1
|
Prasad PV, Li LP, Hack B, Leloudas N, Sprague SM. Quantitative Blood Oxygenation Level Dependent Magnetic Resonance Imaging for Estimating Intra-renal Oxygen Availability Demonstrates Kidneys Are Hypoxemic in Human CKD. Kidney Int Rep 2023; 8:1057-1067. [PMID: 37180507 PMCID: PMC10166744 DOI: 10.1016/j.ekir.2023.02.1092] [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: 12/30/2022] [Revised: 02/08/2023] [Accepted: 02/27/2023] [Indexed: 03/09/2023] Open
Abstract
Introduction Kidney blood oxygenation level dependent (BOLD) magnetic resonance imaging (MRI) has shown great promise in evaluating relative oxygen availability. This method is quite efficacious in evaluating acute responses to physiological and pharmacologic maneuvers. Its outcome parameter, R2∗ is defined as the apparent spin-spin relaxation rate measured in the presence of magnetic susceptibility differences and it is measured using gradient echo MRI. Although associations between R2∗ and renal function decline have been described, it remains uncertain to what extent R2∗ is a true reflection of tissue oxygenation. This is primarily because of not taking into account the confounding factors, especially fractional blood volume (fBV) in tissue. Methods This case-control study included 7 healthy controls and 6 patients with diabetes and chronic kidney disease (CKD). Using data before and after administration of ferumoxytol, a blood pool MRI contrast media, the fBVs in kidney cortex and medulla were measured. Results This pilot study independently measured fBV in kidney cortex (0.23 ± 0.03 vs. 0.17 ± 0.03) and medulla (0.36 ± 0.08 vs. 0.25 ± 0.03) in a small number of healthy controls (n = 7) versus CKD (n = 6). These were then combined with BOLD MRI measurements to estimate oxygen saturation of hemoglobin (StO2) (0.87 ± 0.03 vs. 0.72 ± 0.10 in cortex; 0.82 ± 0.05 vs. 0.72 ± 0.06 in medulla) and partial pressure of oxygen in blood (bloodPO2) (55.4 ± 6.5 vs. 38.4 ± 7.6 mm Hg in cortex; 48.4 ± 6.2 vs. 38.1 ± 4.5 mm Hg in medulla) in control versus CKD. The results for the first time demonstrate that cortex is normoxemic in controls and moderately hypoxemic in CKD. In the medulla, it is mildly hypoxemic in controls and moderately hypoxemic in CKD. Whereas fBV, StO2, and bloodPO2 were strongly associated with estimated glomerular filtration rate (eGFR), R2∗ was not. Conclusion Our results support the feasibility of quantitatively assessing oxygen availability using noninvasive quantitative BOLD MRI that could be translated to the clinic.
Collapse
Affiliation(s)
- Pottumarthi V. Prasad
- Department of Radiology, NorthShore University HealthSystem, Evanston, Illinois, USA
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Lu-Ping Li
- Department of Radiology, NorthShore University HealthSystem, Evanston, Illinois, USA
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Bradley Hack
- Department of Radiology, NorthShore University HealthSystem, Evanston, Illinois, USA
| | - Nondas Leloudas
- Department of Radiology, NorthShore University HealthSystem, Evanston, Illinois, USA
| | - Stuart M. Sprague
- Department of Medicine, NorthShore University HealthSystem, Evanston, Illinois, USA
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois, USA
| |
Collapse
|
2
|
Gursan A, Hendriks AD, Welting D, de Jong PA, Klomp DWJ, Prompers JJ. Deuterium body array for the simultaneous measurement of hepatic and renal glucose metabolism and gastric emptying with dynamic 3D deuterium metabolic imaging at 7 T. NMR IN BIOMEDICINE 2023:e4926. [PMID: 36929629 DOI: 10.1002/nbm.4926] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 02/23/2023] [Accepted: 02/24/2023] [Indexed: 06/18/2023]
Abstract
Deuterium metabolic imaging (DMI) is a novel noninvasive method to assess tissue metabolism and organ (patho)physiology in vivo using deuterated substrates, such as [6,6'-2 H2 ]-glucose. The liver and kidneys play a central role in whole-body glucose homeostasis, and in type 2 diabetes, both hepatic and renal glucose metabolism are dysregulated. Diabetes is also associated with gastric emptying abnormalities. In this study, we developed a four-channel 2 H transmit/receive body array coil for DMI in the human abdomen at 7 T and assessed its performance. In addition, the feasibility of simultaneously measuring gastric emptying, and hepatic and renal glucose uptake and metabolism with dynamic 3D DMI upon administration of deuterated glucose, was investigated. Simulated and measured B1 + patterns were in good agreement. The intrasession variability of the natural abundance deuterated water signal in the liver and right kidney, measured in nine healthy volunteers, was 5.6% ± 0.9% and 4.9% ± 0.7%, respectively. Dynamic 3D DMI scans with oral administration of [6,6'-2 H2 ]-glucose showed similar kinetics of deuterated glucose appearance and disappearance in the liver and kidney. The measured gastric emptying half time was 80 ± 10 min, which is in good agreement with scintigraphy measurements. In conclusion, DMI with oral administration of [6,6'-2 H2 ]-glucose enables simultaneous assessment of gastric emptying and liver and kidney glucose uptake and metabolism. When applied in patients with diabetes, this approach may advance our understanding of the interplay between disturbances in liver and kidney glucose uptake and metabolism and gastric emptying, at a detail that cannot be achieved by any other method.
Collapse
Affiliation(s)
- Ayhan Gursan
- Center for Image Sciences, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Arjan D Hendriks
- Center for Image Sciences, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Dimitri Welting
- Center for Image Sciences, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Pim A de Jong
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Dennis W J Klomp
- Center for Image Sciences, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jeanine J Prompers
- Center for Image Sciences, University Medical Center Utrecht, Utrecht, The Netherlands
| |
Collapse
|
3
|
Niendorf T, Seeliger E, Cantow K, Flemming B, Waiczies S, Pohlmann A. Probing renal blood volume with magnetic resonance imaging. Acta Physiol (Oxf) 2020; 228:e13435. [PMID: 31876349 DOI: 10.1111/apha.13435] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Revised: 12/18/2019] [Accepted: 12/19/2019] [Indexed: 02/06/2023]
Abstract
Damage to the kidney substantially reduces life expectancy. Renal tissue hypoperfusion and hypoxia are key elements in the pathophysiology of acute kidney injury and its progression to chronic kidney disease. In vivo assessment of renal haemodynamics and tissue oxygenation remains a challenge. Blood oxygenation level-dependent (BOLD) magnetic resonance imaging (MRI) is sensitive to changes in the effective transversal relaxation time (T2 *) in vivo, and is non-invasive and indicative of renal tissue oxygenation. However, the renal T2 * to tissue pO2 relationship is not governed exclusively by renal blood oxygenation, but is affected by physiological confounders with alterations in renal blood volume fraction (BVf) being of particular relevance. To decipher this interference probing renal BVf is essential for the pursuit of renal MR oximetry. Superparamagnetic iron oxide nanoparticle (USPIO) preparations can be used as MRI visible blood pool markers for detailing alterations in BVf. This review promotes the opportunities of MRI-based assessment of renal BVf. Following an outline on the specifics of renal oxygenation and perfusion, changes in renal BVf upon interventions and their potential impact on renal T2 * are discussed. We also describe the basic principles of renal BVf assessment using ferumoxytol-enhanced MRI in the equilibrium concentration regimen. We demonstrate that ferumoxytol does not alter control of renal haemodynamics and oxygenation. Preclinical applications of ferumoxytol enhanced renal MRI as well as considerations for its clinical implementation for examining renal BVf changes are provided alongside practical considerations. Finally, we explore the future directions of MRI-based assessment of renal BVf.
Collapse
Affiliation(s)
- Thoralf Niendorf
- Berlin Ultrahigh Field Facility (B.U.F.F.) Max Delbrück Center for Molecular Medicine in the Helmholtz Association Berlin Germany
| | - Erdmann Seeliger
- Institute of Physiology Charité – Universitätsmedizin Berlin Campus Mitte, and Center for Cardiovascular Research (CCR) Berlin Germany
| | - Kathleen Cantow
- Institute of Physiology Charité – Universitätsmedizin Berlin Campus Mitte, and Center for Cardiovascular Research (CCR) Berlin Germany
| | - Bert Flemming
- Institute of Physiology Charité – Universitätsmedizin Berlin Campus Mitte, and Center for Cardiovascular Research (CCR) Berlin Germany
| | - Sonia Waiczies
- Berlin Ultrahigh Field Facility (B.U.F.F.) Max Delbrück Center for Molecular Medicine in the Helmholtz Association Berlin Germany
| | - Andreas Pohlmann
- Berlin Ultrahigh Field Facility (B.U.F.F.) Max Delbrück Center for Molecular Medicine in the Helmholtz Association Berlin Germany
| |
Collapse
|
4
|
Haddock B, Larsson HBW, Francis S, Andersen UB. Human renal response to furosemide: Simultaneous oxygenation and perfusion measurements in cortex and medulla. Acta Physiol (Oxf) 2019; 227:e13292. [PMID: 31046189 PMCID: PMC6767552 DOI: 10.1111/apha.13292] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 04/27/2019] [Accepted: 04/29/2019] [Indexed: 12/11/2022]
Abstract
Aim Disturbances of renal medullary perfusion and metabolism have been implicated in the pathogenesis of kidney disease and hypertension. Furosemide, a loop diuretic, is widely used to prevent renal medullary hypoxia in acute kidney disease by uncoupling sodium metabolism, but its effects on medullary perfusion in humans are unknown. We performed quantitative imaging of both renal perfusion and oxygenation using Magnetic Resonance Imaging (MRI) before and during furosemide. Based on the literature, we hypothesized that furosemide would increase medullary oxygenation, decrease medullary perfusion, but cause minor changes (<10%) in renal artery flow (RAF). Methods Interleaved measurements of RAF, oxygenation (T2*) and perfusion by arterial spin labelling in the renal cortex and medulla of 9 healthy subjects were acquired before and after an injection of 20 mg furosemide. They were preceded by measurements made during isometric exercise (5 minutes handgrip bouts), which are known to induce changes in renal hemodynamics, that served as a control for the sensitivity of the hemodynamic MRI measurements. Experiments were repeated on a second day to establish that the measurements and the induced changes were reproducible. Results After furosemide, T2* values in the medulla increased by 53% (P < 0.01) while RAF and perfusion remained constant. After hand‐grip exercise, T2* values in renal medulla increased by 22% ± 9% despite a drop in medullary perfusion of 7.2% ± 4.7% and a decrease in renal arterial flow of 17.5% ± 1.7% (P < 0.05). Mean coefficients of variation between repeated measurements for all parameters were 7%. Conclusion Furosemide induced the anticipated increase in renal medullary oxygenation, attributable exclusively to a decrease in renal oxygen consumption, since no change of RAF, cortical or medullary perfusion could be demonstrated. All measures and the induced changes were reproducible.
Collapse
Affiliation(s)
- Bryan Haddock
- Department of Clinical Physiology, Nuclear Medicine & PET Rigshospitalet, Copenhagen University Hospital Glostrup Denmark
| | - Henrik B. W. Larsson
- Department of Clinical Physiology, Nuclear Medicine & PET Rigshospitalet, Copenhagen University Hospital Glostrup Denmark
| | - Susan Francis
- Sir Peter Mansfield Magnetic Resonance Centre School of Physics and Astronomy University of Nottingham Nottingham UK
| | - Ulrik B. Andersen
- Department of Clinical Physiology, Nuclear Medicine & PET Rigshospitalet, Copenhagen University Hospital Glostrup Denmark
| |
Collapse
|
5
|
Morell A, Lennmyr F, Jonsson O, Tovedal T, Pettersson J, Bergquist J, Zemgulis V, Einarsson GM, Thelin S, Ahlström H, Bjørnerud A. Influence of blood/tissue differences in contrast agent relaxivity on tracer-based MR perfusion measurements. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2014; 28:135-47. [PMID: 24973020 DOI: 10.1007/s10334-014-0452-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Revised: 05/19/2014] [Accepted: 05/27/2014] [Indexed: 11/25/2022]
Abstract
PURPOSE Perfusion assessment by monitoring the transport of a tracer bolus depends critically on conversion of signal intensity into tracer concentration. Two main assumptions are generally applied for this conversion; (1) contrast agent relaxivity is identical in blood and tissue, (2) change in signal intensity depends only on the primary relaxation effect. The purpose of the study was to assess the validity and influence of these assumptions. MATERIALS AND METHODS Blood and cerebral tissue relaxivities r1, r2, and r2* for gadodiamide were measured in four pigs at 1.5 T. Gadolinium concentration was determined by inductively coupled plasma atomic emission spectroscopy. Influence of the relaxivities, secondary relaxation effects and choice of singular value decomposition (SVD) regularization threshold was studied by simulations. RESULTS In vivo relaxivities relative to blood concentration [in s(-1) mM(-1) for blood, gray matter (GM), white matter (WM)] were for r1 (2.614 ± 1.061, 0.010 ± 0.001, 0.004 ± 0.002), r2 (5.088 ± 0.952, 0.091 ± 0.008, 0.059 ± 0.014), and r2* (13.292 ± 3.928, 1.696 ± 0.157, 0.910 ± 0.139). Although substantial, by a nonparametric test for paired samples, the differences were not statistically significant. The GM to WM blood volume ratio was estimated to 2.6 ± 0.9 by r1, 1.6 ± 0.3 by r2, and 1.9 ± 0.2 by r2*. Secondary relaxation was found to reduce the tissue blood flow, as did the SVD regularization threshold. CONCLUSION Contrast agent relaxivity is not identical in blood and tissue leading to substantial errors. Further errors are introduced by secondary relaxation effects and the SVD regularization.
Collapse
Affiliation(s)
- Arvid Morell
- Section of Radiology, Department of Radiology, Oncology and Radiation Sciences, Uppsala University, Uppsala, Sweden,
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
6
|
Cuenod C, Balvay D. Perfusion and vascular permeability: Basic concepts and measurement in DCE-CT and DCE-MRI. Diagn Interv Imaging 2013; 94:1187-204. [DOI: 10.1016/j.diii.2013.10.010] [Citation(s) in RCA: 138] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
|
7
|
He X, Aghayev A, Gumus S, Ty Bae K. Estimation of single-kidney glomerular filtration rate without exogenous contrast agent. Magn Reson Med 2013; 71:257-66. [PMID: 23468406 DOI: 10.1002/mrm.24668] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Revised: 01/07/2013] [Accepted: 01/10/2013] [Indexed: 11/06/2022]
Abstract
PURPOSE Measurement of single-kidney filtration fraction and glomerular filtration rate (GFR) without exogenous contrast is clinically important to assess renal function and pathophysiology, especially for patients with comprised renal function. The objective of this study is to develop a novel MR-based tool for noninvasive quantification of renal function using conventional MR arterial spin labeling water as endogenous tracer. THEORY AND METHODS The regional differentiation of the arterial spin labeling water between the glomerular capsular space and the renal parenchyma was characterized and measured according to their MR relaxation properties (T1ρ or T2 ), and applied to the estimation of filtration fraction and single-kidney GFR. The proposed approach was tested to quantify GFR in healthy volunteers at baseline and after a protein-loading challenge. RESULTS Biexponential decay of the cortical arterial spin labeling water MR signal was observed. The major component decays the same as parenchyma water; the minor component decays much slower as expected from glomerular ultra-filtrates. The mean single-kidney GFR was estimated to be 49 ± 9 mL/min at baseline and increased by 28% after a protein-loading challenge. CONCLUSION We developed an arterial spin labeling-based MR imaging method that allows us to estimate renal filtration fraction and singe-kidney GFR without use of exogenous contrast.
Collapse
Affiliation(s)
- Xiang He
- Department of Radiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | | | | |
Collapse
|
8
|
|
9
|
Sourbron S. Technical aspects of MR perfusion. Eur J Radiol 2010; 76:304-13. [PMID: 20363574 DOI: 10.1016/j.ejrad.2010.02.017] [Citation(s) in RCA: 91] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2010] [Accepted: 02/23/2010] [Indexed: 12/15/2022]
Abstract
The most common methods for measuring perfusion with MRI are arterial spin labelling (ASL), dynamic susceptibility contrast (DSC-MRI), and T(1)-weighted dynamic contrast enhancement (DCE-MRI). This review focuses on the latter approach, which is by far the most common in the body and produces measures of capillary permeability as well. The aim is to present a concise but complete overview of the technical issues involved in DCE-MRI data acquisition and analysis. For details the reader is referred to the references. The presentation of the topic is essentially generic and focuses on technical aspects that are common to all DCE-MRI measurements. For organ-specific problems and illustrations, we refer to the other papers in this issue. In Section 1 "Theory" the basic quantities are defined, and the physical mechanisms are presented that provide a relation between the hemodynamic parameters and the DCE-MRI signal. Section 2 "Data acquisition" discusses the issues involved in the design of an optimal measurement protocol. Section 3 "Data analysis" summarizes the steps that need to be taken to determine the hemodynamic parameters from the measured data.
Collapse
Affiliation(s)
- Steven Sourbron
- Division of Medical Physics, University of Leeds, Worsley Building, Clarendon Way, LS2 9JT Leeds, UK.
| |
Collapse
|
10
|
Pedersen M, Laustsen C, Perot V, Basseau F, Moonen C, Grenier N. Renal hemodynamics and oxygenation in transient renal artery occluded rats evaluated with iron-oxide particles and oxygenation-sensitive imaging. Z Med Phys 2010; 20:134-42. [PMID: 20540904 DOI: 10.1016/j.zemedi.2010.02.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2009] [Revised: 01/20/2010] [Accepted: 02/24/2010] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Mild or severe renal arterial occlusion is a phenomenon occasionally observed in daily clinical practice, potentially leading to renal ischemia and a general impairment of renal function. Secondly, closing the blood flow to the kidneys can also occur during kidney transplantation procedures. However, the exact physiological effects of these conditions on renal blood perfusion as well as the renal oxygen handling are poorly understood. The objectives of this study were therefore to measure the lateral changes of renal blood perfusion in rats subjected to transient unilateral arterial occlusion (RAS), and in addition, to measure the consequences on the intrarenal oxygenation. METHODS Experimental studies were performed using sixteen adolescent rats. The left renal artery was exposed through a flank incision and acute RAS for 45 min was achieved by placing a ligature around the renal artery. MRI was performed 3 days after the surgical procedure, where a blood oxygenation sensitive sequence (BOLD MRI) was performed, followed by a perfusion-weighted imaging sequence using a single bolus of the iron-oxide nanoparticle Sinerem. The renal oxygenation of blood was indirectly measured by the BOLD-parameter R2*, and perfusion measures include relative renal blood flow, relative renal blood volume and mean transit time. Histopathologic changes through the outer stripe of the outer medulla showing typical histopathologic findings of ischemia. DISCUSSION This study demonstrated that rats with transient renal arterial stenosis (for 45 min) showed a reduction in intrarenal oxygenation and intrarenal blood flow three days after the surgical procedure. A decreased R2* was measured within the ipsilateral medulla in parallel with a decreased medullary blood flow, is probably related to a lower reabsorption load within the ipsilateral kidney. MRI may therefore be a promising tool in long-term evaluation of RAS.
Collapse
Affiliation(s)
- Michael Pedersen
- MR Research Centre, Aarhus University Hospital, Aarhus, Denmark.
| | | | | | | | | | | |
Collapse
|