Magnetic resonance imaging biomarkers for chronic kidney disease: a position paper from the European Cooperation in Science and Technology Action PARENCHIMA

Abstract

Functional renal magnetic resonance imaging (MRI) has seen a number of recent advances, and techniques are now available that can generate quantitative imaging biomarkers with the potential to improve the management of kidney disease. Such biomarkers are sensitive to changes in renal blood flow, tissue perfusion, oxygenation and microstructure (including inflammation and fibrosis), processes that are important in a range of renal diseases including chronic kidney disease. However, several challenges remain to move these techniques towards clinical adoption, from technical validation through biological and clinical validation, to demonstration of cost-effectiveness and regulatory qualification. To address these challenges, the European Cooperation in Science and Technology Action PARENCHIMA was initiated in early 2017. PARENCHIMA is a multidisciplinary pan-European network with an overarching aim of eliminating the main barriers to the broader evaluation, commercial exploitation and clinical use of renal MRI biomarkers. This position paper lays out PARENCHIMA’s vision on key clinical questions that MRI must address to become more widely used in patients with kidney disease, first within research settings and ultimately in clinical practice. We then present a series of practical recommendations to accelerate the study and translation of these techniques.

MRI in autosomal dominant polycystic kidney disease

“…Characterizing the severity of ADPKD by measuring kidney volumes is tedious, imprecise, and only indirectly measures the disease activity. More functional measures such as renal blood flow, renal parenchymal T 1 and T 2 mapping, multi‐B value DWI including intravoxel incoherent motion analysis, blood oxygen level‐dependent (BOLD) MRI, MR elastography, and dynamic contrast enhancement to assess renal perfusion and fibrotic activity may more directly measure the renal damage allowing for earlier detection of subclinical changes.…”

Comparing the interobserver reproducibility of different regions of interest on multi-parametric renal magnetic resonance imaging in healthy volunteers, patients with heart failure and renal transplant recipients

“…Multi-parametric magnetic resonance imaging (MRI) allows acquisition of multiple sequences with potential to inform regarding structure, tissue composition, perfusion, and physiology of renal function in a single scan [2]. However, the clinical utility of each sequence, and indeed the potential additive benefit of their use together, are yet to be proven.…”

Probing renal blood volume with magnetic resonance imaging

“…It is well recognized that dynamic contrast‐enhanced (DCE) methods in conjunction with tracer kinetic principles provide a viable alternative for the quantification of renal perfusion and blood volume . For this purpose, bolus injection of exogenous contrast agents like gadolinium (Gd) chelates or iron oxide nanoparticles is administered .…”

“…24 It is well recognized that dynamic contrast-enhanced (DCE) methods in conjunction with tracer kinetic principles provide a viable alternative for the quantification of renal perfusion and blood volume. 29,[78][79][80][81] For this purpose, bolus injection of exogenous contrast agents like gadolinium (Gd) chelates or iron oxide nanoparticles is administered. [82][83][84][85] Tracking and analysing the dynamic susceptibility contrast (DSC) changes during first-pass contrast agent bolus passage through the kidney requires fast imaging techniques with a temporal resolution of ≤ 1 s. It also requires the measurement of the arterial concentration-time-curve, designated as the arterial input function and its deconvolution from the time course of signal intensity in renal tissue.…”