Consensus-based technical recommendations for clinical translation of renal ASL MRI

Fábio Nery ,Katja Derlin,David L Thomas,Steven Sourbron,Alexandra Ljimani,Marcel Gutberlet,Christoffer Laustsen,Octavia Bane,Anita A Harteveld,Ananth J Madhuranthakam,Kanishka Sharma,Charlotte Buchanan ,H Michael Gach,Jeff L Zhang,David C Alsop,Iván Pedrosa ,Eleanor Cox ,Sean B Fain,Manuel Taso,Danny J.j Wang ,Xavier Golay,Philip M Robson,Pottumarthi V Prasad,Susan T Francis,Aghogho Odudu,María A Fernández‐Seara

doi:10.1007/s10334-019-00800-z

Abstract

ObjectivesThis study aimed at developing technical recommendations for the acquisition, processing and analysis of renal ASL data in the human kidney at 1.5 T and 3 T field strengths that can promote standardization of renal perfusion measurements and facilitate the comparability of results across scanners and in multi-centre clinical studies.MethodsAn international panel of 23 renal ASL experts followed a modified Delphi process, including on-line surveys and two in-person meetings, to formulate a series of consensus statements regarding patient preparation, hardware, acquisition protocol, analysis steps and data reporting.ResultsFifty-nine statements achieved consensus, while agreement could not be reached on two statements related to patient preparation. As a default protocol, the panel recommends pseudo-continuous (PCASL) or flow-sensitive alternating inversion recovery (FAIR) labelling with a single-slice spin-echo EPI readout with background suppression and a simple but robust quantification model.DiscussionThis approach is considered robust and reproducible and can provide renal perfusion images of adequate quality and SNR for most applications. If extended kidney coverage is desirable, a 2D multislice readout is recommended. These recommendations are based on current available evidence and expert opinion. Nonetheless they are expected to be updated as more data become available, since the renal ASL literature is rapidly expanding.

Highlights

Blood delivery to the tissue capillary bed is critical to enable normal function, maintenance, and survival of physiological systems
Extended author information available on the last page of the article is linked to an array of pathophysiological mechanisms in acute kidney injury (AKI) as well as chronic kidney disease (CKD), with renal hypoperfusion involved in the former and potentially promoting progression of the latter [1,2,3]
All surveys included questions focusing on obtaining technical recommendations to facilitate translation of renal Arterial spin labelling (ASL) to the clinic and were divided into several categories: Patient preparation, Hardware, Labelling strategy, flow-sensitive alternating inversion recovery (FAIR) labelling parameters, Pseudo-continuous ASL (PCASL) parameters, Readout, Other sequence details, Data preprocessing and Quantification

Summary

Introduction

Blood delivery to the tissue capillary bed (i.e. tissue perfusion) is critical to enable normal function, maintenance, and survival of physiological systems. Extended author information available on the last page of the article is linked to an array of pathophysiological mechanisms in acute kidney injury (AKI) as well as chronic kidney disease (CKD), with renal hypoperfusion (and subsequent hypoxia and fibrosis) involved in the former and potentially promoting progression of the latter [1,2,3]. Arterial spin labelling (ASL), a magnetic resonance imaging (MRI) technique proposed over 25 years ago [4, 5], has arisen as one of the prime candidates for enabling an imaging-based quantification of tissue perfusion. To this end, arterial blood is used as an endogenous tracer, obviating the need for exogenous contrast agents.

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