecting allografts.

RADIOLOGICAL IMAGING IN RENAL TRANSPLANTATION

SUMMARY – Radiological diagnostic methods have a significant role in the preoperative and postoperative care of patients after kidney transplantation. Improvement and innovations in technology, but also the growing experience of the radiologists who deal with kidney transplant patients as part of the transplant team lead to earlier detection of complications in the postoperative period, which are the leading cause of transplant failure. In this article, we describe, through diagnostic imaging examples, detailed evaluation of all possible complications that can occur after kidney transplantation, with evaluation of different possible diagnostic methods that can be used in the preoperative assessment and postoperative follow up and care of the transplanted patient. The goal of this article is to demonstrate and summarize in detail the possible complications of renal transplantation and how to best diagnostically approach them, with special reference to ultrasound which is the main imaging method for this group of conditions.

Functional MRI in transplanted kidneys

Renal transplantation is the therapy of choice for patients with end-stage renal diseases. Improvement of immunosuppressive therapy has significantly increased the half-life of renal allografts over the past decade. Nevertheless, complications can still arise. An early detection of allograft dysfunction is mandatory for a good outcome. New advances in magnetic resonance imaging (MRI) have enabled the noninvasive assessment of different functional renal parameters in addition to anatomic imaging. Most of these techniques were widely tested on renal allografts in past decades and a lot of clinical data are available. The following review summarizes the comprehensive, functional MRI techniques for the noninvasive assessment of renal allograft function and highlights their potential for the investigations of different etiologies of graft dysfunction.

Quantitative evaluation of renal parenchymal perfusion using contrast-enhanced ultrasonography in renal ischemia-reperfusion injury in dogs

This study evaluated whether renal perfusion changes can be noninvasively estimated by using contrast-enhanced ultrasonography (CEUS) in renal ischemia-reperfusion injury and investigated the correlation between renal perfusion measured by CEUS and necrosis and apoptosis of renal tubular epithelial cells. In six dogs with experimentally induced renal ischemia-reperfusion injury, changes in time to peak intensity, peak intensity, and area under the curve were measured on CEUS. Peak intensity and area under the curve of the renal cortex began to decrease on day 1 (about 20% lower than baseline) and reached the lowest levels (about 50% of baseline) on day 4. They then gradually increased until day 10, at which time peak intensity was about 87% and area under the curve was about 95% of baseline; neither fully recovered. Both parameters were strongly correlated with the necrosis scores on histopathologic examination on day 4 (r = −0.810 of peak intensity and r = −0.886 of area under the curve). CEUS allowed quantitative evaluation of perfusion changes in acute renal ischemia-reperfusion injury, and CEUS results were correlated with renal tubular damage on histopathologic examination. Thus, CEUS could be a noninvasive, quantitative diagnostic method for determining progress of renal ischemia-reperfusion injury.

Value of dynamic MRI using the Ktrans technique for assessment of native kidneys in pre-emptive renal transplantation

Background Different non-invasive imaging techniques such as Doppler ultrasonography and renal scintigraphy are commonly employed to assess allograft function and associated complications. However, all such methods lack sufficient specificity to discriminate between residual renal function of native kidneys. Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) evaluates signal dynamics during the passage of contrast material through the renal cortex, medulla, and collecting system. Purpose To investigate the value of DCE 3T MRI using a quantitative pharmacokinetic parameter (Ktrans) for the assessment of native kidneys before and after pre-emptive renal transplantation. Material and Methods Twenty-five consecutive patients with end-stage renal disease underwent DCE MRI before and 6 months after kidney transplantation. MRI was performed using a 3T scanner. Regions of interests were drawn over each kidney, encompassing the cortex and medulla but excluding the collecting system and any coexisting cysts. Parametric Ktrans values were automatically generated. Results In the pre-transplantation group, mean Ktrans values for the right and left kidneys were 0.55 ± 0.09 min^-1 and 0.44 ± 0.15 min^-1, respectively. In the post-transplantation group, mean Ktrans values of the right and left kidneys were 0.27 ± 0.07 min^-1 and 0.25 ± 0.10 min^-1, respectively. There were statistically significant differences between right and left kidneys in terms of mean Ktrans values in the pre- and post-transplantation groups ( P < 0.001). Conclusion Our preliminary results show that native kidneys were still functioning 6 months after transplantation. MR perfusion using Ktrans may constitute a non-invasive means of determination of the viability of native kidneys after renal transplantation.

Non-invasive approaches in the diagnosis of acute rejection in kidney transplant recipients. Part I. In vivo imaging methods

Kidney transplantation (KTx) represents the best available treatment for patients with end-stage renal disease. Still, full benefits of KTx are undermined by acute rejection (AR). The diagnosis of AR ultimately relies on transplant needle biopsy. However, such an invasive procedure is associated with a significant risk of complications and is limited by sampling error and interobserver variability. In the present review, we summarize the current literature about non-invasive approaches for the diagnosis of AR in kidney transplant recipients (KTRs), including in vivo imaging, gene expression profiling and omics analyses of blood and urine samples. Most imaging techniques, like contrast-enhanced ultrasound and magnetic resonance, exploit the fact that blood flow is significantly lowered in case of AR-induced inflammation. In addition, AR-associated recruitment of activated leukocytes may be detectable by ¹⁸F-fluoro-deoxy-glucose positron emission tomography. In parallel, urine biomarkers, including CXCL9/CXCL10 or a three-gene signature of CD3ε, IP-10 and 18S RNA levels, have been identified. None of these approaches has been adopted yet in the clinical follow-up of KTRs, but standardization of procedures may help assess reproducibility and compare diagnostic yields in large prospective multicentric trials.

[Functional magnetic resonance imaging of the kidneys]

Interest in functional renal magnetic resonance imaging (MRI) has significantly increased in recent years. This review article provides an overview of the most important functional imaging techniques and their potential clinical applications for assessment of native and transplanted kidneys, with special emphasis on the clarification of renal tumors.

New magnetic resonance imaging methods in nephrology

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

A comprehensive non-invasive framework for automated evaluation of acute renal transplant rejection using DCE-MRI

The objective was to develop a novel and automated comprehensive framework for the non-invasive identification and classification of kidney non-rejection and acute rejection transplants using 2D dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI). The proposed approach consists of four steps. First, kidney objects are segmented from the surrounding structures with a geometric deformable model. Second, a non-rigid registration approach is employed to account for any local kidney deformation. In the third step, the cortex of the kidney is extracted in order to determine dynamic agent delivery, since it is the cortex that is primarily affected by the perfusion deficits that underlie the pathophysiology of acute rejection. Finally, we use an analytical function-based model to fit the dynamic contrast agent kinetic curves in order to determine possible rejection candidates. Five features that map the data from the original data space to the feature space are chosen with a k-nearest-neighbor (KNN) classifier to distinguish between acute rejection and non-rejection transplants. Our study includes 50 transplant patients divided into two groups: 27 patients with stable kidney function and the remainder with impaired kidney function. All of the patients underwent DCE-MRI, while the patients in the impaired group also underwent ultrasound-guided fine needle biopsy. We extracted the kidney objects and the renal cortex from DCE-MRI for accurate medical evaluation with an accuracy of 0.97 ± 0.02 and 0.90 ± 0.03, respectively, using the Dice similarity metric. In a cohort of 50 participants, our framework classified all cases correctly (100%) as rejection or non-rejection transplant candidates, which is comparable to the gold standard of biopsy but without the associated deleterious side-effects. Both the 95% confidence interval (CI) statistic and the receiver operating characteristic (ROC) analysis document the ability to separate rejection and non-rejection groups. The average plateau (AP) signal magnitude and the gamma-variate model functional parameter α have the best individual discriminating characteristics.

Functional evaluation of transplanted kidneys using arterial spin labeling MRI

PURPOSE

To investigate non-contrast-enhanced arterial spin labeling (ASL) MRI for functional assessment of transplanted kidneys at 1.5 Tesla (T) and 3T.

MATERIALS AND METHODS

This study was approved by the local ethics committee, and written informed consent was obtained from all participants. Ninety eight renal allograft recipients (mean age, 51.5 ± 14.6 years) were prospectively included in this study. ASL MRI was performed at 1.5T (n = 65) and 3T (n = 33) using a single-slice flow-sensitive alternating inversion recovery true-fast imaging with steady-state precession (FAIR True-FISP) sequence in the paracoronal plane. ASL perfusion was regional analyzed for the renal cortex on parameter maps. ASL was compared between patients with good or moderate allograft function (Group a; estimated glomerular filtration rate [eGFR] > 30 mL/min/1.73 m(2)) and patients with heavily impaired allograft function (Group b; eGFR ≤ 30 mL/min/1.73 m(2)) and correlated to renal function as determined by eGFR.

RESULTS

ASL perfusion and eGFR were comparable at 1.5T (246.9 ± 66.8 mL/100 g/min and 41.9 ± 22.7 mL/min/1.73 m(2)) and 3T (236.5 ± 102.3 mL/100 g/min and 35.9 ± 22.9 mL/min/1.73 m(2)). ASL perfusion was significantly higher in group a (282.7 ± 60.8 mL/100 g/min) as compared to group b (178.2 ± 63.3 mL/100 g/min) (P < 0.0001). ASL perfusion values exhibited a significant correlation with renal function as determined by eGFR (r = 0.59; P < 0.0001).

CONCLUSION

Cortical ASL perfusion values differ between patients with good or moderate allograft function and poor allograft function and correlate significantly with allograft function. Our results highlight the potential of ASL MRI for functional evaluation of renal allografts.

Functional MRI of the kidneys

Renal function is characterized by different physiologic aspects, including perfusion, glomerular filtration, interstitial diffusion, and tissue oxygenation. Magnetic resonance imaging (MRI) shows great promise in assessing these renal tissue characteristics noninvasively. The last decade has witnessed a dramatic progress in MRI techniques for renal function assessment. This article briefly describes relevant renal anatomy and physiology, reviews the applications of functional MRI techniques for the diagnosis of renal diseases, and lists unresolved issues that will require future work.

Comparing kidney perfusion using noncontrast arterial spin labeling MRI and microsphere methods in an interventional swine model

OBJECTIVE

The purpose of this study was to assess the ability of a flow-sensitive alternating inversion recovery-arterial spin labeling (FAIR-ASL) technique to track renal perfusion changes during pharmacologic and physiologic alterations in renal blood flow using microspheres as a gold standard.

MATERIALS AND METHODS

Fluorescent microsphere and FAIR-ASL perfusion were compared in the cortex of the kidney for 11 swine across 4 interventional time points: (1) under baseline conditions, (2) during an acetylcholine and fluid bolus challenge to increase perfusion, (3) initially after switching to isoflurane anesthesia, and (4) after 2 hours of isoflurane anesthesia. In 10 of the 11 swine, a bag of ice was placed on the hilum of 1 kidney at the beginning of isoflurane administration to further reduce perfusion in 1 kidney.

RESULTS

Both ASL and microspheres tracked the expected cortical perfusion changes (P < 0.02) across the interventions, including an increase in perfusion during the acetylcholine challenge and decrease during the administration of isoflurane. Both techniques also measured lower cortical perfusion in the iced compared with the non-iced kidneys (P ≤ 0.01). The ASL values were systematically lower compared with microsphere perfusion. Very good correlation (r = 0.81, P < 0.0001) was observed between the techniques, and the relationship appeared linear for perfusion values in the expected physiologic range (microsphere perfusion <550 mL/min/100 g) although ASL values saturated for perfusion >550 mL/min/100 g.

CONCLUSION

Cortical perfusion measured with ASL correlated with microspheres and reliably detected changes in renal perfusion in response to physiologic challenge.

Repeatability of renal arterial spin labelling MRI in healthy subjects

OBJECT

Arterial spin labelling (ASL) can be used to measure renal perfusion non-invasively. The aim of this study was to determine the repeatability of this technique in healthy kidneys to vindicate its use in clinic.

MATERIALS AND METHODS

Two groups of healthy volunteers were imaged two different days to assess intra- and inter-session repeatability. Oblique-coronal data volumes were acquired on a 1.5 T scanner with a dedicated abdominal 32-channel body phased array coil. ASL was performed using a multi-TI FAIR labelling scheme and 3D GRASE imaging module. Background suppression and respiratory triggering were used. T(1) maps of the kidney were acquired using the same sequence with background suppression disabled.

RESULTS

For the group with multiple intra-session ASL measurements, the average cortical perfusion was 197 mL min(-1)100 g(-1) and average cortical T(1) was 1265 ms. For both perfusion and T(1) the variation shown by the within-subject standard deviation (SDws) (14.6 mL min(-1)100 g(-1) and 33.4 ms) and coefficient of variation (CVws) (7.52 and 2.69%, respectively) was small for all the analyses carried out. Bland-Altman plots were also used to visualise the variation between the same parameters collected from the different scanning sessions in both groups, and demonstrated good reproducibility.

CONCLUSION

We have shown that in healthy volunteers, ASL parameters are repeatable over a short and long period. This supports the overall aim of using ASL in the clinic to assess longitudinal renal perfusion changes in patients.

Reproducibility of renal perfusion MR imaging in native and transplanted kidneys using non-contrast arterial spin labeling

PURPOSE

To examine both inter-visit and intra-visit reproducibility of a MR arterial spin labeling (ASL) perfusion technique in native and transplanted kidneys over a broad range of renal function.

MATERIALS AND METHODS

Renal perfusion exams were performed at 1.5 T in a total of 24 subjects: 10 with native and 14 with transplanted kidneys. Using a flow-sensitive alternating inversion recovery (FAIR) ASL scheme, 32 control/tag pairs were acquired and processed using a single-compartment model. Two FAIR-ASL MR exams were performed at least 24 h apart on all the subjects to assess inter-visit reproducibility. ASL perfusion measurements were also repeated back-to-back within one scanning session in 8 native subjects and in 12 transplant subjects to assess intra-visit reproducibility. Intra-class correlations (ICCs) and coefficients of variation (CVs) were calculated as metrics of reproducibility.

RESULTS

Intra-visit ICCs ranged from 0.96 to 0.98 while CVs ranged from 4.8 to 6.0%. Inter-visit measurements demonstrated slightly more variation with ICCs from 0.89 to 0.94 and CVs from 7.6 to 13.1%. Medullary perfusion demonstrated greater variability compared with cortical blood flow: intra-visit ICCs from 0.72 to 0.78 and CVs from 16.7 to 26.7%, inter-visit ICCs from 0.13 to 0.63 and CVs from 19.8 to 37%.

CONCLUSION

This study indicates that a FAIR-ASL perfusion technique is reproducible in the cortex of native and transplanted kidneys over a broad range in renal function. In contrast, perfusion measurements in the medulla demonstrated moderate to poor reproducibility for intra-visit and inter-visit measures respectively.

Quantitative evaluation of acute renal transplant dysfunction with low-dose three-dimensional MR renography

PURPOSE

To assess prospectively the ability of quantitative low-dose three-dimensional magnetic resonance (MR) renography to help identify the cause of acute graft dysfunction.

MATERIALS AND METHODS

This HIPAA-compliant study was approved by the institutional review board, and written informed consent was obtained. Between December 2001 and May 2009, sixty patients with transplanted kidneys (41 men and 19 women; mean age, 49 years; age range, 22-71 years) were included. Thirty-one patients had normal function and 29 had acute dysfunction due to acute rejection (n = 12), acute tubular necrosis (ATN) (n = 8), chronic rejection (n = 6), or drug toxicity (n = 3). MR renography was performed at 1.5 T with three-dimensional gradient-echo imaging. With use of a multicompartment renal model, the glomerular filtration rate (GFR) and the mean transit time (MTT) of the tracer for the vascular compartment (MTT(A)), the tubular compartment (MTT(T)), and the collecting system compartment (MTT(C)) were calculated. Also derived was MTT for the whole kidney (MTT(K) = MTT(A) + MTT(T) + MTT(C)) and fractional MTT of each compartment (MTT(A/K) = MTT(A)/MTT(K), MTT(T/K) = MTT(T)/MTT(K), MTT(C/K) = MTT(C)/MTT(K)). These parameters were compared in patients in the different study groups. Statistical analysis was performed by using analysis of covariance.

RESULTS

There were significant differences in GFR and MTT(K) between the acute dysfunction group (36.4 mL/min ± 20.8 [standard deviation] and 177.1 seconds ± 46.8, respectively) and the normal function group (65.9 mL/min ± 27.6 and 140.5 seconds ± 51.8, respectively) (P < .001 and P = .004). The MTT(A/K) was significantly higher in the acute rejection group (mean, 12.7% ± 2.9) than in the normal function group (mean, 8.3% ± 2.2; P < .001) or in the ATN group (mean, 7.1% ± 1.4; P < .001). The MTT(T/K) was significantly higher in the ATN group (mean, 83.2% ± 9.2) than in the normal function group (mean, 72.4% ± 10.2; P = .031) or in the acute rejection group (mean, 69.2% ± 6.1; P = .003).

CONCLUSION

Low-dose MR renography analyzed by using a multicompartmental tracer kinetic renal model may help to differentiate noninvasively between acute rejection and ATN after kidney transplantation.

Arterial spin labeling MRI for assessment of perfusion in native and transplanted kidneys

PURPOSE

To apply a magnetic resonance arterial spin labeling (ASL) technique to evaluate kidney perfusion in native and transplanted kidneys.

MATERIALS AND METHODS

This study was compliant with the Health Insurance Portability and Accountability Act and approved by the institutional review board. Informed consent was obtained from all subjects. Renal perfusion exams were performed at 1.5 T in a total of 25 subjects: 10 with native and 15 with transplanted kidneys. A flow-sensitive alternating inversion recovery (FAIR) ASL sequence was performed with respiratory triggering in all subjects and under free-breathing conditions in five transplant subjects. Thirty-two control/tag pairs were acquired and processed using a single-compartment model. Perfusion in native and transplanted kidneys was compared above and below an estimated glomerular filtration rate (eGFR) threshold of 60 ml/min per 1.73 m² and correlations with eGFR were determined.

RESULTS

In many of the transplanted kidneys, major feeding vessels in the coronal plane required a slice orientation sagittal to the kidney. Renal motion during the examination was observed in native and transplant subjects and was corrected with registration. Cortical perfusion correlated with eGFR in native (r=0.85, P=.002) and transplant subjects (r=0.61, P=.02). For subjects with eGFR >60 ml/min per 1.73 m², native kidneys demonstrated greater cortical (P=.01) and medullary (P=.04) perfusion than transplanted kidneys. For subjects with eGFR <60 ml/min per 1.73 m², native kidneys demonstrated greater medullary perfusion (P=.04) compared to transplanted kidneys. Free-breathing acquisitions provided renal perfusion measurements that were slightly lower compared to the coached/triggered technique, although no statistical differences were observed.

CONCLUSION

In conclusion, FAIR-ASL was able to measure renal perfusion in subjects with native and transplanted kidneys, potentially providing a clinically viable technique for monitoring kidney function.

Diffusion and perfusion of the kidney

MRI of the kidney currently makes the transition from depiction of morphology to assessment of function. Functional renal imaging methods provide information on diffusion and perfusion on a microstructural level. This review article presents the current status of functional renal imaging with focus on DWI (diffusion-weighted imaging) and DCE-MRI (dynamic contrast-enhanced MRI), as well as BOLD (blood-oxygenation level dependent) MRI, DTI (diffusion tensor imaging) and arterial spin labeling (ASL). Technical background of these techniques is explained and clinical assessment of renal function, parenchymal disease, transplant function and solid masses is discussed.

Blood oxygen level-dependent and perfusion magnetic resonance imaging: detecting differences in oxygen bioavailability and blood flow in transplanted kidneys

Functional magnetic resonance imaging (fMRI) is a powerful tool for examining kidney function, including organ blood flow and oxygen bioavailability. We have used contrast enhanced perfusion and blood oxygen level-dependent (BOLD) MRI to assess kidney transplants with normal function, acute tubular necrosis (ATN) and acute rejection. BOLD and MR-perfusion imaging were performed on 17 subjects with recently transplanted kidneys. There was a significant difference between medullary R2 values in the group with acute rejection (R2=16.2/s) compared to allografts with ATN (R2=19.8/s; P=.047) and normal-functioning allografts (R2=24.3/s;P=.0003). There was a significant difference between medullary perfusion measurements in the group with acute rejection (124.4+/-41.1 ml/100 g per minute) compared to those in patients with ATN (246.9+/-123.5 ml/100 g per minute; P=.02) and normal-functioning allografts (220.8+/-95.8 ml/100 g per minute; P=.02). This study highlights the utility of combining perfusion and BOLD MRI to assess renal function. We have demonstrated a decrease in medullary R2 (decrease deoxyhemoglobin) on BOLD MRI and a decrease in medullary blood flow by MR perfusion imaging in those allografts with acute rejection, which indicates an increase in medullary oxygen bioavailability in allografts with rejection, despite a decrease in blood flow.

Quantification of renal allograft perfusion using arterial spin labeling MRI: initial results

OBJECTIVE

To quantify renal allograft perfusion in recipients with stable allograft function and acute decrease in allograft function using nonenhanced flow-sensitive alternating inversion recovery (FAIR)-TrueFISP arterial spin labeling (ASL) MR imaging.

METHODS

Following approval of the local ethics committee, 20 renal allograft recipients were included in this study. ASL perfusion measurement and an anatomical T2-weighted single-shot fast spin-echo (HASTE) sequence were performed on a 1.5-T scanner (Magnetom Avanto, Siemens, Erlangen, Germany). T2-weighted MR urography was performed in patients with suspected ureteral obstruction. Patients were assigned to three groups: group a, 6 patients with stable allograft function over the previous 4 months; group b, 7 patients with good allograft function who underwent transplantation during the previous 3 weeks; group c, 7 allograft recipients with an acute deterioration of renal function.

RESULTS

Mean cortical perfusion values were 304.8 +/- 34.4, 296.5 +/- 44.1, and 181.9 +/- 53.4 mg/100 ml/min for groups a, b and c, respectively. Reduction in cortical perfusion in group c was statistically significant.

CONCLUSION

Our results indicate that ASL is a promising technique for nonenhanced quantification of cortical perfusion of renal allografts. Further studies are required to determine the clinical value of ASL for monitoring renal allograft recipients.

Quantitative MR measures of intrarenal perfusion in the assessment of transplanted kidneys: initial experience

RATIONALE AND OBJECTIVES

The purpose of this study was to evaluate prospectively a gadolinium-based perfusion technique for intrarenal blood flow in transplanted kidneys and to determine if magnetic resonance imaging (MRI) measurements of intrarenal perfusion could be used to differentiate between normal-functioning kidney allografts and allografts with acute tubular necrosis (ATN) or acute rejection.

MATERIALS AND METHODS

Twenty-one subjects were enrolled within 4 months of receiving a kidney transplant. A biopsy was performed on subjects to diagnose each allograft as having either ATN or acute rejection. A group of subjects with normal functioning transplants was also enrolled in our study. MRI perfusion images were acquired on a 1.5 T MRI system within 48 hours after biopsy using an echo planar, T2*-weighted sequence, and an injection of gadodiamide contrast agent administered at a dose of 0.1 mmol/kg. Scan parameters were: repetition time/echo time/flip = 1000 ms/30 ms/60 degrees , field of view = 340 x 340 mm, matrix = 128 x 64, slice thickness = 10 mm, and temporal resolution = 1.0 seconds. Cortical and medullary blood flow values were calculated.

RESULTS

Medullary blood flow values were significantly (P = .02) lower in allografts undergoing acute rejection (121 +/- 41 mL/100 g/min) compared to normal-functioning allografts (221 +/- 96 mL/100 g/min) and those with ATN (247 +/- 124 mL/100 g/min). Cortical blood flow values were also significantly (P = .03) reduced in allografts with acute rejection (243 +/- 116 mL/100 g/min) compared to those with normal function (413 +/- 116 mL/100 g/min).

CONCLUSIONS

Preliminary results indicate that MRI perfusion techniques may provide a means of determining noninvasively the viability of renal allografts, potentially alleviating the need for biopsy in some patients.

Renal functional MRI: Are we ready for clinical application?

OBJECTIVE

We review the basics of functional renal imaging and highlight a few clinical applications.

CONCLUSION

Techniques such as contrast-enhanced MR renography, diffusion-weighted imaging, and blood oxygen level-dependent MRI have been investigated in animal models and in a few human studies. Functional renal imaging is a rapidly growing field that has the potential to provide new insight into the pathophysiology of renal disease.

Assessment of renal function with dynamic contrast-enhanced MR imaging

MR imaging is a promising noninvasive modality that can provide a comprehensive picture of renal anatomy and function in a single examination. The advantages of MR imaging are its high contrast and temporal resolution and lack of exposure to ionizing radiation. In the past few years, considerable progress has been made in development of methods of renal functional MR imaging and their applications in various diseases. This article reviews the key factors for acquisition and analysis of dynamic contrast-enhanced renal MR imaging (MR renography) and the most significant developments in this field over the past few years.

Imaging of the renal transplant: comparison of MRI with duplex sonography

Renal transplantation is an established treatment for patients with end-stage renal disease. Many causes of graft dysfunction are treatable, making prompt detection and diagnosis of complications essential. Sensitive, noninvasive imaging procedures, which do not use iodinated contrast media, are therefore highly desirable to evaluate graft function. Duplex sonography (US) has traditionally been the initial investigation of graft dysfunction. US offers many advantages, particularly during the postoperative period, when it can be performed portably regardless of renal function and can guide percutaneous procedures. However, US lacks specificity in assessing hydronephrosis, cannot differentiate parenchymal causes of dysfunction, and may have difficulty assessing transplant vessels. Recently comprehensive magnetic resonance imaging (MRI) protocols including MR urography, gadolinium-enhanced MR angiography, and MR renography have evolved as a "one-stop" diagnostic technique in the evaluation of the entire graft and peritransplant region. Multiplanar capabilities enable MRI to identify the site of urinary obstruction and assess renal vessels in their entirety. The evolving technique of MR renography may also differentiate parenchymal causes of dysfunction. By combining these three components into a single examination, further information may be obtained regarding the graft when compared with US and other conventional studies, with improved patient convenience, less morbidity, and a potential cost saving.

Contrast-enhanced MR angiography (CE-MRA) in the evaluation of vascular complications of renal transplantation

Vascular complications associated with renal transplantation merit urgent investigation since they are often correctable, and timely intervention can help salvage the graft kidney. Contrast-enhanced MR angiography (CE-MRA) is a promising non-invasive technique, uses relatively non-nephrotoxic contrast agents and can rapidly demonstrate the underlying lesion in most instances. In this pictorial review we present the spectrum of abnormalities, as well as the pitfalls of interpretation of CE-MRA, that we encountered in 41 cases where there was clinical suspicion of vascular complications of renal transplantation. We believe that CE-MRA is a valuable, non-invasive screening technique in these cases, and further investigation and management of these patients can be confidently tailored to the results of the CE-MRA study.

Renal Functional Contrast-Enhanced Magnetic Resonance Imaging

OBJECTIVES

The objective of the present study was to compare P792, a new rapid clearance blood pool agent characterized by negligible interstitial diffusion but unrestricted glomerular filtration, with Gd-DOTA in both qualitative and quantitative aspects of renal functional magnetic resonance imaging.

MATERIALS AND METHODS

Dynamic imaging was performed with a fast T1-weighted gradient-echo sequence on a 1.5-T magnet in 25 Sprague-Dawley rats, after injection of 13 micromol Gd/kg-1 of P792 (n = 10), 100 (n = 10), or 50 micromol Gd/kg-1 of Gd-DOTA (n = 5). Signal-time curves from 6 regions of interest (ROIs), including renal parenchyma and contents, were analyzed.

RESULTS

Qualitative analysis depicted a typical pattern of temporal enhancement as previously described with extracellular gadolinium chelates, including early and brief enhancement of the aorta, renal vessels and cortex, quickly followed by enhancement of the medulla and then renal pelvis. However, a decrease in signal intensity was noted in the inner medulla and the renal pelvis approximately 90 seconds after bolus injection, being more marked when using the full dose of Gd-DOTA. Curve analysis showed a similar vascular phase within each parenchymal ROI, confirmed by similar upslopes, which ranged from 0.015 +/- 0.007 to 0.019 +/- 0.005. Following this initial phase, T1-enhancement appeared greater and longer within the medulla and renal pelvis, and subsequently in the whole kidney ROI with P792 (time to maximal enhancement (sec)/ enhancement rate: 85.5 +/- 15.9/3.1 +/- 0.4) as compared with Gd-DOTA full (53.0 +/- 18.9/ 2.7 +/- 0.3) or half dosage (65.2 +/- 20.1/ 2.2 +/- 0.2). The subsequent decrease in signal intensity, characterized by a downslope during the minute following maximal enhancement, was faster with Gd-DOTA (0.006 +/- 0.002) as compared either to P792 or half dosage Gd-DOTA (0.003 +/- 0.001).

CONCLUSIONS

Due to its physicochemical and pharmacokinetic properties, P792 allows the use of a reduced dosage of gadolinium, resulting in less T2* effect without compromising T1 enhancement. Thus, P792 appears suitable for renal functional MR imaging.

Kidney transplantation: evaluation of donors and recipients

MR imaging provides a comprehensive method for noninvasive evaluation of renal donor anatomy. Although multidetector helical CT can provide similar information, MR imaging has the advantage of avoiding exposure to ionizing radiation and potentially nephrotoxic contrast material. These are important considerations in screening a generally healthy donor population. MR imaging also can provide complete evaluation of the kidney after transplantation, where avoidance of potentially nephrotoxic agents and preservation of maximal renal function are critical.

Functional renal MR imaging

MR imaging is the only noninvasive test that may provide a complete picture of renal status with minimal risk to the patient, simultaneously improving diagnosis and lowering costs. This article reviews several MR renography techniques, including approaches for quantifying renal perfusion and glomerular filtration rate. Also discussed are clinical applications for the diagnosis and follow-up of renovascular disease, hydronephrosis,and renal transplant dysfunction. The article concludes with an overview of technical problems and challenges facing MR renography.

Normal and Transplanted Rat Kidneys: Diffusion MR Imaging at 7 T

PURPOSE

To investigate the feasibility of obtaining reproducible apparent diffusion coefficient (ADC) maps of normal rat kidneys by using respiratory-triggered spin-echo diffusion-weighted magnetic resonance (MR) imaging, to investigate the sensitivity of ADC maps in the evaluation of renal blood flow, and to use this technique to monitor acute graft rejection in transplanted rat kidneys.

MATERIALS AND METHODS

Spin-echo diffusion-weighted MR imaging measurements were performed in 20 normal rats and nine rats that had undergone transplantation (six rats had received allografts; three had received isografts) at 7 T. To evaluate the effect of alteration in blood flow and water transport function, angiotensin II was infused in six normal rats and a series of spin-echo diffusion-weighted MR images was obtained at five time points. Transplanted kidneys were monitored by obtaining spin-echo diffusion-weighted MR images and gradient-echo MR images every 2 hours for 8 hours on postoperative day 4. Statistical analysis was performed with repeated-measures multivariate analysis of variance and the paired t test.

RESULTS

No significant differences in ADC values were observed between right and left kidneys in all three orthogonal directions; however, a small difference was observed between the cortex and medulla. ADC values in the cephalocaudal and mediolateral directions were higher than those in the anteroposterior direction (P <.01 for all). ADC values in the cortex and medulla decreased significantly (by >35%, P <.01) during angiotensin II-induced reduction in renal blood flow. No significant signal intensity change was observed between native and transplanted kidneys on gradient-echo MR images. Allografts exhibited decreased ADC values (P <.01) and isografts exhibited similar ADC values compared with native kidneys.

CONCLUSION

These findings suggest that reproducible renal ADC maps can be obtained in rats by using spin-echo diffusion-weighted MR imaging at 7 T. Spin-echo diffusion-weighted MR imaging may have potential as a noninvasive tool for monitoring early graft rejection after kidney transplantation.

MR imaging of renal function

MR imaging is the only single noninvasive test that can potentially provide a complete picture of renal status with minimal risk to the patient, simultaneously improving diagnosis while lowering medical costs by virtue of its being a single test. The strengths of MR imaging lie in its high spatial and temporal resolution and its lack of exposure to ionizing radiation and nephrotoxic contrast agents. This article reviews the use of MR imaging for quantification of renal functional parameters and its application to clinical problems, such as RVD, hydronephrosis, and renal transplantation. Although advances in both the technical and clinical aspects of functional renal MR imaging have been made, much remains to be done. The preliminary results reported in the many studies reviewed are exciting, but these techniques need to be validated against accepted standards where such standards exist. In addition, and perhaps more important, the effects of these new diagnostic methods on patient outcomes must be studied. Finally, further progress in image processing and analysis must be made to make functional renal MR imaging truly practical. With these advances, one can expect functional renal MR imaging to play an ever-expanding and influential role in the care and management of the patient with renal disease.

Newly developed techniques to study and diagnose acute renal failure

Progress in treating human acute renal failure (ARF) is dependent on developing techniques that allow for the rapid diagnosis, quantification of injury, further understanding of the pathophysiology, and the effects of therapy. Therefore, four techniques that will facilitate this progress are described and illustrated by four different investigative teams. Techniques to measure rapid changes in GFR are available for rapid diagnosis and quantification of ARF in humans. State-of-the-art magnetic resonance imaging (MRI) presently allows for enhanced resolution of regional renal blood flow and functional evaluations in patients. Furthermore, new probes and techniques for MRI that allow for identification and quantitation of inflammation, applicable to human ARF, are being developed and tested in animal models. Finally, two-photon microscopy will allow for four-dimensional cellular and subcellular studies in animal models of ARF providing rapid insights into pathophysiology and the therapeutic effects of a variety of promising agents. Further development and utilization of these techniques, especially in concert with genetic, proteomic, and molecular approaches, will allow for needed insights into the pathophysiology and therapy in human ARF.

Functional evaluation of normothermic ischemia and reperfusion injury in dog kidney by combining MR diffusion-weighted imaging and Gd-DTPA enhanced first-pass perfusion

PURPOSE

To evaluate functional alterations of renal ischemia and reperfusion injury using MR diffusion-weighted imaging and dynamic perfusion imaging.

MATERIALS AND METHODS

Twelve dogs were randomly divided into four groups. Animal renal ischemia was respectively induced for 30 (group 1), 60 (group 2), 90 (group 3), and 120 (group 4) minutes by left renal artery ligation under anesthesia. Using a 1.5 T MR system, true-FISP, TSE, EPI, and DWI sequences were acquired in five different periods; specifically, pre-ischemia, onset-ischemia, late ischemia, onset-reperfusion, and post-reperfusion. Moreover, a turbo-FLASH sequence (TR/TE/TI/FA = 5.8/3.2/400 msec/10 degrees ) with a temporal resolution of 1.16 seconds was acquired. Signal intensity (SI) was measured in the cortex, outer medulla, and inner medulla of kidney. Apparent diffusion coefficient (ADC) values were calculated, and SI was plotted as a function of time.

RESULTS

In all animals, significant SI changes of the left kidney on T2/T2*WI were detected following ischemia-reperfusion insult compared to corresponding values of the right kidney. Following ligation, the ADC values decreased in all layers of the left kidney. Immediately after the release of ligation, ADC values in both outer and inner medulla of the left kidney remained lower than those of the right kidney in those animals which were induced with renal ischemia for 60, 90, and 120 minutes. In all groups, a uniphasic enhancement pattern was observed in the outer and inner medulla of the left kidney, accompanied by a decrease of the area under the curve.

CONCLUSION

Our results suggest that MR diffusion-weighted imaging and dynamic perfusion imaging are useful in identifying renal dysfunction following normothermic ischemia and reperfusion injury.

Automated quantitative evaluation of diseased and nondiseased renal transplants with MR renography

PURPOSE

To present a method of automated parametric quantification of dynamic MR enhancement curves of renal transplants and evaluate the disease-discriminating properties of the resulting MR renography (MRR) data.

MATERIALS AND METHODS

This study included 27 patients with nondiseased renal transplants and eight patients with diseased renal transplants. The examination was repeated in 10 patients and the reproducibility of the enhancement parameters was estimated by analysis of variance (ANOVA). The disease-discriminating properties of the transplant volumes and enhancement parameters were tested with t-tests and logistic regression analysis.

RESULTS

The enhancement parameters were reproducible. The mean medullary nephronal washout rate (lambda1) and cortical arterial blood volume (mu0) were lower in diseased renal transplants. The combination of these parameters was a strong predictor of renal transplant disease (area under ROC curve 0.98; 95% confidence interval 0.96-1.0).

CONCLUSION

Automated parametric quantification of cortical and medullary enhancement is feasible and allows the accurate detection of nonsurgical disease in renal transplants by MRR.

Acute cardiac transplant rejection: detection and grading with MR imaging with a blood pool contrast agent--experimental study in the rat

PURPOSE

To investigate the possibility of detecting cardiac transplant rejection and determining its degree of severity with magnetic resonance (MR) imaging with a blood pool contrast agent.

MATERIALS AND METHODS

Rat allogeneic (PVG to Wistar/Kyoto, n = 9) and syngeneic (Wistar/Kyoto to Wistar/Kyoto, n = 6) heterotopic heart transplantations were performed. On the 2nd and 6th postoperative days, an ultrasmall superparamagnetic iron oxide, or USPIO, contrast agent was injected intravenously at a dose of 2 mg of iron per kilogram of body weight. The injection was followed by three-dimensional T1-weighted MR imaging of the heart grafts with an imaging time of approximately 2 minutes for each image for 44 minutes. The signal intensity (SI) was measured in the myocardium over time, and the relative enhancement was calculated. After the 6th day, the rats were sacrificed, and the morphology of the transplanted hearts was assessed histologically. The CIs for the difference of the means on day 2 and day 6 were calculated by using a bootstrap technique, and the correlation between the relative SI change and the histologically determined degree of rejection were calculated with the Spearman rank order correlation coefficient.

RESULTS

On day 6, a statistically significant difference between the groups was found at 4 minutes after injection of the contrast agent and increased with increasing time after injection. The mean percentage change in SI at the last time point for the allogeneic group on day 2 was -8.7% (SD, 8.5) and for the syngeneic group was -6.6% (SD, 6.0). On day 6, the allogeneic group had a relative SI change of 17.7% (SD, 8.7), whereas the syngeneic group had a change of -7.4% (SD, 2.6). There was a significant difference between only the two groups on day 6 (P <.001). Furthermore, in the allogeneic group the histologically determined degree of rejection correlated positively with the relative SI enhancement (r = 0.89, P <.005).

CONCLUSION

Acutely rejecting heart transplants can be distinguished from nonrejecting ones in an animal model with MR imaging and a blood pool contrast agent. In addition, the relative SI enhancement reflects the histologically determined degree of rejection.

Evaluation of a new ultrasmall superparamagnetic iron oxide contrast agent Clariscan, (NC100150) for MRI of renal perfusion: experimental study in an animal model

PURPOSE

To determine the diagnostic value of a new ultrasmall superparamagnetic iron oxide Clariscan, (NC100150) for the evaluation of renal perfusion in an animal model using a 3D-FFE-EPI sequence.

MATERIALS AND METHODS

Four groups of four rabbits each were imaged after bolus injection of NC100150, using a 1.5 T MR system (Gyroscan ACS-NT). T2*w MR images in the coronal plane were acquired over 60 seconds with an echo-shifted 3D-FFE-EPI sequence (TR/TE/alpha = 18/25 msec/8 degrees ). Data were transferred to a workstation and converted into concentration curves. Based on the fitted concentration time curves, parameter maps were calculated pixelwise: bolus arrival time (T0), time-to-peak (TTP), mean transit time (MTT), and relative bolus volume (rBV). Maximum signal decrease was determined with respect to the baseline value.

RESULTS

Mean MTT increased from 4.2 seconds at a dose of 0.25 mg to 5.9 seconds at 1.0 mg (P < .0001). The maximum signal decrease was observed at 0.75 mg, corresponding to 85% of the baseline value. Transit times of the contrast bolus were accurately calculated for the cortex and the outer medulla, but at the level of the inner medulla no arterial flow profile was identified. No significant difference between the cortex and the outer medulla was found for either T0 or rBV, but medullar TTP and MTT were prolonged with regard to cortical TTP and MTT (6.3 seconds vs. 5.7 seconds, P < .001; 5.7 seconds vs. 4.2 seconds, P < .0001).

CONCLUSION

The employed intravascular contrast agent is well suited to assess renal perfusion. By the use of a T2*w3D perfusion sequence, cortical and medullar transit times can be quantified and physiologic information on regional perfusion differences can be obtained.

Evaluation of two cortical fraction estimation algorithms for the calculation of dynamic magnetic resonance renograms

With the high resolution of dynamic magnetic resonance imaging (MRI) scans it is possible to measure cortical renograms directly, but due to partial volume effects this is impossible for medullary renograms. With weighted subtraction of the cortical renogram from a mixed renogram it becomes possible to extract the medullary renogram. For this subtraction the fraction of cortical tissue, present in the region of interest in which the mixed renogram is determined, has to be calculated. We have evaluated two algorithms for calculation of the cortical fraction. Both algorithms use the fact that during an interval after the start of the cortical enhancement no medullary enhancement occurs. One algorithm calculates the ratio between the slopes of both enhancement curves. The other is based on minimising the medullary signal values using a least squares error (LSE) method. Using a computer model of the renograms and measurements on real patients we analysed the accuracy of both methods and determined the best parameters for each.

In vivo detection of acute rat renal allograft rejection by MRI with USPIO particles

BACKGROUND

Magnetic resonance imaging (MRI) for non-invasively detecting renal rejection was developed by monitoring the accumulation of macrophages labeled with dextran-coated ultrasmall superparamagnetic iron oxide (USPIO) particles at the rat renal allografts during acute rejection.

METHODS

Five groups of male rats with DA-->BN renal allografts and one group with BN-->BN renal isografts were investigated by MRI before, immediately after, and 24 hr after intravenous infusion with different doses of USPIO particles. All infusions were done on post-operative day 4. MRI experiments were carried out in a 4.7-Tesla instrument using a gradient echo sequence.

RESULTS

MR signal intensity (MRSI) of the cortex was found to decrease with higher dosages of USPIO particles. In the absence of USPIO infusion, a decrease in MRSI was seen in the medulla region, presumably due to hemorrhage associated with renal graft rejection, while no significant change was observed in the cortex. The optimal dose of USPIO particles for visualizing rejection-associated changes in our rat kidney model appears to be 6 mg Fe/kg body weight. Iron staining results correlated with the MRSI data, indicating that the signal reduction in the MR images was due to the presence of iron. Immunohistochemical results indicated that USPIO particles were mostly taken up by infiltrating macrophages in the rejecting grafts.

CONCLUSIONS

Our results suggest that MRI with intravenous administration of dextran-coated USPIO particles appears to be a valuable and promising tool that can be used as a non-invasive and sensitive method to detect graft rejection in renal transplantation.

Movement correction of the kidney in dynamic MRI scans using FFT phase difference movement detection

To measure cortical and medullary MR renograms, regions of interest (ROIs) are placed on the kidney in images acquired using dynamic MRI. Since native kidneys move with breathing, and breath-holding techniques are not feasible, movement correction is necessary. In this contribution we compare three correction methods, based on image matching, phase difference movement detection (PDMD), and cross-correlation, respectively. The PDMD-based method showed the best performance and was able to determine kidney movement in our test series in 68% of the scans with no visible deviation, and in 88% of the scans if a one-pixel deviation is considered acceptable.

USPIO-enhanced dynamic MRI: evaluation of normal and transplanted rat kidneys

To evaluate first-pass renal perfusion with ultrasmall superparamagnetic iron oxide (USPIO) particles by MRI, 40 normal rats (20 Dark Agouti (DA) rats and 20 Brown Norway (BN) rats) and 16 transplanted rats (12 allografts and four isografts) were studied on day 4 post-transplantation with different USPIO doses (3.0-18.1 mg Fe/kg/body weight). All animals underwent 128 consecutive snapshot fast low-angle shot (FLASH) coronal dynamic studies in 43 s. In the normal rats, a larger maximum signal decrease (MSD) in the cortex and the outer medulla is observed with an increasing dose of USPIO particles (P < 0.01). No significant differences were observed between the right and left kidneys at all doses studied. Higher MSD, time of occurrence of MSD (tMSD), and wash-in slope appear with higher doses of USPIO particles. The dynamic curves for DA rats show similar shapes when compared to those for BN rats. In the transplanted rats, allograft kidneys show lower MSD, longer tMSD, and lower wash-in slope compared to those in the normal kidneys. Isograft kidneys show perfusion patterns similar to those of normal kidneys in the cortex and the outer medulla. Histopathology indicates acute vascular rejection in all allografts and normal kidney architecture in all isografts. The results clearly show good agreement between the renal graft perfusion measurements and histopathological changes associated with rejection. This work also introduces a new signal analysis methodology for the automatic detection of transplanted organ rejection. This method compares the dynamics of the intrarenal signal intensities for native and transplanted kidneys. A quantitative measurement to detect significant differences between these signals was developed, and showed that this technique exhibits good performance in identifying renal rejection.

Complications of renal transplantation: MR findings

Because of its direct multiplanar capability, superb soft tissue contrast and ability to obtain dynamic three-dimensional angiograms using contrast agents without nephrotoxicity, magnetic resonance (MR) imaging and magnetic resonance angiography are ideal techniques for evaluating renal transplants. The following pictorial essay reviews the normal MR appearance of the transplant kidney as well as parenchymal, vascular, and peritransplant complications.

MR renography by semiautomated image analysis: performance in renal transplant recipients

We evaluated a method of semiautomated analysis of dynamic MR image series in renal transplants. Nine patients were studied twice, with an average time interval of 7 days. MR examination consisted of a run of 256 T1-weighted coronal scans (GE; TR/TE/flip: = 11/3.4/60 degrees; slice thickness = 6 mm; temporal resolution = 2 seconds). Gadolinium-DTPA (0.05 mmol/kg) was injected with an injector pump (5 ml/seconds). MR renographs of the cortex and medulla were obtained by segmentation of the renal transplant and placement of two regions of interest (ROIs) overlying the peripheral and central renal parenchyma. In the first 100 frames of the renographs, analysis of variance (ANOVA) demonstrated significant intraclass correlation coefficients with mean values for the cortex and medulla of 0.47 and 0.59, respectively. We conclude that the procedure is a robust technique that generates meaningful signal curves.

MRI and ultrasonographic detection of morphologic and hemodynamic changes in chronic renal allograft rejection in the rat

PURPOSE

The purpose of this study is to describe the sonographic, MRI, and histopathologic findings in a rat model of chronic renal allograft rejection.

MATERIALS AND METHODS

Allogeneic renal grafts (male DA kidney into male Lewis rat with unilateral nephrectomy, N = 27) and syngeneic renal grafts (male Lewis kidney into male Lewis rat, N = 19) were examined serially with ultrasound, MRI, and histology.

RESULTS

Nonparametric Spearman rank correlation showed significance between the histologic score and the following parameters: the MRI score (r(s) = 0.91, P < 0.01, N = 46), the ultrasound score (r(s) = 0.9, P < 0.01, N = 46), the power Doppler score (r(s) = 0.86, P < 0.01, N = 46), and the MRI perfusion (r(s) = -0.80, P < 0.01, N = 45). Positive correlations were also found between the MRI volume estimations (graft r(s) = 0.49, P < 0.01, N = 46; native r(s) = 0.59, P < 0.01, N = 46), and the ultrasound volume estimations (graft r(s) = 0.39, P < 0.01, N = 45; native r(s) = 0.64, P < 0.01, N = 46) as well as with actual graft weight.

CONCLUSIONS

This study shows that both MRI and ultrasound can provide complementary, accurate information compared to histology in regard to the alterations in anatomy and hemodynamic changes associated with chronic allograft nephropathy.

MR renography: an algorithm for calculation and correction of cortical volume averaging in medullary renographs

We evaluated a mathematical algorithm for the generation of medullary signal from raw dynamic magnetic resonance (MR) data. Five healthy volunteers were studied. MR examination consisted of a run of 100 T1-weighted coronal scans (gradient echo; TR/TE 11/3.4 msec, flip angle 60 degrees; slice thickness 6 mm; temporal resolution 2 seconds). Gadolinium-diethylene triamine pentaacetic acid (DTPA; 0. 05 mmol/kg) was injected with an injector pump (5 ml/sec). Medullary MR renographs (MRRs) were calculated for regions of interest with strong and moderate cortical volume averaging (CVA). A reference medullary MRR, devoid of CVA, was obtained. Percentual signal differences between calculated and reference medullary MRRs were estimated for each consecutive scan. Run averaged values of these differences were calculated. Mean values, after subtraction of the resting state signal, were +0.2% (SD 9.7%) and +0.7% (SD 9.0%) for areas with strong and moderate CVA, respectively. We conclude that with this algorithm reliable extraction of medullary MRRs is feasible, providing a unique tool for clinical evaluation of medullary disease. J. Magn. Reson. Imaging 2000;12:453-459.

Contrast-enhanced three-dimensional fast spoiled gradient-echo renal MR imaging: evaluation of vascular and nonvascular disease

Breath-hold contrast material enhanced three-dimensional (3D) fast spoiled gradient-echo (FSPGR) sequences are valuable techniques for evaluation of renal arteries and veins and diagnosis of significant renal arterial stenosis at magnetic resonance (MR) imaging. The excellent spatial and contrast resolution with these techniques, combined with the ability to perform studies in multiple vascular phases, also make them attractive for the diagnosis of a wide range of nonvascular processes that affect the kidneys, including renal infections, renal parenchymal diseases, and renal trauma. Particularly when combined with T1- and T2-weighted MR imaging, the contrast-enhanced techniques are highly effective for characterization of renal masses owing to the ability to portray dynamic contrast enhancement. The ability to display venous structures with contrast-enhanced 3D FSPGR techniques helps staging of renal cell carcinoma. This article presents examples of the wide range of vascular and nonvascular renal diseases that may be effectively imaged with contrast material enhanced 3D FSPGR techniques and illustrates the usefulness of the techniques for renal MR imaging.

Quantitation of renal perfusion using arterial spin labeling with FAIR-UFLARE

Quantitative perfusion imaging of human kidneys was performed using arterial spin labeling MRI with a fast spin echo readout-sequence. Perfusion maps of centrally located single slices were obtained in axial and coronal orientations. In ten healthy volunteers, the mean value of perfusion was 213+/-55 mL/(100g min) with a range from 140 to 319 mL/(100g min). These results are in accordance with literature data, considering the fact that FAIR only measures the perfusion component normal to the imaging plane. Intra-individual reproducibility errors of +/-11% were smaller than the natural interindividual variability of renal perfusion (SD = +/- 25%). Perfusion in the cortex was approximately 3-4 times higher compared to the medulla. Considering the relatively high resolution of 2x2x10 mm3, the ability to quantify perfusion, and the lack of ionizing radiation and contrast media, this technique should prove useful in diagnosing renal pathologies that are associated with reductions in tissue perfusion.