Abstract
BackgroundMulti-parametric magnetic resonance imaging (MRI) provides the potential for a more comprehensive non-invasive assessment of organ structure and function than individual MRI measures, but has not previously been comprehensively evaluated in chronic kidney disease (CKD).MethodsWe performed multi-parametric renal MRI in persons with CKD (n = 22, 61 ± 24 years) who had a renal biopsy and measured glomerular filtration rate (mGFR), and matched healthy volunteers (HV) (n = 22, 61 ± 25 years). Longitudinal relaxation time (T1), diffusion-weighted imaging, renal blood flow (phase contrast MRI), cortical perfusion (arterial spin labelling) and blood-oxygen-level-dependent relaxation rate (R2*) were evaluated.ResultsMRI evidenced excellent reproducibility in CKD (coefficient of variation <10%). Significant differences between CKD and HVs included cortical and corticomedullary difference (CMD) in T1, cortical and medullary apparent diffusion coefficient (ADC), renal artery blood flow and cortical perfusion. MRI measures correlated with kidney function in a combined CKD and HV analysis: estimated GFR correlated with cortical T1 (r = −0.68), T1 CMD (r = −0.62), cortical (r = 0.54) and medullary ADC (r = 0.49), renal artery flow (r = 0.78) and cortical perfusion (r = 0.81); log urine protein to creatinine ratio (UPCR) correlated with cortical T1 (r = 0.61), T1 CMD (r = 0.61), cortical (r = −0.45) and medullary ADC (r = −0.49), renal artery flow (r = −0.72) and cortical perfusion (r = −0.58). MRI measures (cortical T1 and ADC, T1 and ADC CMD, cortical perfusion) differed between low/high interstitial fibrosis groups at 30–40% fibrosis threshold.ConclusionComprehensive multi-parametric MRI is reproducible and correlates well with available measures of renal function and pathology. Larger longitudinal studies are warranted to evaluate its potential to stratify prognosis and response to therapy in CKD.
Highlights
Chronic kidney disease (CKD) is a major global health burden [1] affecting 13% of adults [2], with rates predicted to rise by 5– 8% per annum [3]
EGFR and measured glomerular filtration rate (mGFR) were highly correlated (R 1⁄4 0.83, P < 0.001). In both healthy volunteers (HV) and chronic kidney disease (CKD) groups, eGFR fell with age (Figure 1B)
magnetic resonance imaging (MRI) shows promise as a non-invasive technique for evaluating whole kidney structure and function but progress towards clinical application has been slow, in part because MRI measures have generally been applied in isolation (e.g. diffusion weighted imaging (DWI) [20], BOLD [15, 21,22,23] and Arterial Spin Labelling (ASL) [24])
Summary
Chronic kidney disease (CKD) is a major global health burden [1] affecting 13% of adults [2], with rates predicted to rise by 5– 8% per annum [3]. A more comprehensive assessment of renal structure, microstructure, haemodynamics and oxygenation is provided by multi-parametric MRI. Multi-parametric magnetic resonance imaging (MRI) provides the potential for a more comprehensive noninvasive assessment of organ structure and function than individual MRI measures, but has not previously been comprehensively evaluated in chronic kidney disease (CKD). We performed multi-parametric renal MRI in persons with CKD (n 1⁄4 22, 61 6 24 years) who had a renal biopsy and measured glomerular filtration rate (mGFR), and matched healthy volunteers (HV) (n 1⁄4 22, 61 6 25 years). Longitudinal relaxation time (T1), diffusion-weighted imaging, renal blood flow (phase contrast MRI), cortical perfusion (arterial spin labelling) and blood-oxygen-level-dependent relaxation rate (R2*) were evaluated. Comprehensive multi-parametric MRI is reproducible and correlates well with available measures of renal function and pathology.
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