Role of blood oxygen level-dependent MRI in differentiation of acute renal allograft dysfunction

Lal, Hira; Mohamed, Ezaz; Soni, Neelam; Yadav, Priyank; Jain, Manoj; Bhadauria, Dharmendra; Kaul, Anupma; Prasad, Narayan; Gupta, Amit; Sharma, RK

doi:10.4103/ijn.ijn_43_18

Cited by 5 publications

(6 citation statements)

References 33 publications

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“…In a study of 40 patients conducted by Lal et al (19) to evaluate BOLD-MRI using 3 T (32 normally functioning transplants, six with biopsy-proven acute rejection, and two with biopsy-proven ATN), they found that in the acute rejection group, the mean cortical R2* and mean medullary R2* values were significantly lower compared with ATN and normal function graft groups. They also found that ATN allografts showed increased R2* values in the cortex and medulla, which is similar to our observation.…”

Section: Discussionmentioning

confidence: 99%

“… Values are given as mean ± SD, unless otherwise indicated. This is a modified table after Lal et al (19). AR, acute rejection; ATN, acute tubular necrosis; CR2*, cortical R2*; MCR, medullary over cortical R2* ratio; MR2*, medullary R2*; MRI, magnetic resonance imaging. …”

Section: Discussionmentioning

confidence: 99%

“…Since the first evaluation of the renal oxygenation state using BOLD-MRI in an animal model in 1996 (12), several studies have investigated the potential of BOLD-MRI to identify various renal pathologic conditions, such as renal artery stenosis (13,14), ureteral obstruction (15), diabetes mellitus (16), renal allograft rejection, and ATN (5,11,(17)(18)(19).…”

Section: Introductionmentioning

confidence: 99%

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Functional MRI evaluation of blood oxygen dependent (BOLD) in renal allograft dysfunction: a prospective study

Farg,

El-Diasty,

Ali-El-Dein

et al. 2023

Acta Radiol

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Background Blood oxygen level dependent-magnetic resonance imaging (BOLD-MRI) is a non-invasive functional imaging technique that can be used to assess renal allograft dysfunction. Purpose To evaluate the diagnostic performance of BOLD-MRI using a 3-T scanner in discriminating causes of renal allograft dysfunction in the post-transplant period. Material and Methods This prospective study was conducted on 112 live donor-renal allograft recipients: 53 with normal graft function, as controls; 18 with biopsy-proven acute rejection (AR); and 41 with biopsy-proven acute tubular necrosis (ATN). Multiple fast-field echo sequences were performed to obtain T2*-weighted images. Cortical R2* (CR2*) level, medullary R2* (MR2*) level, and medullary over cortical R2* ratio (MCR) were measured in all participants. Results The mean MR2* level was significantly lower in the AR group (20.8 ± 2.8/s) compared to the normal group (24 ± 2.4/s, P <0.001) and ATN group (27.4 ± 1.7/s, P <0.001). The MCR was higher in ATN group (1.47 ± 0.18) compared to the AR group (1.18 ± 0.17) and normal functioning group (1.34 ± 0.2). Both MR2* (area under the curve [AUC] = 0.837, P <0.001) and MCR (AUC = 0.727, P = 0.003) can accurately discriminate ATN from AR, however CR2* (AUC = 0.590, P = 0.237) showed no significant difference between both groups. Conclusion In early post-transplant renal dysfunction, BOLD-MRI is a valuable non-invasive diagnostic technique that can differentiate between AR and ATN by measuring changes in intra-renal tissue oxygenation.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Functional MRI evaluation of blood oxygen dependent (BOLD) in renal allograft dysfunction: a prospective study

Farg,

El-Diasty,

Ali-El-Dein

et al. 2023

Acta Radiol

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“…Research has ( 21 ) reported higher R2* values in patients with acute rejection than in those without rejection. A previous study ( 22 ) showed that acute tubular necrosis (ATN) and AR patients had lower R2* values than functionally normal allograft patients. Another study ( 23 ) reported that the medullary R2* values were lower in transplanted kidneys than native kidneys, which may be due to increased blood flow due to allograft debulking.…”

Section: Discussionmentioning

confidence: 99%

A clinical study of using ROC to compare the efficiency of ASL and BOLD in diagnosis of renal allograft function

Jin¹,

Yang²,

Zhu³

et al. 2023

Transl Androl Urol

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Background: This retrospective study aims to evaluate the effectiveness of renal transplantation function by comparing arterial spin labeling (ASL) and blood oxygen level dependent (BOLD) imaging with the receiver operating characteristic (ROC) curve.Methods: According to the estimated glomerular filtration rate (eGFR) values, 42 patients with normal kidney grafts (the normal kidney graft group, eGFR <60 mL/min/1.73 m 2 ) and 93 patients with injured grafts (the kidney graft injury group, eGFR <60 mL/min/1.73 m 2 ) were included in the present study. Renal blood flow (RBF) and the effective transverse relaxation rate (R2*) were calculated by comparing ASL and BOLD imaging. The ROC curve and the youden index were used to evaluate the diagnostic performance of ASL, BOLD, and the combination of them. Results:The results showed that all the clinical features of the patients, except for gender, differed significantly between the 2 groups (P<0.05). The mean RBF value of the renal transplant injury group (104.33±54.76 mL/100 g/min) was significantly lower than that of the normal group (191.84±63.96 mL/ 100 g/min, P<0.01). The mean medullary R2* value of the renal transplant injury group (27.91±3.35 1/s) was significantly higher than that of the normal group (25.22±2.94 1/s, P<0.01). Negative correlations were found between R2* and eGFR (r=-0.44), and RBF and R2* (r=-0.54; both P<0.01). The ROC analysis showed that both RBF and R2* reflected injured renal function [area under the curves (AUC) =0.86 and 0.72, respectively]. In addition, the AUC of RBF and R2* combined was 0.86, which was comparable to that of RBF alone (P=0.95), while combining R2* and RBF improved the diagnostic performance of R2* alone (AUC =0.86 versus 0.72, respectively; P<0.01). The youden index analysis showed that the diagnostic accuracy of ASL was 80.00%, better than 71.85% of BOLD; the sensitivity and specificity of ASL in diagnosing renal allograft dysfunction were 79.57% and 80.95%, superior to 77.42% and 59.52% of BOLD.Conclusions: Our results showed that the non-invasive assessment of ASL in clinical kidney transplant function is a more promising imaging technique than BOLD.

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“…However, few studies have used 3 Tesla (3T) magnets, which allow for higher spatial resolution and better visual differentiation between the renal cortex and medulla. (1,5,7,8)…”

Section: ❚ Introductionmentioning

confidence: 99%

Evaluation of the blood-oxygen-level-dependent (BOLD) sequence with 3 Tesla device in renal transplant patients in the assessment of early allograft disfunction, correlated with biopsy

Mendes

Falsarella

Garcia

et al. 2021

Einstein (São Paulo)

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Objective To evaluate the ability of blood-oxygen-level-dependent (BOLD) magnetic resonance imaging at 3 Tesla to measure tissue oxygen bioavailability based on R2* values, and to differentiate between acute tubular necrosis and acute rejection compared to renal biopsy (gold standard). Methods A prospective, single-center study, with patients submitted to renal transplantation between 2013 and 2014, who developed graft dysfunction less than 4 weeks after transplantation. All patients were submitted to abdominal magnetic resonance imaging at 3 Tesla using the same protocol, followed by two BOLD sequences and kidney biopsy. Results Twelve male (68.75%) and three female (31.25%) patients were included. A total of 19 percutaneous renal biopsies were performed (four patients required a second biopsy due to changes in clinical findings). Pathological findings revealed ten cases of acute tubular necrosis, four cases of acute rejection, and five cases with other (miscellaneous) diagnoses. Comparison between the four groups of interest failed to reveal significant differences (p=0.177) in cortical R2* values, whereas medullary R2* values differed significantly (p=0.033), with lower values in the miscellaneous diagnoses and the acute tubular necrosis group. Conclusion BOLD magnetic resonance imaging at 3 Tesla is a feasible technique that uses indirect tissue oxygen level measurements to differentiate between acute rejection and acute tubular necrosis in renal grafts.

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Role of blood oxygen level-dependent MRI in differentiation of acute renal allograft dysfunction

Cited by 5 publications

References 33 publications

Functional MRI evaluation of blood oxygen dependent (BOLD) in renal allograft dysfunction: a prospective study

Functional MRI evaluation of blood oxygen dependent (BOLD) in renal allograft dysfunction: a prospective study

A clinical study of using ROC to compare the efficiency of ASL and BOLD in diagnosis of renal allograft function

Evaluation of the blood-oxygen-level-dependent (BOLD) sequence with 3 Tesla device in renal transplant patients in the assessment of early allograft disfunction, correlated with biopsy

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