Evaluation of Renal Blood Flow and Oxygenation in CKD Using Magnetic Resonance Imaging

Khatir, Dinah Sherzad; Pedersen, Michael; Jespersen, Bente; Buus, Niels Henrik

doi:10.1053/j.ajkd.2014.11.022

Cited by 71 publications

(63 citation statements)

References 45 publications

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“…This is in good agreement with a recent report that evaluated ASL perfusion MRI in diabetic nephropathy [21]. It is also consistent with the report by Khatir et al [39] on renal artery blood flow using phase contrast MRI. The novel finding in this study is the significant association of renal perfusion with eGFR_slope, a marker of progressive CKD (Tables 3, 4a; Fig.…”

Section: Discussionsupporting

confidence: 93%

Cortical Perfusion and Tubular Function as Evaluated by Magnetic Resonance Imaging Correlates with Annual Loss in Renal Function in Moderate Chronic Kidney Disease

Prasad

Thacker

et al. 2019

Am J Nephrol

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Background: Chronic hypoxia is a well-recognized factor in the pathogenesis of chronic kidney disease (CKD). Loss of microcirculation is thought to lead to enhanced renal hypoxia, which in turn results in the development of fibrosis, a hallmark of progressive CKD. To evaluate the role of functional magnetic resonance imaging (MRI), we performed perfusion, oxygenation, and diffusion MRI measurements in individuals with diabetes and stage 3 CKD. Methods: Fifty-four subjects (41 individuals with diabetes and stage 3 CKD and 13 healthy controls) participated in this study. Data with blood oxygenation level dependent (BOLD), arterial spin labeling perfusion and diffusion MRI were acquired using a 3T scanner. Results: Renal cortical perfusion was reduced in CKD compared to the controls (109.54 ± 25.38 vs. 203.17 ± 27.47 mL/min/100 g; p < 0.001). Cortical apparent diffusion coefficient showed no significant reduction in CKD compared to controls (1,596.10 ± 196.64 vs. 1,668.72 ± 77.29 × 10^–6 mm²/s; p = 0.45) but was significantly associated with perfusion. Cortical R2* values were modestly increased in CKD (20.76 ± 4.08 vs. 18.74 ± 2.37 s^–1; p = 0.12). Within the CKD group, R2*_Medulla and R2*_Kidney were moderately and negatively associated with estimated glomerular filtration rate. There was a significant association between cortical perfusion and medullary response to furosemide with annual loss of renal function, used as an estimate of CKD progression. Conclusions: Subjects with a moderate degree of CKD had significantly lower renal perfusion. Diffusion and BOLD MRI showed more modest differences between the groups. Individuals with progressive CKD had lower perfusion and response to furosemide.

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Section: Discussionsupporting

confidence: 93%

Cortical Perfusion and Tubular Function as Evaluated by Magnetic Resonance Imaging Correlates with Annual Loss in Renal Function in Moderate Chronic Kidney Disease

Prasad

Thacker

et al. 2019

Am J Nephrol

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“…Unfortunately, many of the “early” studies lacked information on drug-or sodium intake, did not standardize water intake, or did not differentiate between the underlying causes of CKD. However, even well-designed studies failed to show differences in R2 * between persons with and without CKD (Khatir et al, 2015). It has become clear that the analysis technique has a large impact on the results.…”

Section: Bold-mri In Ckdmentioning

confidence: 99%

Blood Oxygenation Level-Dependent MRI to Assess Renal Oxygenation in Renal Diseases: Progresses and Challenges

2017

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BOLD-MRI (blood oxygenation-level dependent magnetic resonance imaging) allows non-invasive measurement of renal tissue oxygenation in humans, without the need for contrast products. BOLD-MRI uses the fact that magnetic properties of hemoglobin depend of its oxygenated state:: the higher local deoxyhemoglobin, the higher the so called apparent relaxation rate R2* (sec−1), and the lower local tissue oxygen content. Several factors other than deoxyhemoglobin (such as hydration status, dietary sodium intake, and susceptibility effects) influence the BOLD signal, and need to be taken into account when interpreting results. The last 5 years have witnessed important improvements in the standardization of these factors, and the appearance of new, highly reproducible analysis techniques of BOLD-images, that are reviewed in this article. Using these new BOLD-MRI analysis techniques, it has recently been shown that persons suffering from chronic kidney diseases (CKD) have lower cortical oxygenation than normotensive controls, thus confirming the chronic hypoxia hypothesis. The acute alterations in R2* after the administration of furosemide are smaller in CKD, and represent an estimate of the oxygen-dependent tubular transport of sodium. BOLD-MRI-alone or in combination with other functional MRI methods- can be used to monitor the renal effects of drugs, and is increasingly used in the preclinical setting. The near future will tell whether or not BOLD-MRI represents a new tool to predict renal function decline an adverse renal outcome.

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“…Renal perfusion, often reported as renal plasma flow (RPF), has been shown to be a valuable parameter for assessing renal diseases including chronic kidney disease [1], renal artery stenosis [2], and diabetic nephropathy [3,4]. Para-aminohippurate (PAH) clearance methods for measuring RPF [5,6] involve complicated procedures requiring urine collection and blood sampling [7], and do not measure RPF separately for the individual kidneys.…”

Section: Introductionmentioning

confidence: 99%

Renal plasma flow (RPF) measured with multiple-inversion-time arterial spin labeling (ASL) and tracer kinetic analysis: Validation against a dynamic contrast-enhancement method

Conlin

Oesingmann

Bolster³

et al. 2017

Magnetic Resonance Imaging

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Purpose-To propose and validate a method for accurately quantifying renal plasma flow (RPF) with arterial spin labeling (ASL).Materials and methods-The proposed method employs a tracer-kinetic approach and derives perfusion from the slope of the ASL difference signal sampled at multiple inversion-times (TIs). To validate the method's accuracy, we performed a HIPAA-compliant and IRB-approved study with 15 subjects (9 male, 6 female; age range 24-73) to compare RPF estimates obtained from ASL to those from a more established dynamic contrast-enhanced (DCE) MRI method. We also investigated the impact of TI-sampling density on the accuracy of estimated RPF.Results-Good agreement was found between ASL-and DCE-measured RPF, with a mean difference of 9 ± 30 ml/min and a correlation coefficient R = 0.92 when ASL signals were acquired at 16 TIs and a mean difference of 9 ± 57 ml/min and R = 0.81 when ASL signals were acquired at 5 TIs. RPF estimated from ASL signals acquired at only 2 TIs (400 and 1200 ms) showed a low correlation with DCE-measured values (R = 0.30). Conclusion-The proposed ASL method is capable of measuring RPF with an accuracy that is comparable to DCE MRI. At least 5 TIs are recommended for the ASL acquisition to ensure reliability of RPF measurements.

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Evaluation of Renal Blood Flow and Oxygenation in CKD Using Magnetic Resonance Imaging

Cited by 71 publications

References 45 publications

Cortical Perfusion and Tubular Function as Evaluated by Magnetic Resonance Imaging Correlates with Annual Loss in Renal Function in Moderate Chronic Kidney Disease

Cortical Perfusion and Tubular Function as Evaluated by Magnetic Resonance Imaging Correlates with Annual Loss in Renal Function in Moderate Chronic Kidney Disease

Blood Oxygenation Level-Dependent MRI to Assess Renal Oxygenation in Renal Diseases: Progresses and Challenges

Renal plasma flow (RPF) measured with multiple-inversion-time arterial spin labeling (ASL) and tracer kinetic analysis: Validation against a dynamic contrast-enhancement method

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