Quantitative Evaluation of Acute Renal Transplant Dysfunction with Low-Dose Three-dimensional MR Renography

Yamamoto, Akira; Zhang, Jeff L.; Rusinek, Henry; Chandarana, Hersh; Vivier, P.-H.; Babb, James S.; Diflo, Thomas; John, Devon; Benstein, Judith A.; Barisoni, Laura; Stoffel, David R.; Lee, Vivian S.

doi:10.1148/radiol.11101664

Cited by 36 publications

(35 citation statements)

References 28 publications

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“…A significantly higher RPF in the cortex compared to the medulla is expected for the more vascularized cortex. A three-compartment model was chosen, rather than simpler models (Patlak plot, whole-kidney or dual compartment) because it permits separation of cortical and medullary function, and was previously shown to provide information on renal tubular function, and to differentiate between acute rejection and acute tubular necrosis of renal allografts (27). Like previous investigators, we found that the model–derived GFR was systematically lower than serum eGFR (2).…”

Section: Discussionmentioning

confidence: 99%

Assessment of renal function using intravoxel incoherent motion diffusion‐weighted imaging and dynamic contrast‐enhanced MRI

Bane

Wagner

Zhang

et al. 2016

Magnetic Resonance Imaging

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Objective To assess the correlation between each of intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) and dynamic contrast-enhanced MRI (DCE-MRI) metrics in renal parenchyma with renal function, in a cohort of patients with chronic liver disease. Materials and Methods Thirty patients with liver disease underwent abdominal MRI at 1.5T, including a respiratory-triggered IVIM-DWI sequence and a coronal 3D FLASH DCE-MRI acquisition. Diffusion signals in the renal cortex and medulla were fitted to the IVIM model to estimate the diffusion coefficient (D), pseudodiffusion coefficient (D*) and perfusion fraction (PF). Apparent diffusion coefficient (ADC) was calculated using all b-values. GFR, cortical and medullary renal plasma flow (RPF), mean transit times (MTT) of vascular and tubular compartments and the whole kidney, were calculated from DCE-MRI data by fitting to a three-compartment model. eGFR was calculated from serum creatinine measured 30 ± 27 days of MRI. Results ADC, PF, and RPF were significantly higher in renal cortex vs medulla (p < 10−5). DCE-MRI GFR significantly correlated with, but under-estimated eGFR (Spearman’s r/p=0.49/0.01). IVIM-DWI parameters were not significantly correlated with eGFR. DCE-MRI GFR correlated weakly with D (cortex, r/p=0.3/0.03; medulla r/p=0.27/0.05) and ADC (cortex r/p=0.28/0.04; medulla r/p=0.34/0.01). Weak correlations were observed for pooled cortical and medullar RPF with PF (r/p=0.32/10−3) and with ADC (r/p=0.29/0.0025). Significant negative correlations were observed for vascular MTT with cortical D* (r/p=−0.38/0.004) and D*×PF (r/p=−0.34/0.01). Conclusion The weak correlations between renal IVIM and DCE-MRI perfusion parameters imply that these functional measures could be complementary.

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Section: Discussionmentioning

confidence: 99%

Assessment of renal function using intravoxel incoherent motion diffusion‐weighted imaging and dynamic contrast‐enhanced MRI

Bane

Wagner

Zhang

et al. 2016

Magnetic Resonance Imaging

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“…New advances in the quick acquisition of dynamic, postcontrast, time-resolved images and delayed postcontrast excretion urographic images have introduced comprehensive MR nephro-urography and renography, enabling quantitative measurements of renal function, including individual kidney GFR and renal blood flow, in postprocessing. More recently, multicompartm ental kinetic modeling was applied in the postprocessing of MR renography, generating separate parameters for the vascular and tubular compartments [21][22][23][24] . This model benefits from the use of the lowest possible concentration of gadolinium-chelate [3] .…”

Section: Mr Nephro-urography/renographymentioning

confidence: 99%

“…To assess intrinsic causes of renal dysfunction, such as AR and ATN, Yamamoto et al [24] performed quantitative low-dose 3D MR renography on sixty patients with transplanted kidneys. The GFR and the mean transit time (MTT) of the tracer were calculated using a multicompartment renal model.…”

Section: Mr Nephro-urography/renographymentioning

confidence: 99%

Functional assessment of transplanted kidneys with magnetic resonance imaging

Wang

Yin

et al. 2015

WJR

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Kidney transplantation has emerged as the treatment of choice for many patients with end-stage renal disease, which is a significant cause of morbidity and mortality. Given the shortage of clinically available donor kidneys and the significant incidence of allograft dysfunction, a noninvasive and accurate assessment of the allograft renal function is critical for postoperative management. Prompt diagnosis of graft dysfunction facilitates clinical intervention of kidneys with salvageable function. New advances in magnetic resonance imaging (MRI) technology have enabled the calculation of various renal parameters that were previously not feasible to measure noninvasively. Diffusion-weighted imaging provides information on renal diffusion and perfusion simultaneously, with quantification by the apparent diffusion coefficient, the decrease of which reflects renal function impairment. Diffusion-tensor imaging accounts for the directionality of molecular motion and measures fractional anisotropy of the kidneys. Blood oxygen level-dependent MR evaluates intrarenal oxygen bioavailability, generating the parameter of R2* (reflecting the concentration of deoxyhemoglobin). A decrease in R2* could happen during acute rejection. MR nephro-urography/renography demonstrates structural data depicting urinary tract obstructions and functional data regarding the glomerular filtration and blood flow. MR angiography details the transplant vasculature and is particularly suitable for detecting vascular complications, with good correlation with digital subtraction angiography. Other functional MRI technologies, such as arterial spin labeling and MR spectroscopy, are showing additional promise. This review highlights MRI as a comprehensive modality to diagnose a variety of etiologies of graft dysfunction, including prerenal (e.g. , renal vasculature), renal (intrinsic causes) and postrenal (e.g. , obstruction of the collecting system) etiologies.

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“…Another problem is the potential nephrotoxicity of the gadolinium which is generally used as contrast agent in a chelated form. Using low dose three dimensional magnetic resonance renography, the mean transit time of the tracer for the different compartment of the kidney (vascular, tubular and collecting system) was measured different in normal kidneys, transplanted kidneys with acute tubular necrosis and transplanted kidney with acute rejection (Yamamoto et al, 2011) indicating that a multicompartimental tracer kinetic renal model may help to differentiate acute rejection from acute tubular necrosis in transplanted kidney.…”

Section: Magnetic Resonance In Vivo 31 Mrimentioning

confidence: 99%

Magnetic Resonance Spectroscopy (MRS) in Kidney Transplantation: Interest and Perspectives

Bon¹,

François²,

Hauet³

2012

Magnetic Resonance Spectroscopy

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Quantitative Evaluation of Acute Renal Transplant Dysfunction with Low-Dose Three-dimensional MR Renography

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

Cited by 36 publications

References 28 publications

Assessment of renal function using intravoxel incoherent motion diffusion‐weighted imaging and dynamic contrast‐enhanced MRI

Assessment of renal function using intravoxel incoherent motion diffusion‐weighted imaging and dynamic contrast‐enhanced MRI

Functional assessment of transplanted kidneys with magnetic resonance imaging

Magnetic Resonance Spectroscopy (MRS) in Kidney Transplantation: Interest and Perspectives

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