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De Mul A, Schleef M, Filler G, McIntyre C, Lemoine S. In vivo assessment of pediatric kidney function using multi-parametric and multi-nuclear functional magnetic resonance imaging: challenges, perspectives, and clinical applications. Pediatr Nephrol 2025; 40:1539-1548. [PMID: 39556211 PMCID: PMC11946951 DOI: 10.1007/s00467-024-06560-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 10/09/2024] [Accepted: 10/09/2024] [Indexed: 11/19/2024]
Abstract
The conventional methods for assessing kidney function, such as glomerular filtration rate and microalbuminuria, provide only partial insight into kidney function. Multi-parametric and multi-nuclear functional resonance magnetic imaging (MRI) techniques are innovative approaches to unraveling kidney physiology. Multi-parametric MRI includes various sequences to evaluate kidney perfusion, tissue oxygenation, and microstructure characterization, including fibrosis-a key pathological event in acute and chronic kidney disease and in transplant patients-without the need for invasive kidney biopsy. Multi-nuclear MRI detects nuclei other than protons. 23Na MRI enables visualization of the corticomedullary gradient and assessment of tissue sodium storage, which can be particularly relevant for personalized medicine in salt-wasting tubular disorders. Meanwhile, 31P-MRS measures intracellular phosphate and ATP variations, providing insights into oxidative metabolism in the muscle during exercise and recovery. This technique can be useful for detecting subclinical ischemia in chronic kidney disease and in tubulopathies with kidney phosphate wasting. These techniques are non-invasive and do not involve radiation exposure, making them especially suitable for longitudinal and serial assessments. They enable in vivo evaluation of kidney function on a whole-organ basis within a short acquisition time and with the ability to distinguish between medullary and cortical compartments. Therefore, they offer considerable potential for pediatric patients. In this review, we provide a brief overview of the main imaging techniques, summarize available literature data on both adult and pediatric populations, and examine the perspectives and challenges associated with multi-parametric and multi-nuclear MRI.
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Affiliation(s)
- Aurélie De Mul
- Service de Néphrologie Et d'exploration Fonctionnelle Rénale, Hôpital Édouard-Herriot, Hospices Civils de Lyon, Lyon, France.
- Université, Lyon 1, Lyon, France.
- Centre de Référence Des Maladies Rares du Calcium Et du Phosphore, Centre de Référence Des Maladies Rénales Rares, Filières de Santé Maladies Rares OSCAR, ORKID Et ERKNet, Lyon, France.
| | - Maxime Schleef
- Service de Néphrologie Et d'exploration Fonctionnelle Rénale, Hôpital Édouard-Herriot, Hospices Civils de Lyon, Lyon, France
- Université, Lyon 1, Lyon, France
- Centre de Référence Des Maladies Rares du Calcium Et du Phosphore, Centre de Référence Des Maladies Rénales Rares, Filières de Santé Maladies Rares OSCAR, ORKID Et ERKNet, Lyon, France
| | - Guido Filler
- Department of Paediatrics (Division of Nephrology) and Medicine (Division of Nephrology), Western University, and London Health Sciences Centre, London, ON, Canada
- The Lilibeth Caberto Kidney Clinical Research Unit, London Health Sciences Centre, London, ON, Canada
| | - Christopher McIntyre
- Department of Paediatrics (Division of Nephrology) and Medicine (Division of Nephrology), Western University, and London Health Sciences Centre, London, ON, Canada
- The Lilibeth Caberto Kidney Clinical Research Unit, London Health Sciences Centre, London, ON, Canada
- Department of Biophysics, Western University, and London Health Sciences Centre, London, ON, Canada
| | - Sandrine Lemoine
- Service de Néphrologie Et d'exploration Fonctionnelle Rénale, Hôpital Édouard-Herriot, Hospices Civils de Lyon, Lyon, France
- Université, Lyon 1, Lyon, France
- Centre de Référence Des Maladies Rares du Calcium Et du Phosphore, Centre de Référence Des Maladies Rénales Rares, Filières de Santé Maladies Rares OSCAR, ORKID Et ERKNet, Lyon, France
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El-Ksas M, El-Metwally D, Fahmy D, Shebel H. Early and late assessment of renal allograft dysfunction using intravoxel incoherent motion (IVIM) and diffusion-weighted imaging (DWI): a prospective study. Abdom Radiol (NY) 2024; 49:3902-3912. [PMID: 38976056 PMCID: PMC11519223 DOI: 10.1007/s00261-024-04470-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Revised: 06/19/2024] [Accepted: 06/20/2024] [Indexed: 07/09/2024]
Abstract
PURPOSE To evaluate the ability of the Intravoxel Incoherent Motion (IVIM) and monoexponentially ADC in renal allograft function in the early and late phases of transplantation, and to predict their effectiveness in discrimination of the graft pathology. METHODS This is a prospective study included participants scanned with quantitative diffusion and perfusion sequences on a 3-T MR scanner (Philips, Ingenia); the ADC and IVIM parameters; were calculated. Correlations and regression analysis with the eGFR, transplantation periods, and pathology were assessed. RESULTS This study included 105 renal allograft recipients (85 males, and 20 females with mean age = 32.4 ± 11.9 years and age range = 22-61 years). There was a significant positive correlation between the whole parameters of the ADC and IVIM with eGFR however, the cortical parameters showed higher significant correlation coefficients (p < 0.001). Regression analysis revealed the most significant model can predict eGFR groups included cortical pseudo diffusion (D*) and cortical ADC (p < 0.001). In graft dysfunction eGFR was 61.5 ml/min and normal graft was 64 ml/min. This model demonstrates a high performance of an AUC 96% [0.93-0.97]. In the late transplantation, there is a higher correlation with D* compared to ADC, p-values = 0.001. CONCLUSION IVIM and ADC Values are significant biomarkers for renal allograft function assessment, cortical ADC, and D* had the highest performance even in situations with mild impairment that is not affect the eGFR yet as cases of proteinuria with normal eGFR. Furthermore, D* is superior to ADC in the late assessment of the renal transplant.
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Affiliation(s)
- Mostafa El-Ksas
- Radiology Department, Urology and Nephrology Center, Mansoura University, El Gomhoureya St, Mansoura, Egypt
| | | | - Dalia Fahmy
- Radiology Department, Mansoura University, Mansoura, Egypt
| | - Haytham Shebel
- Radiology Department, Urology and Nephrology Center, Mansoura University, El Gomhoureya St, Mansoura, Egypt.
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Wittsack HJ, Thiel TA, Valentin B, Stabinska J, Benkert T, Schimmöller L, Antoch G, Ljimani A. Presentation of microstructural diffusion components by color schemes in abdominal organs. Magn Reson Med 2024; 92:2074-2080. [PMID: 38852176 DOI: 10.1002/mrm.30183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 04/24/2024] [Accepted: 05/17/2024] [Indexed: 06/11/2024]
Abstract
PURPOSE Development of a color scheme representation to facilitate the interpretation of tri-exponential DWI data from abdominal organs, where multi-exponential behavior is more pronounced. METHODS Multi-exponential analysis of DWI data provides information about the microstructure of the tissue under study. The tri-exponential signal analysis generates numerous parameter images that are difficult to analyze individually. Summarized color images can simplify at-a-glance analysis. A color scheme was developed in which the slow, intermediate, and fast diffusion components were each assigned to a different red, green, and blue color channel. To improve the appearance of the image, histogram equalization, gamma correction, and white balance were used, and the processing parameters were adjusted. Examples of the resulting color maps of the diffusion fractions of healthy and pathological kidney and prostate are shown. RESULTS The color maps obtained by the presented method show the merged information of the slow, intermediate, and fast diffusion components in a single view. A differentiation of the different fractions becomes clearly visible. Fast diffusion regimes, such as in the renal hilus, can be clearly distinguished from slow fractions, such as in dense tumor tissue. CONCLUSION Combining the diffusion information from tri-exponential DWI analysis into a single color image allows for simplified interpretation of the diffusion fractions. In the future, such color images may provide additional information about the microstructural nature of the tissue under study.
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Affiliation(s)
- Hans-Jörg Wittsack
- Department of Diagnostic and Interventional Radiology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Thomas Andreas Thiel
- Department of Diagnostic and Interventional Radiology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Birte Valentin
- Department of Diagnostic and Interventional Radiology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Julia Stabinska
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Maryland, USA
| | - Thomas Benkert
- MR Applications Predevelopment, Siemens Healthineers AG, Forchheim, Germany
| | - Lars Schimmöller
- Department of Diagnostic and Interventional Radiology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
- Department of Diagnostic, Interventional Radiology and Nuclear Medicine, Marien Hospital Herne, University Hospital of the Ruhr-University Bochum, Herne, Germany
| | - Gerald Antoch
- Department of Diagnostic and Interventional Radiology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Alexandra Ljimani
- Department of Diagnostic and Interventional Radiology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
- Center for Integrated Oncology (CIO Aachen, Bonn, Cologne, Duesseldorf), Aachen, Bonn, Cologne, Düsseldorf, Germany
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Bane O, Seeliger E, Cox E, Stabinska J, Bechler E, Lewis S, Hickson LJ, Francis S, Sigmund E, Niendorf T. Renal MRI: From Nephron to NMR Signal. J Magn Reson Imaging 2023; 58:1660-1679. [PMID: 37243378 PMCID: PMC11025392 DOI: 10.1002/jmri.28828] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 05/11/2023] [Accepted: 05/12/2023] [Indexed: 05/28/2023] Open
Abstract
Renal diseases pose a significant socio-economic burden on healthcare systems. The development of better diagnostics and prognostics is well-recognized as a key strategy to resolve these challenges. Central to these developments are MRI biomarkers, due to their potential for monitoring of early pathophysiological changes, renal disease progression or treatment effects. The surge in renal MRI involves major cross-domain initiatives, large clinical studies, and educational programs. In parallel with these translational efforts, the need for greater (patho)physiological specificity remains, to enable engagement with clinical nephrologists and increase the associated health impact. The ISMRM 2022 Member Initiated Symposium (MIS) on renal MRI spotlighted this issue with the goal of inspiring more solutions from the ISMRM community. This work is a summary of the MIS presentations devoted to: 1) educating imaging scientists and clinicians on renal (patho)physiology and demands from clinical nephrologists, 2) elucidating the connection of MRI parameters with renal physiology, 3) presenting the current state of leading MR surrogates in assessing renal structure and functions as well as their next generation of innovation, and 4) describing the potential of these imaging markers for providing clinically meaningful renal characterization to guide or supplement clinical decision making. We hope to continue momentum of recent years and introduce new entrants to the development process, connecting (patho)physiology with (bio)physics, and conceiving new clinical applications. We envision this process to benefit from cross-disciplinary collaboration and analogous efforts in other body organs, but also to maximally leverage the unique opportunities of renal physiology. LEVEL OF EVIDENCE: 1 TECHNICAL EFFICACY STAGE: 2.
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Affiliation(s)
- Octavia Bane
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
- Icahn School of Medicine at Mount Sinai, BioMedical Engineering and Imaging Institute, New York City, New York, USA
| | - Erdmann Seeliger
- Institute of Translational Physiology, Charité-University Medicine Berlin, Berlin, Germany
| | - Eleanor Cox
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, UK
| | - Julia Stabinska
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Maryland, USA
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Eric Bechler
- Department of Diagnostic and Interventional Radiology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Sara Lewis
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - LaTonya J Hickson
- Division of Nephrology and Hypertension, Mayo Clinic, Jacksonville, Florida, USA
| | - Sue Francis
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, UK
| | - Eric Sigmund
- Bernard and Irene Schwartz Center for Biomedical Imaging Center for Advanced Imaging Innovation and Research (CAI2R), New York University Langone Health, New York City, New York, USA
| | - Thoralf Niendorf
- Berlin Ultrahigh Field Facility (B.U.F.F.), Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany
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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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Stabinska J, Zöllner HJ, Thiel TA, Wittsack HJ, Ljimani A. Image downsampling expedited adaptive least-squares (IDEAL) fitting improves intravoxel incoherent motion (IVIM) analysis in the human kidney. Magn Reson Med 2023; 89:1055-1067. [PMID: 36416075 DOI: 10.1002/mrm.29517] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 10/13/2022] [Accepted: 10/14/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE To improve the reliability of intravoxel incoherent motion (IVIM) model parameter estimation for the DWI in the kidney using a novel image downsampling expedited adaptive least-squares (IDEAL) approach. METHODS The robustness of IDEAL was investigated using simulated DW-MRI data corrupted with different levels of Rician noise. Subsequently, the performance of the proposed method was tested by fitting bi- and triexponential IVIM model to in vivo renal DWI data acquired on a clinical 3 Tesla MRI scanner and compared to conventional approaches (fixed D* and segmented fitting). RESULTS The numerical simulations demonstrated that the IDEAL algorithm provides robust estimates of the IVIM parameters in the presence of noise (SNR of 20) as indicated by relatively low absolute percentage bias (maximal sMdPB <20%) and normalized RMSE (maximal RMSE <28%). The analysis of the in vivo data showed that the IDEAL-based IVIM parameter maps were less noisy and more visually appealing than those obtained using the fixed D* and segmented methods. Further, coefficients of variation for nearly all IVIM parameters were significantly reduced in cortex and medulla for IDEAL-based biexponential (coefficients of variation: 4%-50%) and triexponential (coefficients of variation: 7.5%-75%) IVIM modelling compared to the segmented (coefficients of variation: 4%-120%) and fixed D* (coefficients of variation: 17%-174%) methods, reflecting greater accuracy of this method. CONCLUSION The proposed fitting algorithm yields more robust IVIM parameter estimates and is less susceptible to poor SNR than the conventional fitting approaches. Thus, the IDEAL approach has the potential to improve the reliability of renal DW-MRI analysis for clinical applications.
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Affiliation(s)
- Julia Stabinska
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, 21205, USA
- Division of MR Research, The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA
- Department of Diagnostic and Interventional Radiology, Medical Faculty, Heinrich-Heine University Dusseldorf, Düsseldorf, Germany
| | - Helge J Zöllner
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, 21205, USA
- Division of MR Research, The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA
| | - Thomas A Thiel
- Department of Diagnostic and Interventional Radiology, Medical Faculty, Heinrich-Heine University Dusseldorf, Düsseldorf, Germany
| | - Hans-Jörg Wittsack
- Department of Diagnostic and Interventional Radiology, Medical Faculty, Heinrich-Heine University Dusseldorf, Düsseldorf, Germany
| | - Alexandra Ljimani
- Department of Diagnostic and Interventional Radiology, Medical Faculty, Heinrich-Heine University Dusseldorf, Düsseldorf, Germany
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Liu W, Liu H, Xie S, Masokano IB, Bai Y, Wang X, Zhong L, Wu Y, Nie J, Zhou G, Pei Y, Li W. Comparing the clinical utility of single-shot, readout-segmented and zoomit echo-planar imaging in diffusion-weighted imaging of the kidney at 3 T. Sci Rep 2022; 12:12389. [PMID: 35859112 PMCID: PMC9300617 DOI: 10.1038/s41598-022-16670-w] [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: 01/09/2022] [Accepted: 07/13/2022] [Indexed: 12/04/2022] Open
Abstract
We compared the clinical utility of single-shot echo-planar imaging (SS-EPI) using different breathing schemes, readout-segmented EPI and zoomit EPI in the repeatability of apparent diffusion coefficient (ADC) measurements, cortico-medullary contrast to noise ratio (c-mCNR) and image quality. In this institutional review board-approved prospective study, some common clinically applicable diffusion-weighted imaging (b = 50, 400, 800 s/mm2) of kidney on 3.0 T MRI were performed on 22 volunteers using SS-EPI with breath-hold diffusion-weighted imaging (BH-DWI), free-breathing (FB-DWI), navigator-triggered (NT-DWI) and respiratory-triggered (RT-DWI), readout-segmented DWI (RS-DWI), and Zoomit DWI (Z-DWI). ADC and c-mCNR were measured in 12 anatomic locations (the upper, middle, and lower pole of the renal cortex and medulla), and image quality was assessed on these DWI sequences. A DWI with the optimal clinical utility was decided by systematically assessing the ADC repeatability, c-mCNR and image quality among the DWIs. For ADC measurements, Z-DWI had an excellent intra-observer agreement (intra-class correlation coefficients (ICCs): 0.876–0.944) and good inter-observer agreement (inter-class ICCs: 0.798–0.856) in six DWI sequences. Z-DWI had the highest ADC repeatability in most of the 12 anatomic locations of the kidneys (mean ADC absolute difference: 0.070–0.111 × 10−3 mm2/s, limit of agreement: 0.031–0.056 × 10−3 mm2/s). In all DWIs, Z-DWI yielded a slightly higher c-mCNR than other DWIs in most representative locations (P > 0.05), which was significantly higher than BH-DWI and FB-DWI in the middle pole of both kidneys and the upper pole of the left kidney (P < 0.05). In addition, Z-DWI yielded image quality that was similar to RT-DWI and NT-DWI (P > 0.05) and superior to BH-DWI, FB-DWI and RS-DWI (P < 0.05). Our results suggest that Z-DWI provides the highest ADC reproducibility, better c-mCNR and good image quality on 3.0 T MRI, making it the recommended sequence for clinical DWI of the kidney.
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Affiliation(s)
- Wenguang Liu
- Department of Radiology, Xiangya Hospital, Central South University, No. 87 Xiangya Rd., Kai Fu District, Changsha, 410008, Hunan, People's Republic of China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, People's Republic of China
| | - Hui Liu
- Department of Radiology, Xiangya Hospital, Central South University, No. 87 Xiangya Rd., Kai Fu District, Changsha, 410008, Hunan, People's Republic of China
| | - Simin Xie
- Department of Radiology, Xiangya Hospital, Central South University, No. 87 Xiangya Rd., Kai Fu District, Changsha, 410008, Hunan, People's Republic of China
| | - Ismail Bilal Masokano
- Department of Radiology, The Third Xiangya Hospital, Central South University, Changsha, 410013, Hunan, People's Republic of China
| | - Yu Bai
- Department of Radiology, Xiangya Hospital, Central South University, No. 87 Xiangya Rd., Kai Fu District, Changsha, 410008, Hunan, People's Republic of China
| | - Xiao Wang
- Department of Radiology, Xiangya Hospital, Central South University, No. 87 Xiangya Rd., Kai Fu District, Changsha, 410008, Hunan, People's Republic of China
| | - Linhui Zhong
- Department of Radiology, Xiangya Hospital, Central South University, No. 87 Xiangya Rd., Kai Fu District, Changsha, 410008, Hunan, People's Republic of China
| | - Yi Wu
- Department of Radiology, Xiangya Hospital, Central South University, No. 87 Xiangya Rd., Kai Fu District, Changsha, 410008, Hunan, People's Republic of China
| | - Jilin Nie
- Department of Radiology, Xiangya Hospital, Central South University, No. 87 Xiangya Rd., Kai Fu District, Changsha, 410008, Hunan, People's Republic of China
| | - Gaofeng Zhou
- Department of Radiology, Xiangya Hospital, Central South University, No. 87 Xiangya Rd., Kai Fu District, Changsha, 410008, Hunan, People's Republic of China
| | - Yigang Pei
- Department of Radiology, Xiangya Hospital, Central South University, No. 87 Xiangya Rd., Kai Fu District, Changsha, 410008, Hunan, People's Republic of China. .,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, People's Republic of China.
| | - Wenzheng Li
- Department of Radiology, Xiangya Hospital, Central South University, No. 87 Xiangya Rd., Kai Fu District, Changsha, 410008, Hunan, People's Republic of China. .,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, People's Republic of China.
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Liu Q, Xu Z, Zhao K, Hoge WS, Zhang X, Mei Y, Lu Q, Niendorf T, Feng Y. Diffusion-weighted magnetic resonance imaging in rat kidney using two-dimensional navigated, interleaved echo-planar imaging at 7.0 T. NMR IN BIOMEDICINE 2022; 35:e4652. [PMID: 34820933 DOI: 10.1002/nbm.4652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 10/29/2021] [Accepted: 10/30/2021] [Indexed: 06/13/2023]
Abstract
The purpose of this study was to investigate the feasibility of two-dimensional (2D) navigated, interleaved multishot echo-planar imaging (EPI) to enhance kidney diffusion-weighted imaging (DWI) in rats at 7.0 T. Fully sampled interleaved four-shot EPI with 2D navigators was tailored for kidney DWI (Sprague-Dawley rats, n = 7) on a 7.0-T small bore preclinical scanner. The image quality of four-shot EPI was compared with T2 -weighted rapid acquisition with relaxation enhancement (RARE) (reference) and single-shot EPI (ss-EPI) without and with parallel imaging (PI). The contrast-to-noise ratio (CNR) was examined to assess the image quality for the EPI approaches. The Dice similarity coefficient and the Hausdorff distance were used for evaluation of image distortion. Mean diffusivity (MD) and fractional anisotropy (FA) were calculated for renal cortex and medulla for all DWI approaches. The corticomedullary difference of MD and FA were assessed by Wilcoxon signed-rank test. Four-shot EPI showed the highest CNR among the three EPI variants and lowest geometric distortion versus T2 -weighted RARE (mean Dice: 0.77 for ss-EPI without PI, 0.88 for ss-EPI with twofold undersampling, and 0.92 for four-shot EPI). The FA map derived from four-shot EPI clearly identified a highly anisotropic region corresponding to the inner stripe of the outer medulla. Four-shot EPI successfully discerned differences in both MD and FA between renal cortex and medulla. In conclusion, 2D navigated, interleaved multishot EPI facilitates high-quality rat kidney DWI with clearly depicted intralayer and interlayer structure and substantially reduced image distortion. This approach enables the anatomic integrity of DWI-MRI in small rodents and has the potential to benefit the characterization of renal microstructure in preclinical studies.
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Affiliation(s)
- Qiang Liu
- School of Biomedical Engineering, Southern Medical University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Medical Image Processing & Guangdong Province Engineering Laboratory for Medical Imaging and Diagnostic Technology, Southern Medical University, Guangzhou, China
- Guangdong-Hong Kong-Macao Greater Bay Area Center for Brain Science and Brain-Inspired Intelligence & Key Laboratory of Mental Health of the Ministry of Education, Southern Medical University, Guangzhou, China
| | - Zhongbiao Xu
- Department of Radiation Oncology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Kaixuan Zhao
- School of Biomedical Engineering, Southern Medical University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Medical Image Processing & Guangdong Province Engineering Laboratory for Medical Imaging and Diagnostic Technology, Southern Medical University, Guangzhou, China
- Guangdong-Hong Kong-Macao Greater Bay Area Center for Brain Science and Brain-Inspired Intelligence & Key Laboratory of Mental Health of the Ministry of Education, Southern Medical University, Guangzhou, China
| | - W Scott Hoge
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Radiology, Harvard Medical School, Boston, Massachusetts, USA
| | - Xinyuan Zhang
- School of Biomedical Engineering, Southern Medical University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Medical Image Processing & Guangdong Province Engineering Laboratory for Medical Imaging and Diagnostic Technology, Southern Medical University, Guangzhou, China
- Guangdong-Hong Kong-Macao Greater Bay Area Center for Brain Science and Brain-Inspired Intelligence & Key Laboratory of Mental Health of the Ministry of Education, Southern Medical University, Guangzhou, China
| | - Yingjie Mei
- School of Biomedical Engineering, Southern Medical University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Medical Image Processing & Guangdong Province Engineering Laboratory for Medical Imaging and Diagnostic Technology, Southern Medical University, Guangzhou, China
- Guangdong-Hong Kong-Macao Greater Bay Area Center for Brain Science and Brain-Inspired Intelligence & Key Laboratory of Mental Health of the Ministry of Education, Southern Medical University, Guangzhou, China
| | - Qiqi Lu
- School of Biomedical Engineering, Southern Medical University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Medical Image Processing & Guangdong Province Engineering Laboratory for Medical Imaging and Diagnostic Technology, Southern Medical University, Guangzhou, China
- Guangdong-Hong Kong-Macao Greater Bay Area Center for Brain Science and Brain-Inspired Intelligence & Key Laboratory of Mental Health of the Ministry of Education, Southern Medical University, Guangzhou, China
| | - Thoralf Niendorf
- Berlin Ultrahigh Field Facility (B.U.F.F.), Max Delbrueck Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany
| | - Yanqiu Feng
- School of Biomedical Engineering, Southern Medical University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Medical Image Processing & Guangdong Province Engineering Laboratory for Medical Imaging and Diagnostic Technology, Southern Medical University, Guangzhou, China
- Guangdong-Hong Kong-Macao Greater Bay Area Center for Brain Science and Brain-Inspired Intelligence & Key Laboratory of Mental Health of the Ministry of Education, Southern Medical University, Guangzhou, China
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9
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Stabinska J, Ljimani A, Zöllner HJ, Wilken E, Benkert T, Limberg J, Esposito I, Antoch G, Wittsack HJ. Spectral diffusion analysis of kidney intravoxel incoherent motion MRI in healthy volunteers and patients with renal pathologies. Magn Reson Med 2021; 85:3085-3095. [PMID: 33462838 DOI: 10.1002/mrm.28631] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 10/22/2020] [Accepted: 11/12/2020] [Indexed: 12/12/2022]
Abstract
PURPOSE To assess the feasibility of measuring tubular and vascular signal fractions in the human kidney using nonnegative least-square (NNLS) analysis of intravoxel incoherent motion data collected in healthy volunteers and patients with renal pathologies. METHODS MR imaging was performed at 3 Tesla in 12 healthy subjects and 3 patients with various kidney pathologies (fibrotic kidney disease, failed renal graft, and renal masses). Relative signal fractions f and mean diffusivities of the diffusion components in the cortex, medulla, and renal lesions were obtained using the regularized NNLS fitting of the intravoxel incoherent motion data. Test-retest repeatability of the NNLS approach was tested in 5 volunteers scanned twice. RESULTS In the healthy kidneys, the NNLS method yielded diffusion spectra with 3 distinguishable components that may be linked to the slow tissue water diffusion, intermediate tubular and vascular flow, and fast blood flow in larger vessels with the relative signal fractions, fslow , finterm and ffast , respectively. In the pathological kidneys, the diffusion spectra varied substantially from those acquired in the healthy kidneys. Overall, the renal cyst showed substantially higher finterm and lower fslow , whereas the fibrotic kidney, failed renal graft, and renal cell carcinoma demonstrated the opposite trend. CONCLUSION NNLS-based intravoxel incoherent motion could potentially become a valuable tool in assessing changes in tubular and vascular volume fractions under pathophysiological conditions.
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Affiliation(s)
- Julia Stabinska
- Department of Diagnostic and Interventional Radiology, Medical Faculty, Heinrich Heine University Dusseldorf, Düsseldorf, Germany
| | - Alexandra Ljimani
- Department of Diagnostic and Interventional Radiology, Medical Faculty, Heinrich Heine University Dusseldorf, Düsseldorf, Germany
| | - Helge Jörn Zöllner
- Department of Diagnostic and Interventional Radiology, Medical Faculty, Heinrich Heine University Dusseldorf, Düsseldorf, Germany.,Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.,F. M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Enrica Wilken
- Department of Diagnostic and Interventional Radiology, Medical Faculty, Heinrich Heine University Dusseldorf, Düsseldorf, Germany
| | - Thomas Benkert
- MR Application Development, Siemens Healthcare GmbH, Erlangen, Germany
| | - Juliane Limberg
- Institute of Pathology, Medical Faculty, Heinrich Heine University Dusseldorf, Düsseldorf, Germany
| | - Irene Esposito
- Institute of Pathology, Medical Faculty, Heinrich Heine University Dusseldorf, Düsseldorf, Germany
| | - Gerald Antoch
- Department of Diagnostic and Interventional Radiology, Medical Faculty, Heinrich Heine University Dusseldorf, Düsseldorf, Germany
| | - Hans-Jörg Wittsack
- Department of Diagnostic and Interventional Radiology, Medical Faculty, Heinrich Heine University Dusseldorf, Düsseldorf, Germany
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10
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Gaudiano C, Clementi V, Corcioni B, Renzulli M, Mancini E, Golfieri R. Diffusion tensor imaging in renal artery stenosis: a preliminary report. Br J Radiol 2020; 93:20200101. [DOI: 10.1259/bjr.20200101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Objective: To investigate the diffusion properties in the kidneys affected by renal artery stenosis (RAS) using diffusion tensor imaging (DTI). Methods: In this prospective study, 35 patients with RAS and 15 patients without renal abnormalities were enrolled and examined using DTI. Cortical and medullary regions of interest (ROIs) were located to obtain the corresponding values of the apparent diffusion coefficient (ADC) and fractional anisotropy (FA). The cortical and medullary ADC and FA were compared in the kidney affected by variable degrees of stenosis (RAS 50–75% and >75%) vs controls, using the one-way ANOVA and Student’s t-test. The Spearman correlation test was used to correlate the mean ADC and FA values in the cortex and medulla with the estimate glomerular filtration rate (eGFR). Results: For the controls, the ADC value was significantly (p = 0.03) higher in the cortex than in the medulla; the FA value was significantly (p = 0.001) higher in the medulla than in the cortex. Compared with the controls, a significant reduction in the cortical ADC was present with a RAS of 50–75% and >75% (p = 0.001 and 0.041, respectively); a significant reduction in the medullary FA was verified only for RAS >75% (p = 0.023). The Spearman correlation test did not show a statistically significant correlation between the cortical and medullary ADC and FA, and the eGFR. Conclusion: The alterations of the diffusional parameters caused by RAS can be detected by DTI and could be useful in the diagnostic evaluation of these patients. Advances in knowledge: 1. Magnetic resonance DTI could provide useful information about renal involvement in RAS. 2. Magnetic resonance DTI allows non-invasive repeatable evaluation of the renal parenchyma, without contrast media.
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Affiliation(s)
- Caterina Gaudiano
- Department of Radiology, Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, Bologna- Italia, Bologna, Italy
| | - Valeria Clementi
- Medical Technology Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Beniamino Corcioni
- Department of Radiology, Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, Bologna- Italia, Bologna, Italy
| | - Matteo Renzulli
- Department of Radiology, Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, Bologna- Italia, Bologna, Italy
| | - Elena Mancini
- Nephrology, Dialysis and Hypertension Unit, Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, Bologna- Italia, Bologna, Italy
| | - Rita Golfieri
- Department of Radiology, Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, Bologna- Italia, Bologna, Italy
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11
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Renal fibrosis detected by diffusion-weighted magnetic resonance imaging remains unchanged despite treatment in subjects with renovascular disease. Sci Rep 2020; 10:16300. [PMID: 33004888 PMCID: PMC7530710 DOI: 10.1038/s41598-020-73202-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 09/11/2020] [Indexed: 02/07/2023] Open
Abstract
Tissue fibrosis is an important index of renal disease progression. Diffusion-weighted magnetic resonance imaging’s (DWI-MRI) apparent diffusion coefficient (ADC) reveals water diffusion is unobstructed by microstructural alterations like fibrosis. We hypothesized that ADC may indicate renal injury and response to therapy in patients with renovascular disease (RVD). RVD patients were treated with medical therapy (MT) and percutaneous transluminal renal angioplasty (MT + PTRA) (n = 11, 3 bilaterally, n = 14 kidneys) or MT (n = 9). ADC and renal hypoxia (R2*) by blood-oxygen-level-dependent MRI were studied before (n = 27) and 3 months after (n = 20) treatment. Twelve patients underwent renal biopsies. Baseline ADC values were correlated with changes in eGFR, serum creatinine (SCr), systolic blood pressure (SBP), renal hypoxia, and renal vein levels of pro-inflammatory marker tumor necrosis-factor (TNF)-α. Renal oxygenation, eGFR, and SCr improved after MT + PTRA. ADC inversely correlated with the histological degree of renal fibrosis, but remained unchanged after MT or MT + PTRA. Basal ADC values correlated modestly with change in SBP, but not in renal hypoxia, TNF-α levels, or renal function. Lower ADC potentially reflects renal injury in RVD patients, but does not change in response to medical or interventional therapy over 3 months. Future studies need to pinpoint indices of kidney recovery potential.
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12
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Emad-Eldin S, Yadav S, Galal REE, Elzayat WA. DWI as a biomarker of renal function in children with CKD: what is the potential? THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2020. [DOI: 10.1186/s43055-020-00277-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Abstract
Background
Evaluation of renal microstructure is pivotal for diagnosing and monitoring chronic renal disease. DWI has been proved to be practicable and reliable examination for the assessment of renal function and parenchymal damage in some renal diseases. Our aim is to appraise DWI sequence and ADC measurement as a potential tool of renal function assessment as well as establishing a possible relationship between the different CKD stages and the renal parenchymal ADC values changes.
Results
Regarding the cause of CKD, nine patients (45%) had glomerulonephritis, 5 patients (25%) had hemolytic uremic syndrome, 2 patients (10%) had lupus nephritis, 2 patients (10%) had nepheronophthisis, and 1 patient (1.5%) had infantile nepherosis, whereas the cause of CKD was unknown in 1 patient (1.5%).
The stages of CKD were classified according to KIDGO guidelines: 6 patients (30%) were stage 1, 4 patients (20%) were stage 2, 3 patients (15%) were stage 3, 2 patients (10%) were stage 4, and 5 patients (25%) were stage 5. The patients’ group (group A) had a mean ADC value (1.85 × 10−3 ± 0.24) which was significantly lower than that of the control group (group B) (2.21 × 10−3 ± 0.12). As for the correlation between stage of CKD and ADC, we found it to be a moderate negative one with r’ value of − .655 and a significant p value of < 0.001.
Conclusion
DWI is recognized as a promising imaging tool that can take part in the assessment of the morphological and functional changes in diffuse renal parenchymal disease, hence playing an important role in the early diagnosis and staging of chronic kidney disease.
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Chen L, Ren T, Zuo P, Fu Y, Xia S, Shen W. Detecting impaired function of renal allografts at the early stage after transplantation using intravoxel incoherent motion imaging. Acta Radiol 2019; 60:1039-1047. [PMID: 30450922 DOI: 10.1177/0284185118810979] [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] [Indexed: 12/14/2022]
Abstract
Background Detecting renal allografts with impaired function early after renal transplantation and timely intervention are important to ensure a successful outcome. Purpose To detect impaired function of renal allografts at the early stage after renal transplantation using intravoxel incoherent motion imaging (IVIM). Material and Methods Forty-six recipients with good allograft function and 32 recipients with impaired function were included in this study. All participants were scanned with IVIM using 11 b-values on a 3-T magnetic resonance (MR) scanner; the apparent diffusion coefficient (ADC), ADC of slow diffusion (ADCslow), pseudo-diffusion (ADCfast), and perfusion fraction (f) values were calculated using a full bi-exponential model. Correlations between estimated glomerular filtration rate (eGFR) and the IVIM parameters were assessed by using Spearman correlation analysis. Receiver operating characteristics were used to assess the diagnostic utilities for detecting allografts with impaired function. Results The ADC, ADCslow, ADCfast, and f values of the renal cortex and the ADC and ADCslow values of the renal medulla were significantly higher in allografts with good function compared to those with impaired function (all P < 0.05). There was a significant corticomedullary difference in ADCslow, ADC, and f in all allografts. ADCfast values were higher in the cortex than in the medulla for allografts with good function but no differences were seen in allografts with impaired function ( P > 0.05). Combined use of all cortical IVIM parameters has higher efficacy in detecting renal allograft dysfunction than any single parameter (sensitivity = 90.62%; specificity = 78.26%). Conclusion IVIM technique may be useful for detecting renal allograft dysfunction, especially combined use of cortical parameters.
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Affiliation(s)
- Lihua Chen
- Department of Radiology, Tianjin Clinical Research Center for Organ Transplantation, Tianjin First Centre Hospital, Tianjin, PR China
| | - Tao Ren
- Department of Radiology, Tianjin Clinical Research Center for Organ Transplantation, Tianjin First Centre Hospital, Tianjin, PR China
| | - Panli Zuo
- MR Collaborations NE Asia, Siemens Healthcare China, Beijing, PR China
| | - Yingxin Fu
- Department of Kidney Transplantation, Tianjin Clinical Research Center for Organ Transplantation, Tianjin First Centre Hospital, Tianjin, PR China
| | - Shuang Xia
- Department of Radiology, Tianjin Clinical Research Center for Organ Transplantation, Tianjin First Centre Hospital, Tianjin, PR China
| | - Wen Shen
- Department of Radiology, Tianjin Clinical Research Center for Organ Transplantation, Tianjin First Centre Hospital, Tianjin, PR China
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Fan M, Ni X, Li Y, Chen J, Cheng D, Shi D, He X, Wen J. Assessment of transplant renal artery stenosis with diffusion-weighted imaging: A preliminary study. Magn Reson Imaging 2019; 60:157-163. [DOI: 10.1016/j.mri.2019.05.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Revised: 03/28/2019] [Accepted: 05/04/2019] [Indexed: 01/19/2023]
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Caroli A, Schneider M, Friedli I, Ljimani A, De Seigneux S, Boor P, Gullapudi L, Kazmi I, Mendichovszky IA, Notohamiprodjo M, Selby NM, Thoeny HC, Grenier N, Vallée JP. Diffusion-weighted magnetic resonance imaging to assess diffuse renal pathology: a systematic review and statement paper. Nephrol Dial Transplant 2018; 33:ii29-ii40. [PMID: 30137580 PMCID: PMC6106641 DOI: 10.1093/ndt/gfy163] [Citation(s) in RCA: 120] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 05/02/2018] [Indexed: 12/26/2022] Open
Abstract
Diffusion-weighted magnetic resonance imaging (DWI) is a non-invasive method sensitive to local water motion in the tissue. As a tool to probe the microstructure, including the presence and potentially the degree of renal fibrosis, DWI has the potential to become an effective imaging biomarker. The aim of this review is to discuss the current status of renal DWI in diffuse renal diseases. DWI biomarkers can be classified in the following three main categories: (i) the apparent diffusion coefficient-an overall measure of water diffusion and microcirculation in the tissue; (ii) true diffusion, pseudodiffusion and flowing fraction-providing separate information on diffusion and perfusion or tubular flow; and (iii) fractional anisotropy-measuring the microstructural orientation. An overview of human studies applying renal DWI in diffuse pathologies is given, demonstrating not only the feasibility and intra-study reproducibility of DWI but also highlighting the need for standardization of methods, additional validation and qualification. The current and future role of renal DWI in clinical practice is reviewed, emphasizing its potential as a surrogate and monitoring biomarker for interstitial fibrosis in chronic kidney disease, as well as a surrogate biomarker for the inflammation in acute kidney diseases that may impact patient selection for renal biopsy in acute graft rejection. As part of the international COST (European Cooperation in Science and Technology) action PARENCHIMA (Magnetic Resonance Imaging Biomarkers for Chronic Kidney Disease), aimed at eliminating the barriers to the clinical use of functional renal magnetic resonance imaging, this article provides practical recommendations for future design of clinical studies and the use of renal DWI in clinical practice.
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Affiliation(s)
- Anna Caroli
- Medical Imaging Unit, Bioengineering Department, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Bergamo, Italy
| | - Moritz Schneider
- Department of Radiology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany
- Comprehensive Pneumology Center, German Center for Lung Research, Munich, Germany
| | - Iris Friedli
- Division of Radiology, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
| | - Alexandra Ljimani
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Dusseldorf, Germany
| | - Sophie De Seigneux
- Service and Laboratory of Nephrology, Department of Internal Medicine Specialties and Department of Physiology and Metabolism, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
| | - Peter Boor
- Institute of Pathology and Division of Nephrology, RWTH University of Aachen, Aachen, Germany
| | - Latha Gullapudi
- Centre for Kidney Research and Innovation, University of Nottingham, Nottingham, UK
| | - Isma Kazmi
- Centre for Kidney Research and Innovation, University of Nottingham, Nottingham, UK
| | - Iosif A Mendichovszky
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke’s Hospital, Cambridge, UK
| | | | - Nicholas M Selby
- Centre for Kidney Research and Innovation, University of Nottingham, Nottingham, UK
| | - Harriet C Thoeny
- Department of Diagnostic, Pediatric, and Interventional Radiology, Inselspital University Hospital, Bern, Switzerland
| | - Nicolas Grenier
- Service d'Imagerie Diagnostique et Interventionnelle de l'Adulte, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Jean-Paul Vallée
- Division of Radiology, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
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16
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Ito K, Hayashida M, Kanki A, Yamamoto A, Tamada T, Yoshida K, Tanabe M. Alterations in apparent diffusion coefficient values of the kidney during the cardiac cycle: Evaluation with ECG-triggered diffusion-weighted MR imaging. Magn Reson Imaging 2018; 52:1-8. [PMID: 29778691 DOI: 10.1016/j.mri.2018.05.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 04/04/2018] [Accepted: 05/13/2018] [Indexed: 01/17/2023]
Abstract
PURPOSE To evaluate dynamic changes in apparent diffusion coefficient (ADC) values of the kidney at different time points during the cardiac cycle using electrocardiographic (ECG)-triggered diffusion-weighted MR imaging in normal subjects, and to elucidate the differences in ADC values between the right and left kidneys during a cardiac cycle. MATERIALS AND METHODS The study was approved by our institutional review board and informed consent was obtained from subjects. Twenty healthy volunteers who underwent ECG-triggered diffusion-weighted MR imaging of the kidney were included. The differences in ADC values of each kidney during different cardiac phases were compared. Additionally, the differences in maximum and minimum ADC values between the right and left kidney were also evaluated. RESULTS ADC values in the right and left kidney changed significantly during the cardiac cycle (P < 0.00001). Maximum and minimum ADC values during the cardiac cycle of the left kidney were significantly higher (P = 0.026 and 0.017, respectively) than those of the right kidney. Maximum ADC value in the left kidney had a significantly strong positive correlation with the left renal vein ratio (r = 0.83, P < 0.00001). In the right kidney, maximum ADC showed a weakly positive correlation with the diameter of the right renal vein (r = 0.45, P = 0.048). CONCLUSION ADC values of the kidney obtained using ECG-triggered diffusion-weighted MR imaging change significantly during the cardiac cycle. Maximum (systolic) ADC during the cardiac cycle of the left kidney was significantly higher than that of the right kidney, probably due to the anatomical difference in the renal vein.
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Affiliation(s)
- Katsuyoshi Ito
- Department of Radiology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-kogushi, Ube, Yamaguchi 755-8505, Japan; Department of Diagnostic Radiology, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama 701-0192, Japan.
| | - Minoru Hayashida
- Department of Diagnostic Radiology, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama 701-0192, Japan
| | - Akihiko Kanki
- Department of Diagnostic Radiology, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama 701-0192, Japan
| | - Akira Yamamoto
- Department of Diagnostic Radiology, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama 701-0192, Japan
| | - Tsutomu Tamada
- Department of Diagnostic Radiology, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama 701-0192, Japan
| | - Koji Yoshida
- Department of Diagnostic Radiology, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama 701-0192, Japan
| | - Masahiro Tanabe
- Department of Radiology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-kogushi, Ube, Yamaguchi 755-8505, Japan
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Zhang B, Dong Y, Guo B, Chen W, Ouyang F, Lian Z, Liu J, Zhang S. Application of noninvasive functional imaging to monitor the progressive changes in kidney diffusion and perfusion in contrast-induced acute kidney injury rats at 3.0 T. Abdom Radiol (NY) 2018; 43:655-662. [PMID: 28677006 DOI: 10.1007/s00261-017-1247-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Contrast-induced acute kidney injury is a prevalent cause of renal failure, and the noninvasive tools to monitor its progress are lacking. We applied intravoxel incoherent motion (IVIM) DWI to measure the progressive changes in kidney diffusion and perfusion of CI-AKI. METHODS Twenty-four rats received Iopromide (370 mg/ml, 1600 mg iodine/kg) to induce CI-AKI. IVIM DWI was performed on rats (n = 6) at 24 h prior to and 12, 24, 48, 72, and 96 h after the injection using a 3.0 T MRI scanner. The progressive changes in the diffusion (D) and perfusion parameters (D* and f) were studied in the cortex (CO), outer medulla (OM), and inner medulla (IM). For the histology group (n = 18), three rats were sacrificed at each time point. RESULTS In the CO, D reduced progressively from 24 to 48 h (P < 0.001) and increased starting from 72 h (P < 0.001). However, D decreased until to 72 h in the medulla (P < 0.001) and increased starting from 96 h (P < 0.001). D* decreased to the bottom at 24 h in the cortex and medulla (P = 0.037) and started to recover at 48 h (P = 0.007). f decreased in the cortex and medulla in an early stage (12 h) (P = 0.035) of CI-AKI and then ascended in the later stage (72 h) (P = 0.017). The H & E staining showed different degrees of serial pathological change including cloudy swelling, atrophy, even necrosis, and interstitial vasodilation of tubule epithelial cells and glomerulus cells. CONCLUSION Our study demonstrates the feasibility of using IVIM DWI to monitor the progress of CI-AKI, implying that IVIM DWI is a useful biomarker in the staging of CI-AKI.
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18
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Poynton CB, Lee MM, Li Y, Laszik Z, Worters PW, Mackenzie JD, Courtier J. Intravoxel incoherent motion analysis of renal allograft diffusion with clinical and histopathological correlation in pediatric kidney transplant patients: A preliminary cross-sectional observational study. Pediatr Transplant 2017; 21. [PMID: 28653457 DOI: 10.1111/petr.12996] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/09/2017] [Indexed: 02/06/2023]
Abstract
The purpose of this study was to compare IVIM values in pediatric renal transplants with histopathology and clinical management change. Fifteen pediatric renal transplant recipients (mean 15.7±2.9 years) were prospectively scanned on a 3T MR scanner with multi-b DTI, prior to same-day transplant biopsy. IVIM maps from 14 subjects were analyzed (one excluded due to motion). Mean values were computed from cortical ROIs and medullary ROIs corresponding to the biopsy site. Subjects were also grouped according to whether or not the biopsy resulted in a change in clinical management. Cortico-medullary IVIM estimates and histopathologic Banff scores were correlated with KT. Cortico-medullary IVIM differences between the "change" and "no change" groups was compared with Mann-Whitney U test. Cortical Dp showed significant moderate negative correlation with Banff t and ci scores (KT=-0.497, P=.035 and KT=-0.46, P=.046) and moderate positive correlation with Banff i score (KT=0.527, P=.028). Cortical Pf showed significant moderate correlation with ci and ct scores (KT=0.489, P=.035 and KT=0.457, P=.043). Tissue diffusivity, Dt , estimated with IVIM was significantly different between the "change" and "no change" groups in medullary ROIs (U=6, P=.021). IVIM analysis has potential as a noninvasive biomarker in assessment of pediatric renal allograft pathology.
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Affiliation(s)
- Clare B Poynton
- Department of Radiology and Biomedical Imaging, UCSF Benioff Children's Hospital, San Francisco, CA, USA
| | - Marsha M Lee
- Department of Pediatrics, Division of Pediatric Nephrology, UCSF Benioff Children's Hospital, San Francisco, CA, USA
| | - Yi Li
- Department of Radiology and Biomedical Imaging, UCSF Benioff Children's Hospital, San Francisco, CA, USA
| | - Zoltan Laszik
- Department of Pathology, UCSF Benioff Children's Hospital, San Francisco, CA, USA
| | - Pauline W Worters
- Global Applied Science Laboratory, GE Healthcare, Menlo Park, CA, USA
| | - John D Mackenzie
- Department of Radiology and Biomedical Imaging, UCSF Benioff Children's Hospital, San Francisco, CA, USA
| | - Jesse Courtier
- Department of Radiology and Biomedical Imaging, UCSF Benioff Children's Hospital, San Francisco, CA, USA
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Diffusion-weighted imaging of the kidneys in haemolytic uraemic syndrome. Eur Radiol 2017; 27:4591-4601. [PMID: 28500363 DOI: 10.1007/s00330-017-4848-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 03/15/2017] [Accepted: 04/10/2017] [Indexed: 12/20/2022]
Abstract
OBJECTIVES To evaluate the kidneys of patients with haemolytic uraemic syndrome (HUS) using diffusion-weighted imaging (DWI) and Doppler ultrasound (US) compared with healthy controls. MATERIALS AND METHODS Fifteen patients (mean age 33.3 years; three male; 12 female) with diarrhoea-positive HUS and 15 healthy volunteers were prospectively evaluated with DWI and Doppler US. A total apparent diffusion coefficient (ADCTOT), and ADCs predominantly reflecting microperfusion (ADCLOW) and diffusion (ADCHIGH) were calculated. Doppler US evaluated renal vascularity and flow. RESULTS When compared with controls, kidneys affected by HUS showed reduced cortical ADC values (ADCTOT 1.79±0.22 vs. 2.04±0.1x10-3 mm2/s, P 0.001), resulting in either low corticomedullary differences (11/15 patients) or an inverted corticomedullary pattern (4/15 patients). Reduction of cortical ADC values was associated with a decrease of cortical vascularity on Doppler US (ADCTOT, P<0.001; ADCLOW, P 0.047). Kidneys with complete absence of the cortical vasculature on Doppler US (four patients) also demonstrated limited diffusion (ADCHIGH, P 0.002). Low glomerular filtration rate, requirement for haemodialysis during hospitalization, and longer duration of haemodialysis were associated with decreased cortical diffusivity (ADCTOT: P 0.04, 0.007, and <0.001, respectively). CONCLUSION DWI shows qualitative and quantitative abnormalities in kidneys affected by HUS, thereby extending the non-invasive assessment of renal parenchymal damage. KEY POINTS • In HUS, DWI is feasible for functional characterization of kidney involvement. • Kidneys affected by HUS showed reduced cortical diffusivity. • Decreased cortical diffusivity was associated with lower kidney function. • Requirement and duration of haemodialysis was linked to degree of cortical alterations.
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20
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Herrmann J, Ittrich H, Kaul MG, Groth M, Tozakidou M, Blohm M, Oh J, Adam G. Functional assessment of the kidneys in a 10 month-old child with renal artery stenosis by intravoxel incoherent motion. Nephrology (Carlton) 2017; 22:257-260. [PMID: 28205351 DOI: 10.1111/nep.12896] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 08/11/2016] [Accepted: 08/16/2016] [Indexed: 11/27/2022]
Abstract
Renovascular stenosis is an important cause for arterial hypertension in childhood. We report a 10-month-old girl with arterial hypertension caused by right-sided renal artery stenosis detected by Doppler ultrasound. Magnetic resonance imaging (MRI) was performed before renal artery angioplasty to depict vascular anatomy in detail and to retrieve additional functional information of the kidneys by analysis of intravoxel incoherent motion (IVIM). The value of quantitative diffusion weighted imaging of the kidneys prior to percutaneous transluminal renal angioplasty (PTRA) is discussed.
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Affiliation(s)
| | - Harald Ittrich
- Diagnostic and Interventional Radiology and Nuclear Medicine
| | | | | | | | | | | | - Gerhard Adam
- Diagnostic and Interventional Radiology and Nuclear Medicine
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Jerome NP, Boult JKR, Orton MR, d’Arcy J, Collins DJ, Leach MO, Koh DM, Robinson SP. Modulation of renal oxygenation and perfusion in rat kidney monitored by quantitative diffusion and blood oxygen level dependent magnetic resonance imaging on a clinical 1.5T platform. BMC Nephrol 2016; 17:142. [PMID: 27716094 PMCID: PMC5048450 DOI: 10.1186/s12882-016-0356-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 09/26/2016] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND To investigate the combined use of intravoxel incoherent motion (IVIM) diffusion-weighted (DW) and blood oxygen level dependent (BOLD) magnetic resonance imaging (MRI) to assess rat renal function using a 1.5T clinical platform. METHODS Multiple b-value DW and BOLD MR images were acquired from adult rats using a parallel clinical coil arrangement, enabling quantitation of the apparent diffusion coefficient (ADC), IVIM-derived diffusion coefficient (D), pseudodiffusion coefficient (D*) and perfusion fraction (f), and the transverse relaxation time T2*, for whole kidney, renal cortex, and medulla. Following the acquisition of two baseline datasets to assess measurement repeatability, images were acquired following i.v. administration of hydralazine, furosemide, or angiotensin II for up to 40 min. RESULTS Excellent repeatability (CoV <10 %) was observed for ADC, D, f and T2* measured over the whole kidney. Hydralazine induced a marked and significant (p < 0.05) reduction in whole kidney ADC, D, and T2*, and a significant (p < 0.05) increase in D* and f. Furosemide significantly (p < 0.05) increased whole kidney ADC, D, and T2*. A more variable response to angiotensin II was determined, with a significant (p < 0.05) increase in medulla D* and significant (p < 0.05) reduction in whole kidney T2* established. CONCLUSIONS Multiparametric MRI, incorporating quantitation of IVIM DWI and BOLD biomarkers and performed on a clinical platform, can be used to monitor the acute effects of vascular and tubular modulating drugs on rat kidney function in vivo. Clinical adoption of such functional imaging biomarkers can potentially inform on treatment effects in patients with renal dysfunction.
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Affiliation(s)
- Neil P. Jerome
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy & Imaging, The Institute of Cancer Research, London, SM2 5NG UK
| | - Jessica K. R. Boult
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy & Imaging, The Institute of Cancer Research, London, SM2 5NG UK
| | - Matthew R. Orton
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy & Imaging, The Institute of Cancer Research, London, SM2 5NG UK
| | - James d’Arcy
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy & Imaging, The Institute of Cancer Research, London, SM2 5NG UK
| | - David J. Collins
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy & Imaging, The Institute of Cancer Research, London, SM2 5NG UK
| | - Martin O. Leach
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy & Imaging, The Institute of Cancer Research, London, SM2 5NG UK
| | - Dow-Mu Koh
- Department of Radiology, Royal Marsden NHS Foundation Trust, Sutton, Surrey SM2 5PT UK
| | - Simon P. Robinson
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy & Imaging, The Institute of Cancer Research, London, SM2 5NG UK
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Wang WJ, Pui MH, Guo Y, Wang LQ, Wang HJ, Liu M. 3T magnetic resonance diffusion tensor imaging in chronic kidney disease. ACTA ACUST UNITED AC 2016; 39:770-5. [PMID: 24623033 DOI: 10.1007/s00261-014-0116-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To investigate the relationship of apparent diffusion coefficient (ADC) and fractional anisotropy (FA) values with renal function on 3T diffusion tensor imaging (DTI) in chronic kidney disease. MATERIALS AND METHODS Twenty healthy volunteers and 29 patients with CKD underwent DTI. The relationship among ADC, FA, and renal function was analyzed. RESULTS Cortical and medullary ADC and FA values of patients with chronic kidney disease were lower than those of healthy volunteers (P = 0.000). Both the renal ADC and FA values correlated inversely with serum creatinine and blood urea nitrogen (P < 0.05). CONCLUSION DTI is a feasible and non-invasive means to reflect the severity of renal function damaged.
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Affiliation(s)
- Wen-juan Wang
- Department of Radiology, The First Affiliated Hospital of Sun Yat-sen University, 58 Zhongshan 2th Road, Guangzhou, 510080, Guangdong, China
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Wu CJ, Wang Q, Zhang J, Wang XN, Liu XS, Zhang YD, Shi HB. Readout-segmented echo-planar imaging in diffusion-weighted imaging of the kidney: comparison with single-shot echo-planar imaging in image quality. Abdom Radiol (NY) 2016; 41:100-8. [PMID: 26830616 DOI: 10.1007/s00261-015-0615-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The purpose of this study was to compare the image quality of readout-segmented echo-planar imaging (RS-EPI) and that of standard single-shot echo-planar imaging (SS-EPI) in the kidney in a rat model. MATERIALS AND METHODS Twelve Wistar rats undergoing MRI examinations were imaged with two diffusion-weighted (DW) imaging protocols: a standard SS-EPI and a new RS-EPI protocol, both with a 1.0 × 1.0 × 3.0 mm voxel. The two groups of diffusion-weighted images were independently scored on geometric distortion, image blurring, signal dropout, and the overall image quality by two radiologists. Signal-to-noise ratio (SNR) and apparent diffusion coefficient (ADC) were measured on both sequences. Inter-rater agreement (IRA) was evaluated by Fleiss kappa (κ) and inter-class correlation coefficient (ICC) statistics. Comparisons of image qualities were made by Wilcoxon signed-rank test and paired-sample t test. RESULTS Both RS-EPI and SS-EPI had good IRAs in scoring image qualities (κ = 0.607-0.833) and measuring renal ADCs (ICC = 0.828-0.945). Compared to SS-EPI, RS-EPI produced less geometric distortion (median score 1.5 versus 2.5, p < 0.0001), less image blurring (1.75 versus 2.0, p = 0.0003), less signal dropout (1.0 versus 3.0, p = 0.0001), and a lower score in overall image artifacts (4.25 versus 7.25; p < 0.0001). RS-EPI had higher SNR of renal DW images than SS-EPI (p < 0.001). The intra-variability of ADCs in cortex, outer medulla, and inner medulla ranged from 9.6% to 11.1% (Pearson correlation coefficient ρ = 0.675-0.729; p < 0.001) between the two protocols. CONCLUSION We showed that for DWI of the kidney at 1.0 × 1.0 × 3.0 mm(3) voxel sizes, the new protocol provided better image quality than standard SS-EPI protocol.
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Affiliation(s)
- Chen-Jiang Wu
- Department of Radiology, The First Affiliated Hospital with Nanjing Medical University, No. 300, Guangzhou Road, Nanjing, 210000, China.
| | - Qing Wang
- Department of Radiology, The First Affiliated Hospital with Nanjing Medical University, No. 300, Guangzhou Road, Nanjing, 210000, China.
| | - Jing Zhang
- Department of Radiology, The First Affiliated Hospital with Nanjing Medical University, No. 300, Guangzhou Road, Nanjing, 210000, China.
| | - Xiao-Ning Wang
- Department of Radiology, The First Affiliated Hospital with Nanjing Medical University, No. 300, Guangzhou Road, Nanjing, 210000, China.
| | - Xi-Sheng Liu
- Department of Radiology, The First Affiliated Hospital with Nanjing Medical University, No. 300, Guangzhou Road, Nanjing, 210000, China.
| | - Yu-Dong Zhang
- Department of Radiology, The First Affiliated Hospital with Nanjing Medical University, No. 300, Guangzhou Road, Nanjing, 210000, China.
| | - Hai-Bin Shi
- Department of Radiology, The First Affiliated Hospital with Nanjing Medical University, No. 300, Guangzhou Road, Nanjing, 210000, China.
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Ye J, Kumar BS, Li XB, Li HM, Zhou YW, Liu LQ. Clinical applications of diffusion-weighted magnetic resonance imaging in diagnosis of renal lesions - a systematic review. Clin Physiol Funct Imaging 2015; 37:459-473. [PMID: 26648310 DOI: 10.1111/cpf.12313] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 09/21/2015] [Indexed: 01/07/2023]
Abstract
Diffusion-weighted magnetic resonance imaging (DW-MRI) is an established technique to detect the changes of the diffusion of water in biological tissues and reflect the pathophysiological process on the molecular level. It is a promising non-invasive imaging modality in detection of microstructural and functional changes in pathologies of kidney. To systematically review the research advancement of the DW-MRI in diagnosis of renal lesions, a systematic literature search was performed up to 8 October 2014 using the MEDLINE/PubMed and Embase databases for articles reporting on DW-MRI in diagnosis of renal lesions. Only articles with full data about DW-MRI application with potential implication in solving usually encountered clinical challenges about renal lesions were finally examined. The clinical application of DW-MRI allows a better understanding of some pathologic conditions of the kidney including renal insufficiency, renal artery stenosis, ureteral obstruction, foetal kidney disease, hydronephrosis and pyonephrosis. In addition, DW-MRI can also provide clinicians with the information of function evaluation of renal allograft and curative effect assessment of renal tumour. In summary, performance of renal DW-MRI, presuming that measurements are high quality, will further boost this modality, particularly for early detection of diffusion renal conditions, as well as more accurate characterization of renal lesions.
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Affiliation(s)
- Jing Ye
- Department of Imaging, Northern Jiangsu People's Hospital, Yangzhou, China
| | | | - Xiao-Bo Li
- Department of Neurology, Northern Jiangsu People's Hospital, Yangzhou, China
| | - Hong-Mei Li
- Department of Imaging, Northern Jiangsu People's Hospital, Yangzhou, China
| | - Ying-Wen Zhou
- Department of Imaging, Northern Jiangsu People's Hospital, Yangzhou, China
| | - Li-Qin Liu
- Department of Oncology, Northern Jiangsu People's Hospital, Yangzhou, China
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25
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Wang HY, Wang J, Tang YH, Ye HY, Ma L. Coronal diffusion-weighted magnetic resonance imaging of the kidney: agreement with axial diffusion-weighted magnetic imaging in terms of apparent diffusion coefficient values. Chin Med J (Engl) 2015; 128:499-503. [PMID: 25673453 PMCID: PMC4836254 DOI: 10.4103/0366-6999.151103] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background: Coronal diffusion-weighted magnetic resonance imaging (DW-MRI) and apparent diffusion coefficient (ADC) values have gradually become applied (following conventional axial DW-MRI) in the renal analysis. To explore whether data obtained using coronal DW-MRI are comparable with those derived using axial DW-MRI, this preliminary study sought to assess the agreement in renal ADC values between coronal DW-MRI and axial DW-MRI. Methods: Thirty-four healthy volunteers were enrolled in the study; written consents were obtained. All subjects underwent respiratory-triggered axial and coronal DW-MRI using a 1.5-MR system with b values of 0 and 800 s/mm2. The signal-to-noise ratios (SNRs) of the two DW-MRI sequences were measured and statistically compared using the paired t-test. The extent of agreement of ADC values of the upper pole, mid-pole, and lower pole of the kidney; the mean ADC values of the left kidney and right kidney; and the mean ADC values of the bilateral kidneys were evaluated via calculation of intraclass correlation coefficients (ICCs) or Bland–Altman method between the two DW-MRI sequences. Results: The SNR of coronal DW-MR images was statistically inferior to that of axial DW-MR images (P < 0.001). The ICCs of the ADC values of each region of interest, and the mean ADC values of bilateral kidneys, between the two sequences, were greater than 0.5, and the mean ADCs of the bilateral kidneys demonstrated the highest ICC (0.869; 95% confidence interval: 0.739–0.935). In addition, 94.1% (32/34), 94.1% (32/34), and 97.1% (31/34) of the ADC bias was inside the limits of agreement in terms of the mean ADC values of the left kidneys, right kidneys, and bilateral kidneys when coronal and axial DWI-MRI were compared. Conclusions: ADC values derived using coronal DW-MRI exhibited moderate-to-good agreement to those of axial DW-MRI, rendering the former an additional useful DW-MRI method, and causing the ADC values derived using the two types of DW-MRI to be comparable.
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Affiliation(s)
| | | | | | - Hui-Yi Ye
- Department of Radiology, Chinese People's Liberation Army General Hospital, Beijing 100853, China
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26
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Using intravoxel incoherent motion MR imaging to study the renal pathophysiological process of contrast-induced acute kidney injury in rats: Comparison with conventional DWI and arterial spin labelling. Eur Radiol 2015; 26:1597-605. [DOI: 10.1007/s00330-015-3990-y] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Revised: 06/23/2015] [Accepted: 08/31/2015] [Indexed: 01/01/2023]
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Renal Apparent Diffusion Coefficient Values in Patients with Obstructive Uropathy and High Values of Creatinine. J Belg Soc Radiol 2015; 99:82-86. [PMID: 30039074 PMCID: PMC6032691 DOI: 10.5334/jbr-btr.854] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose: Diffusion weighted magnetic resonance imaging (DW-MRI) of the kidneys provides noninvasive information on renal function in healthy volunteers, and it is feasible in severely ill patients. It may provide information on the degree of kidney dysfunction. The purpose of this study is to evaluate apparent diffusion coefficient (ADC) values using DW-MRI in patients with obstructive uropathy and elevated serum creatinine levels. Methods: Fifty patients with high serum creatinine levels and diagnoses of chronic urinary obstruction detected by ultrasonography were included in this study. DW-MRIs were obtained from 50 patients with hydronephrotic kidneys and 26 healthy volunteers using a 1.5T whole-body MR scanner. Results: ADC measurements of renal parenchyma in hydronephrotic kidneys were significantly lower compared to normal kidneys (p < 001). Conclusion: The measurement of ADC values has potential value in the evaluation of the functional status of hydronephrotic kidneys.
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28
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Lin F, Li Z, Gan Y, Sun L, Fang D, Xiang K, Liu L. Relationship between renal apparent diffusion coefficient values and glomerular filtration rate in infants with congenital hydronephrosis. Biosci Trends 2015; 8:274-9. [PMID: 25382444 DOI: 10.5582/bst.2014.01110] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The aim was to investigate the relationship between apparent diffusion coefficient (ADC) values measured by diffusion-weighted magnetic resonance imaging (DW MRI) and the split glomerular filtration rate (GFR) in infants with congenital hydronephrosis. Diffusion-weighted imaging (DWI) (b = 0 and 700 seconds/mm(2)) was performed with a General Electric Company (GE) Signa 1.5T MR unit in 46 infants suffering single congenital hydronephrosis and in 30 healthy infants as normal control group. The ADCs were calculated with regions of interest (ROIs) positioned in the renal parenchyma. The 46 obstructed kidneys were classified into four groups according to the GFR level: renal dysfunction compensated group, renal dysfunction decompensated group, renal failure group, and uremia group. The renal ADCs in six groups (normal kidneys in control group, contralateral kidneys, and four groups of hydronephrotic kidneys) were compared statistically using analysis of variance (ANOVA), and the correlative relationship between ADCs and GFR was examined by Pearson's correlation test. There were statistically significant differences in renal ADCs among the six groups. The ADCs of hydronephrotic kidneys were lower than that of the normal kidneys. There was a moderate positive correlation between the ADCs of hydronephrotic kidneys and split GFR (r = 0.744). This study indicated that the ADCs of congenital hydronephrotic kidneys were lower than that of normal renal parenchyma, and there was a positive correlation between the ADCs and split renal GFR, which demonstrates that the ADCs can reflect the filtration function of hydronephrotic kidneys and may provide some reference to help clinical physician to explore a novel noninvasive approach to evaluate the single renal function.
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Affiliation(s)
- Feifei Lin
- Department of Radiology, The Children Hospital of Shenzhen
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29
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Friedli I, Crowe LA, Viallon M, Porter DA, Martin PY, de Seigneux S, Vallée JP. Improvement of renal diffusion-weighted magnetic resonance imaging with readout-segmented echo-planar imaging at 3T. Magn Reson Imaging 2015; 33:701-8. [DOI: 10.1016/j.mri.2015.02.023] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 02/20/2015] [Indexed: 01/06/2023]
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30
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Renal function impairment in liver cirrhosis: preliminary results with diffusion-weighted imaging at 3 T. AJR Am J Roentgenol 2015; 204:1024-30. [PMID: 25905937 DOI: 10.2214/ajr.14.13418] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE The purpose of this study was to investigate the utility of diffusion-weighted MRI (DWI) at 3 T for assessing renal function impairment in patients with liver cirrhosis. MATERIALS AND METHODS Sixty-four patients with liver cirrhosis who underwent both DWI at 3 T and renal function testing were retrospectively included. Twenty-two patients had moderate or severe renal function impairment (group A, estimated glomerular filtration rate [eGFR] < 60 mL/min/1.73 m(2)) and 42 had good renal function or mild renal function impairment (group B, eGFR ≥ 60 mL/min/1.73 m(2)). Cortical and medullary apparent diffusion coefficients (ADCs) of both kidneys were measured. AUC was assessed for predicting group A with ADC. The correlation between renal ADC and eGFR or serum creatinine was analyzed. The reproducibility of ADC measurement was investigated. RESULTS Both cortical and medullary ADCs were lower in group A than in group B, (both, p < 0.05). In all patients, AUCs were 0.784 and 0.737 with cortical and medullary ADCs, respectively, for predicting group A. Both cortical and medullary ADCs had linear correlation with eGFR or serum creatinine (both, p < 0.05). The reproducibility of measurement was excellent for cortex (intraclass coefficient [ICC] = 0.808) and good for medulla (ICC = 0.692), with 1.6% or less variability. CONCLUSION DWI may have potential for assessing renal function impairment in patients with liver cirrhosis.
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31
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Nononcologic applications of diffusion-weighted imaging in the gastrointestinal system. AJR Am J Roentgenol 2015; 204:758-67. [PMID: 25794064 DOI: 10.2214/ajr.14.12729] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The purpose of this article is to review infectious, inflammatory, and auto-immune-mediated processes in the gastrointestinal system where diffusion-weighted imaging can be helpful as well as pitfalls associated with its use. CONCLUSION Diffusion-weighted imaging has become an important and widely used tool in abdominal and pelvic MRI, but it has been used primarily for oncologic applications. As more body MRI protocols are routinely including diffusion-weighted imaging, this sequence can be useful in evaluating an increasing number of nononcologic processes.
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32
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Assessment of renal artery stenosis using intravoxel incoherent motion diffusion-weighted magnetic resonance imaging analysis. Invest Radiol 2015; 49:640-6. [PMID: 24743589 DOI: 10.1097/rli.0000000000000066] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Diffusion-weighted magnetic resonance imaging is a powerful tool to assess renal morphology. However, its quantitative index, apparent diffusion coefficient (ADC), derived from a conventional monoexponential model can vary with both functional and structural alterations as well as the choice of b values. In contrast, the intravoxel incoherent motion (IVIM) biexponential model provides independent parameters that may represent broader aspects of renal pathophysiology. We hypothesized that IVIM analysis is capable of detecting early morphological and functional changes in the swine kidney distal to renal artery stenosis (RAS). MATERIALS AND METHODS Domestic pigs divided into 3 groups (n = 6-7 each) were studied for 16 weeks. Unilateral RAS was induced in 2 groups, of which 1 group was fed with a high-cholesterol diet to induce early atherosclerosis (ARAS), whereas the other (RAS) consumed regular diet. The third group included healthy pigs that served as control sham. Renal function, hemodynamics, tubular function, and morphology were assessed using multidetector computed tomography and histology. Diffusion-weighted magnetic resonance images were acquired at 3T and analyzed using monoexponential and biexponential models. Parameters of ADC and IVIM (diffusivity [D(t)], flow-dependent pseudodiffusivity [D(p)], and fluid fraction [f(p)]) were calculated in the cortex and medulla of the stenotic (STK) and contralateral kidneys (CLKs). Results were analyzed using analysis of variance, Student t test, and regression analysis. RESULTS In both RAS and ARAS, the STK shrank and the CLK underwent hypertrophy. Glomerular filtration rate and renal blood flow declined in STKs, and CLKs manifested hyperfiltration. In addition, ARAS kidneys showed reduced mean transit time in distal tubular segments. Apparent diffusion coefficient and diffusivity both decreased in STK of RAS and ARAS. D(p) and f(p) were elevated in both the STK and CLK of RAS and more prominently in ARAS. The STK cortical ADC and D(t) correlated inversely with the degree of fibrosis and directly with glomerular filtration rate. Furthermore, D(p) correlated with tubular injury score in all kidneys. CONCLUSIONS Apparent diffusion constant and D(t) both correlated with cortical and medullary fibrosis; however, IVIM-derived parameters can detect subtle functional and structural changes in the post-STK and may also serve as markers for tubular injury.
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Rathod SB, Kumbhar SS, Nanivadekar A, Aman K. Role of diffusion-weighted MRI in acute pyelonephritis: a prospective study. Acta Radiol 2015; 56:244-9. [PMID: 24443116 DOI: 10.1177/0284185114520862] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Imaging is vital in diagnosis of complicated pyelonephritis and has been traditionally performed by computed tomography (CT). However, CT with contrast agents cannot be performed in patients with renal failure. Diffusion-weighted (DW) magnetic resonance imaging (MRI) has the potential to overcome this disadvantage. PURPOSE To prospectively evaluate the accuracy of quantitative apparent diffusion coefficient (ADC) values to differentiate nephritis from renal abscesses in patients with pyelonephritis. MATERIAL AND METHODS Forty-two patients with clinical and laboratory diagnosis of pyelonephritis underwent CT and DW MRI examinations. Diffusion images were obtained by using a non-breath-hold, single-shot echo-planar sequence with b values of 0, 600, and 1000 s/mm(2). Circular regions of interest were places on areas of nephritis, normal renal parenchyma, and renal abscesses as localized by CT and DW MRI images to obtain the ADC values of each of these regions. The ADC values of these three different tissue types were statistically compared using the one-way analysis of variance test for statistical significance. A P value <0.05 was considered to be statistically significant. RESULTS For the diagnosis of pyelonephritis, DW MRI had a higher sensitivity of 95.3% as compared to that of non-contrast CT (66.7%) and contrast-enhanced CT (88.1%). Areas of nephritis had significantly lower ADC values (P < 0.001) than the normal renal cortical parenchyma. Also, renal abscesses had significantly lower ADC values (P < 0.001) than areas of nephritis. However, CT is more useful for the diagnosis of renal calculi and emphysematous pyelonephritis. CONCLUSION ADC values derived from the diffusion sequence have significantly lower values in renal abscesses than in areas of nephritis.
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Affiliation(s)
| | | | | | - Kumar Aman
- Department of Radiology, TN Medical College, Mumbai, India
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34
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Boor P, Perkuhn M, Weibrecht M, Zok S, Martin IV, Gieseke J, Schoth F, Ostendorf T, Kuhl C, Floege J. Diffusion-weighted MRI does not reflect kidney fibrosis in a rat model of fibrosis. J Magn Reson Imaging 2015; 42:990-8. [DOI: 10.1002/jmri.24853] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2014] [Accepted: 01/02/2015] [Indexed: 12/23/2022] Open
Affiliation(s)
- Peter Boor
- Institute of Pathology, RWTH University Aachen; Aachen Germany
- Division of Nephrology, RWTH University Aachen; Aachen Germany
- Electron Microscopic Facility, Medical Faculty RWTH; Aachen Germany
- Institute of Molecular Biomedicine, Comenius University; Bratislava Slovakia
| | - Michael Perkuhn
- Department of Radiology; RWTH University Aachen; Aachen Germany
- Philips Technologie GmbH Innovative Technologies; Research Laboratories; Aachen Germany
| | - Martin Weibrecht
- Department of Radiology; RWTH University Aachen; Aachen Germany
- Philips Technologie GmbH Innovative Technologies; Research Laboratories; Aachen Germany
| | - Stephanie Zok
- Division of Nephrology, RWTH University Aachen; Aachen Germany
| | - Ina V. Martin
- Division of Nephrology, RWTH University Aachen; Aachen Germany
| | | | - Felix Schoth
- Department of Radiology; RWTH University Aachen; Aachen Germany
| | - Tammo Ostendorf
- Division of Nephrology, RWTH University Aachen; Aachen Germany
| | - Christiane Kuhl
- Department of Radiology; RWTH University Aachen; Aachen Germany
| | - Jürgen Floege
- Division of Nephrology, RWTH University Aachen; Aachen Germany
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35
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Apparent diffusion coefficient measurements of bilateral kidneys at 3 T MRI: Effects of age, gender, and laterality in healthy adults. Clin Radiol 2014; 69:e491-6. [DOI: 10.1016/j.crad.2014.08.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Revised: 08/12/2014] [Accepted: 08/13/2014] [Indexed: 02/07/2023]
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36
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Notohamiprodjo M, Chandarana H, Mikheev A, Rusinek H, Grinstead J, Feiweier T, Raya JG, Lee VS, Sigmund EE. Combined intravoxel incoherent motion and diffusion tensor imaging of renal diffusion and flow anisotropy. Magn Reson Med 2014; 73:1526-32. [PMID: 24752998 DOI: 10.1002/mrm.25245] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Revised: 02/19/2014] [Accepted: 03/17/2014] [Indexed: 12/27/2022]
Abstract
PURPOSE We used a combined intravoxel incoherent motion-diffusion tensor imaging (IVIM-DTI) methodology to distinguish structural from flow effects on renal diffusion anisotropy. METHODS Eight volunteers were examined with IVIM-DTI at 3T with 20 diffusion directions and 10 b-values. Mean diffusivity (MD) and fractional anisotropy (FA) from DTI analysis were calculated for low (b ≤ 200 s/mm(2) ), high (b > 200 s/mm(2) ), and full b-value ranges. IVIM-parameters perfusion-fraction fP , pseudo-diffusivity Dp , and tissue-diffusivity Dt were first calculated independently on a voxelwise basis for all directions. After estimating a fixed isotropic fp from these data, global anisotropies of Dt and Dp in the cortex and medulla were determined in a constrained cylindrical description and visualized using polar plots and cosine scatterplots. RESULTS For all b-value ranges, medullary FA was significantly higher than that of the cortex. The corticomedullary difference was smaller for the high b-value range. Significantly higher fp and Dt were determined for the cortex and showed a significantly higher directional variance in the medulla. Polar plot analysis displayed nearly isotropic Dp and Dt in the cortex and anisotropy in the medulla. CONCLUSION Both flow and microstructure apparently contribute to the medullary diffusion anisotropy. The described novel method may be useful in separating decreased tubular flow from irreversible structural tubular damage, for example, in diabetic nephropathy or during allograft rejection.
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Affiliation(s)
- Mike Notohamiprodjo
- Center for Biomedical Imaging, Department of Radiology, NYU Langone Medical Center, New York, New York, USA; Department of Clinical Radiology, University Hospitals Munich, Munich, Germany; Department of Radiology, University Hospital Tuebingen, Tuebingen, Germany
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Zhang JL, Morrell G, Rusinek H, Sigmund EE, Chandarana H, Lerman LO, Prasad PV, Niles D, Artz N, Fain S, Vivier PH, Cheung AK, Lee VS. New magnetic resonance imaging methods in nephrology. Kidney Int 2014; 85:768-78. [PMID: 24067433 PMCID: PMC3965662 DOI: 10.1038/ki.2013.361] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Revised: 07/16/2013] [Accepted: 07/17/2013] [Indexed: 02/06/2023]
Abstract
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.
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Affiliation(s)
- Jeff L Zhang
- Department of Radiology, University of Utah, Salt Lake City, Utah, USA
| | - Glen Morrell
- Department of Radiology, University of Utah, Salt Lake City, Utah, USA
| | - Henry Rusinek
- Department of Radiology, New York University, New York, New York, USA
| | - Eric E Sigmund
- Department of Radiology, New York University, New York, New York, USA
| | - Hersh Chandarana
- Department of Radiology, New York University, New York, New York, USA
| | - Lilach O Lerman
- Department of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | | | - David Niles
- Department of Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Nathan Artz
- Department of Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Sean Fain
- Department of Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | | | - Alfred K Cheung
- Division of Nephrology and Hypertension, University of Utah, Salt Lake City, Utah, USA
| | - Vivian S Lee
- Department of Radiology, University of Utah, Salt Lake City, Utah, USA
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38
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Koçyiğit A, Bayram R, Yüksel S, Yılmaz I, Karabulut N. Diffusion weighted magnetic resonance imaging of kidneys in children with vesicoureteral reflux. Eur J Radiol 2014; 83:e56-e60. [PMID: 24161782 DOI: 10.1016/j.ejrad.2013.09.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Revised: 09/25/2013] [Accepted: 09/30/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE The apparent diffusion coefficient (ADC) which obtain from diffusion-weighted magnetic resonance imaging (DWI), is a quantitative parameter representing the renal function and parenchymal damage in some renal disorders. The primary aim of this study was to investigate whether renal tissue alterations associated with vesicoureteral reflux (VUR) can be displayed by DWI. The secondary aim was to assess how ADC values change with age in kidneys with and without VUR. MATERIALS AND METHODS This prospective study included 46 patients (8 boys, 38 girls; mean age 7.3 ± 4.2; range 1-15 years) with VUR and 54 control subjects (21 boys, 33 girls; mean age 7.7 ± 5.2; range 1-17 years). All subjects underwent DWI of the kidneys using b value of 600s/mm(2) in addition to MR urography. The ADC values of 71 kidneys with VUR were compared with those of 81 kidneys without VUR. RESULTS The mean ADC values were (1.93 ± 0.36)×10(-3)mm(2)/s, (1.97 ± 0.24)× 10(-3)mm(2)/s, (1.83 ± 0.37)× 10(-3)mm(2)/s, (1.98 ± 0.20)×10(-3)mm(2)/s and (2.08 ± 0.42)× 10(-3)mm(2)/s in normal kidneys, and in those with grade 1, grade 2, grade 3 and grade 4 VUR, respectively. There was no significant difference in ADC values between kidneys with and without VUR. There was a significant positive correlation between the age and ADC values both in kidneys with and without VUR (r=0.79, p<0.001 and r=0.82; p<0.001, respectively). CONCLUSION DWI does not reveal probable parenchymal alterations in reflux nephropathy. ADC values increase with age during childhood not only in normal kidneys but also in kidneys with VUR.
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Affiliation(s)
- Ali Koçyiğit
- Pamukkale University Faculty of Medicine, Department of Radiology, Denizli, Turkey.
| | - Recep Bayram
- Pamukkale University Faculty of Medicine, Department of Radiology, Denizli, Turkey
| | - Selçuk Yüksel
- Pamukkale University Faculty of Medicine, Department of Pediatric Nephrology, Denizli, Turkey
| | - Ismail Yılmaz
- Pamukkale University Faculty of Medicine, Department of Radiology, Denizli, Turkey
| | - Nevzat Karabulut
- Pamukkale University Faculty of Medicine, Department of Radiology, Denizli, Turkey
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Jaimes C, Darge K, Khrichenko D, Carson RH, Berman JI. Diffusion tensor imaging and tractography of the kidney in children: feasibility and preliminary experience. Pediatr Radiol 2014; 44:30-41. [PMID: 24022583 DOI: 10.1007/s00247-013-2774-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Revised: 07/01/2013] [Accepted: 07/26/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Functional magnetic resonance urography (fMRU) provides morphological and functional information based on perfusion. Diffusion tensor imaging (DTI) complements fMRU by measuring renal microstructure and provides insight into the relationship between renal structure and function. OBJECTIVE To evaluate the feasibility and utility of renal DTI and tractography in the setting of fMRU in children. MATERIALS AND METHODS We prospectively enrolled 9 children (6 boys, 3 girls) with a mean age of 4.3 years (range 6 months to 14.8 years). All children were examined with MRI at 3.0 tesla. DTI was acquired with an echo-planar sequence (TR/TE = 2,300/69 ms, b = 300 s/mm2) with 12 non-collinear directions and 3 signal averages. Functional MRU results were used to group the moieties as normal or abnormal. Regions of interest were placed in the medulla and cortex to measure DTI parameters of microstructure. DTI tractography measures of parenchymal volume were compared to fMRU-derived volumes. RESULTS We analyzed 19 moieties (13 normal; 6 abnormal). Tractography of normal moieties showed numerous tracks with a radial arrangement and convergence into pyramids. Abnormal moieties did not show the radial arrangement or converging architecture and had tracks that were loosely arranged and left hollow spaces. Tractography volume correlated with MRU parenchymal volume (r 2 = 0.93, P < 0.005) and abnormal moieties exhibited greater tractography volume than normal moieties (P < 0.005). Tractography volume also correlated with age of the child (P < 0.001). In normal moieties, the medulla had higher fractional anisotropy (0.401 +/−0.05) than the cortex (0.183 +/− 0.03) (P < 0.001); fractional anisotropy in these regions did not change with age (P > 0.1). There were no differences in apparent diffusion coefficient values between the cortex and medulla (P > 0.5). We observed a trend of increasing apparent diffusion coefficient values with age in the cortex and medulla, which did not reach statistical significance (cortex: r2 = 0.21, P > 0.1; medulla: r2 = 0.135, P > 0.1). CONCLUSION DTI with tractography is feasible in children and can complement the functional information obtained from fMRU.
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Schmid-Tannwald C, Oto A, Reiser MF, Zech CJ. Diffusion-weighted MRI of the abdomen: current value in clinical routine. J Magn Reson Imaging 2013; 37:35-47. [PMID: 23255414 DOI: 10.1002/jmri.23643] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2011] [Accepted: 02/17/2012] [Indexed: 02/01/2023] Open
Abstract
Magnetic resonance imaging (MRI) provides high tissue contrast without ionizing radiation exposure and unenhanced images are often diagnostic. Therefore, MRI is especially an attractive tool for patients with allergies for gadolinium-based contrast agents or renal failure. Technical advantages have led to the increasing use of diffusion-weighted (DW) MRI in abdominal imaging, which provides qualitative and quantitative information of tissue cellularity and the integrity of cellular membranes. This review article presents the current status of noncontrast MRI with the focus of DW-MRI. Technical background and clinical applications are explained and discussed.
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Morani AC, Elsayes KM, Liu PS, Weadock WJ, Szklaruk J, Dillman JR, Khan A, Chenevert TL, Hussain HK. Abdominal applications of diffusion-weighted magnetic resonance imaging: Where do we stand. World J Radiol 2013; 5:68-80. [PMID: 23671743 PMCID: PMC3650207 DOI: 10.4329/wjr.v5.i3.68] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2012] [Revised: 10/21/2012] [Accepted: 01/31/2013] [Indexed: 02/06/2023] Open
Abstract
Diffusion-weighted imaging (DWI) is one of the magnetic resonance imaging (MRI) sequences providing qualitative as well as quantitative information at a cellular level. It has been widely used for various applications in the central nervous system. Over the past decade, various extracranial applications of DWI have been increasingly explored, as it may detect changes even before signal alterations or morphological abnormalities become apparent on other pulse sequences. Initial results from abdominal MRI applications are promising, particularly in oncological settings and for the detection of abscesses. The purpose of this article is to describe the clinically relevant basic concepts of DWI, techniques to perform abdominal DWI, its analysis and applications in abdominal visceral MR imaging, in addition to a brief overview of whole body DWI MRI.
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Korsmo MJ, Ebrahimi B, Eirin A, Woollard JR, Krier JD, Crane JA, Warner L, Glaser K, Grimm R, Ehman RL, Lerman LO. Magnetic resonance elastography noninvasively detects in vivo renal medullary fibrosis secondary to swine renal artery stenosis. Invest Radiol 2013; 48:61-8. [PMID: 23262789 PMCID: PMC3694773 DOI: 10.1097/rli.0b013e31827a4990] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Magnetic resonance elastography (MRE) can noninvasively sample tissue stiffness in vivo. Renal fibrosis secondary to renal artery stenosis (RAS), which is aggravated in atherosclerotic RAS (ARAS), may increase its stiffness. An increase in cortical stiffness in vivo can be masked by intrinsic hemodynamic determinants, whereas renal medullary stiffness is less dependent on renal hemodynamics. Therefore, this study tested the hypothesis that MRE-determined medullary stiffness would correspond to the histological degree of medullary fibrosis in stenotic kidneys in RAS and detect its exacerbation in ARAS. MATERIALS AND METHODS Seventeen pigs were studied 10 weeks after induction of unilateral RAS (n = 6), ARAS (n = 5), or sham (n = 6). Stiffness of the cortex and the medulla was determined through 3-dimensional MRE, and renal perfusion and function were determined using multidetector computed tomography. Kidney fibrosis was subsequently assessed ex vivo using the Masson trichrome staining. RESULTS Renal stenotic cortex and medulla were significantly more fibrotic in RAS and ARAS compared with healthy kidney. However, MRE detected increased stiffness in RAS compared with the healthy kidney (12.7 ± 0.41 kPa vs 10.7 ± 0.18 kPa; P = 0.004) only in the medulla, which was further increased in ARAS (16.6 ± 1.3 kPa; P = 0.017 vs RAS). Magnetic resonance elastography-derived medullary, but not cortical, stiffness significantly correlated with histological degree of fibrosis, although cortical and medullary fibroses were correlated. Renal blood flow and function were similarly decreased in RAS and ARAS compared with the healthy kidney. CONCLUSIONS Noninvasive 3-dimensional MRE detects increased renal medullary stiffness in RAS and ARAS in vivo, which correlates with its fibrosis ex vivo and may also reflect cortical fibrosis. Hence, MRE-derived medullary stiffness can be potentially useful in detecting renal fibrosis and track disease progression.
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Affiliation(s)
- Michael J Korsmo
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
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Sigmund EE, Vivier PH, Sui D, Lamparello NA, Tantillo K, Mikheev A, Rusinek H, Babb JS, Storey P, Lee VS, Chandarana H. Intravoxel incoherent motion and diffusion-tensor imaging in renal tissue under hydration and furosemide flow challenges. Radiology 2012; 263:758-69. [PMID: 22523327 DOI: 10.1148/radiol.12111327] [Citation(s) in RCA: 184] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE To assess the reproducibility and the distribution of intravoxel incoherent motion (IVIM) and diffusion-tensor (DT) imaging parameters in healthy renal cortex and medulla at baseline and after hydration or furosemide challenges. MATERIALS AND METHODS Using an institutional review board-approved HIPAA-compliant protocol with written informed consent, IVIM and DT imaging were performed at 3 T in 10 volunteers before and after water loading or furosemide administration. IVIM (apparent diffusion coefficient [ADC], tissue diffusivity [D(t)], perfusion fraction [f(p)], pseudodiffusivity [D(p)]) and DT (mean diffusivity [MD], fractional anisotropy [FA], eigenvalues [λ(i)]) imaging parameters and urine output from serial bladder volumes were calculated. (a)Reproducibility was quantified with coefficient of variation, intraclass correlation coefficient, and Bland-Altman limits of agreement; (b) contrast and challenge response were quantified with analysis of variance; and (c) Pearson correlations were quantified with urine output. RESULTS Good reproducibility was found for ADC, D(t), MD, FA, and λ(i) (average coefficient of variation, 3.7% [cortex] and 5.0% [medulla]), and moderate reproducibility was found for D(p), f(p), and f(p) · D(p) (average coefficient of variation, 18.7% [cortex] and 25.9% [medulla]). Baseline cortical diffusivities significantly exceeded medullary values except D(p), for which medullary values significantly exceeded cortical values, and λ(1,) which showed no contrast. ADC, D(t), MD, and λ(i) increased significantly for both challenges. Medullary diffusivity increases were dominated by transverse diffusion (1.72 ± 0.09 [baseline] to 1.79 ± 0.10 [hydration] μm(2)/msec, P = .0059; or 1.86 ± 0.07 [furosemide] μm(2)/msec, P = .0094). Urine output correlated with cortical ADC with furosemide (r = 0.7, P = .034) and with medullary λ(1) (r = 0.83, P = .0418), λ(2) (r = 0.85, P = .0301), and MD (r = 0.82, P = .045) with hydration. CONCLUSION Diffusion MR metrics are sensitive to flow changes in kidney induced by diuretic challenges. The results of this study suggest that vascular flow, tubular dilation, water reabsorption, and intratubular flow all play important roles in diffusion-weighted imaging contrast.
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Affiliation(s)
- Eric E Sigmund
- Department of Radiology, NYU Langone Medical Center, 660 First Ave, 4th Floor, New York, NY 10016, USA.
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44
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Mannelli L, Maki JH, Osman SF, Chandarana H, Lomas DJ, Shuman WP, Linnau KF, Green DE, Laffi G, Moshiri M. Noncontrast functional MRI of the kidneys. Curr Urol Rep 2012; 13:99-107. [PMID: 22102220 DOI: 10.1007/s11934-011-0229-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Functional magnetic resonance imaging (fMRI) techniques enable noninvasive assessment of renal function. Diffusion-weighted imaging, diffusion tensor imaging, blood oxygen level-dependent MRI, magnetic resonance elastography, and arterial spin labeling are some of the emerging techniques that have potential to investigate renal function without the use of exogenous gadolinium contrast. This article discusses the principles of these techniques, as well as their possible applications and limitations. This will introduce the readers to these novel imaging tools, which appear to have promising futures.
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Affiliation(s)
- Lorenzo Mannelli
- Department of Radiology, University of Washington, Seattle, WA 98104, USA.
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45
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Attenberger UI, Morelli JN, Schoenberg SO, Michaely HJ. Assessment of the kidneys: magnetic resonance angiography, perfusion and diffusion. J Cardiovasc Magn Reson 2011; 13:70. [PMID: 22085467 PMCID: PMC3228749 DOI: 10.1186/1532-429x-13-70] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2011] [Accepted: 11/15/2011] [Indexed: 01/03/2023] Open
Abstract
Renal magnetic resonance (MR) imaging has undergone major improvements in the past several years. This review focuses on the technical basics and clinical applications of MR angiography (MRA) with the goal of enabling readers to acquire high-resolution, high quality renal artery MRA. The current role of contrast agents and their safe use in patients with renal impairment is discussed. In addition, an overview of promising techniques on the horizon for renal MR is provided. The clinical value and specific applications of renal MR are critically discussed.
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Affiliation(s)
- Ulrike I Attenberger
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - John N Morelli
- Scott and White Memorial Hospital and Clinic - Texas A&M University Health Sciences Center, Temple, TX, USA
| | - Stefan O Schoenberg
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Henrik J Michaely
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
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46
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Wang CL, Chea YW, Boll DT, Samei E, Neville AM, Dale BM, Merkle EM. Effect of gadolinium chelate contrast agents on diffusion weighted MR imaging of the liver, spleen, pancreas and kidney at 3T. Eur J Radiol 2011; 80:e1-7. [DOI: 10.1016/j.ejrad.2010.05.019] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2010] [Revised: 05/19/2010] [Accepted: 05/21/2010] [Indexed: 12/27/2022]
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47
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Zhang JL, Sigmund EE, Rusinek H, Chandarana H, Storey P, Chen Q, Lee VS. Optimization of b-value sampling for diffusion-weighted imaging of the kidney. Magn Reson Med 2011; 67:89-97. [PMID: 21702062 DOI: 10.1002/mrm.22982] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2011] [Accepted: 04/05/2011] [Indexed: 12/20/2022]
Abstract
Diffusion-weighted imaging (DWI) involves data acquisitions at multiple b values. In this paper, we presented a method of selecting the b values that maximize estimation precision of the biexponential analysis of renal DWI data. We developed an error propagation factor for the biexponential model, and proposed to optimize the b-value samplings by minimizing the error propagation factor. A prospective study of four healthy human subjects (eight kidneys) was done to verify the feasibility of the proposed protocol and to assess the validity of predicted precision for DWI measures, followed by Monte Carlo simulations of DWI signals based on acquired data from renal lesions of 16 subjects. In healthy subjects, the proposed methods improved precision (P = 0.003) and accuracy (P < 0.001) significantly in region-of-interest based biexponential analysis. In Monte Carlo simulation of renal lesions, the b-sampling optimization lowered estimation error by at least 20-30% compared with uniformly distributed b values, and improved the differentiation between malignant and benign lesions significantly. In conclusion, the proposed method has the potential of maximizing the precision and accuracy of the biexponential analysis of renal DWI.
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Affiliation(s)
- Jeff L Zhang
- Department of Radiology, New York University, New York, New York, USA.
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48
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Abstract
Applications of diffusion-weighted (DW) magnetic resonance (MR) imaging outside the brain have gained increasing importance in recent years. Owing to technical improvements in MR imaging units and faster sequences, the need for noninvasive imaging without contrast medium administration, mainly in patients with renal insufficiency, can be met successfully by applying this technique. DW MR imaging is quantified by the apparent diffusion coefficient (ADC), which provides information on diffusion and perfusion simultaneously. By using a biexponential fitting process of the DW MR imaging data, these two entities can be separated, because this type of fitting process can serve as an estimate of both the perfusion fraction and the true diffusion coefficient. DW MR imaging can be applied for functional evaluation of the kidneys in patients with acute or chronic renal failure. Impairment of renal function is accompanied by a decreased ADC. Acute ureteral obstruction leads to perfusion and diffusion changes in the affected kidney, and renal artery stenosis results in a decreased ADC. In patients with pyelonephritis, diffuse or focal changes in signal intensity are seen on the high-b-value images, with increased signal intensity corresponding to low signal intensity on the ADC map. The feasibility and reproducibility of DW MR imaging in patients with transplanted kidneys have already been demonstrated, and initial results seem to be promising for the assessment of allograft deterioration. Overall, performance of renal DW MR imaging, presuming that measurements are of high quality, will further boost this modality, particularly for early detection of diffuse renal conditions, as well as more accurate characterization of focal renal lesions.
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Affiliation(s)
- Harriet C Thoeny
- Department of Radiology, Neuroradiology and Nuclear Medicine, University of Bern, Inselspital, Freiburgstrasse 10, CH-3010 Bern, Switzerland.
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Bittencourt LK, Matos C, Coutinho AC. Diffusion-weighted magnetic resonance imaging in the upper abdomen: technical issues and clinical applications. Magn Reson Imaging Clin N Am 2011; 19:111-31. [PMID: 21129638 DOI: 10.1016/j.mric.2010.09.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Recent technological achievements have enabled the transposition of diffusion-weighted imaging (DWI) with good diagnostic quality into other body regions, especially the abdomen and pelvis. Many emerging and established applications are now being evaluated on the upper abdomen, the liver being the most studied organ. This article discusses imaging strategies for DWI on the upper abdomen, describes the clinical protocol, and reviews the most common clinical applications of DWI on solid abdominal organs.
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Affiliation(s)
- Leonardo K Bittencourt
- Clínica de Diagnóstico por Imagem, Carlos Bittencourt Diagnóstico por Imagem and Department of Radiology, Rio de Janeiro Federal University (UFRJ), Av. Das Américas, 4666, Centro Medico, Sala 325, Rio de Janeiro 22649-900, Brazil.
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50
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Notohamiprodjo M, Reiser MF, Sourbron SP. Diffusion and perfusion of the kidney. Eur J Radiol 2010; 76:337-47. [PMID: 20580179 DOI: 10.1016/j.ejrad.2010.05.033] [Citation(s) in RCA: 132] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2010] [Accepted: 05/28/2010] [Indexed: 01/18/2023]
Abstract
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.
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Affiliation(s)
- Mike Notohamiprodjo
- Department of Clinical Radiology, University Hospitals Munich, Campus Großhadern, Marchioninistrasse 15, 81377 Munich, Germany.
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