MR Renography Research Articles

Renal function measurements from MR renography and a simplified multicompartmental model

The purpose of this study was to determine the accuracy and sources of error in estimating single-kidney glomerular filtration rate (GFR) derived from low-dose gadolinium-enhanced T1-weighted MR renography. To analyze imaging data, MR signal intensity curves were converted to concentration vs. time curves, and a three-compartment, six-parameter model of the vascular-nephron system was used to analyze measured aortic, cortical, and medullary enhancement curves. Reliability of the parameter estimates was evaluated by sensitivity analysis and by Monte Carlo analyses of model solutions to which random noise had been added. The dominant sensitivity of the medullary enhancement curve to GFR 1-4 min after tracer injection was supported by a low coefficient of variation in model-fit GFR values (4%) when measured data were subjected to 5% noise. These analyses also showed the minimal effects of bolus dispersion in the aorta on parameter reliability. Single-kidney GFR from MR renography analyzed by the three-compartment model (4.0-71.4 ml/min) agreed well with reference measurements from (99m)Tc-DTPA clearance and scintigraphy (r = 0.84, P < 0.001). Bland-Altman analysis showed an average difference of 11.9 ml/min (95% confidence interval = 5.8-17.9 ml/min) between model and reference values. We conclude that a nephron-based multicompartmental model can be used to derive clinically useful estimates of single-kidney GFR from low-dose MR renography.

Magnetic Resonance Urography for Evaluating Outcomes After Pediatric Pyeloplasty

We report the role of magnetic resonance urography in children with ureteropelvic junction obstruction. Differential renal function, the single kidney glomerular filtration rate index, renal transit time, renal length and renal pelvis anteroposterior diameter were compared before and after pyeloplasty. Magnetic resonance urography was performed before and after pyeloplasty in 24 patients with a mean age of 1.9 years (range 3 months to 10 years). Renal length, renal transit time and renal pelvis anteroposterior diameter were determined by the radiologist. The volume of functioning renal tissue and descending aorta were segmented and the ratio of the volumes of functioning kidney tissue was used to calculate differential renal function. Rutland-Patlak plots were used to calculate single kidney glomerular filtration rate index, that is the Patlak score. Mean renal pelvis renal pelvis anteroposterior diameter was 3.3 cm preoperatively and 2.5 cm postoperatively (p = 0.0003). There was no difference in average renal length (p = 0.22). Of the 24 cases 22 (92%) showed stable or improved differential renal function. Improvement in renal transit time was seen in 20 of 23 cases (87%). Of 15 patients with complete Patlak scores 14 (93%) showed postoperative improvement. Mean preoperative and postoperative differential renal function, renal transit time and Patlak score were 36% and 41% (p = 0.003), 16.2 and 8.6 minutes (p = 0.0005), and 6.6 and 11.9 ml per minute (p = 0.01), respectively. Magnetic resonance urography provides superior anatomical and unprecedented functional information to fully define the preoperatively and postoperative status of corrected ureteropelvic junction obstruction. Magnetic resonance urography has the potential to become the imaging study of choice for evaluating pediatric hydronephrosis and obstructive uropathy.

Imaging of the renal transplant: comparison of MRI with duplex sonography

Renal transplantation is an established treatment for patients with end-stage renal disease. Many causes of graft dysfunction are treatable, making prompt detection and diagnosis of complications essential. Sensitive, noninvasive imaging procedures, which do not use iodinated contrast media, are therefore highly desirable to evaluate graft function. Duplex sonography (US) has traditionally been the initial investigation of graft dysfunction. US offers many advantages, particularly during the postoperative period, when it can be performed portably regardless of renal function and can guide percutaneous procedures. However, US lacks specificity in assessing hydronephrosis, cannot differentiate parenchymal causes of dysfunction, and may have difficulty assessing transplant vessels. Recently comprehensive magnetic resonance imaging (MRI) protocols including MR urography, gadolinium-enhanced MR angiography, and MR renography have evolved as a "one-stop" diagnostic technique in the evaluation of the entire graft and peritransplant region. Multiplanar capabilities enable MRI to identify the site of urinary obstruction and assess renal vessels in their entirety. The evolving technique of MR renography may also differentiate parenchymal causes of dysfunction. By combining these three components into a single examination, further information may be obtained regarding the graft when compared with US and other conventional studies, with improved patient convenience, less morbidity, and a potential cost saving.

MR renography using a dynamic gradient-echo sequence and low-dose gadopentetate dimeglumine as an alternative to radionuclide renography.

Our aim was to evaluate the feasibility of acquiring an MR signal intensity-time renographic curve and dynamic serial images in a way similar to that of acquiring radionuclide renograms, with a dynamic gradient-echo sequence and a low-dose gadopentetate dimeglumine technique, using a commonly available 1.5-T MR scanner. SUBJECTS AND METHODS. Patients who underwent both radionuclide and MR renographic studies within a 3-month period were included in the analysis. This yielded 21 studies from 19 patients. Nineteen of the 21 studies were available for analysis. Two studies were excluded because of technical errors during MR renographic acquisition. Serial MR renograms were obtained using a dynamic two-dimensional spoiled gradient-echo fast low-angle shot T1-weighted sequence. Low-dose IV furosemide and gadopentetate dimeglumine (0.025 mmol/kg of body weight) were administered. Intensity-time curves were obtained from the manually selected regions of interest over the renal parenchyma and whole kidney for calculation of split renal function and assessment of urinary excretion, respectively. Results were compared with those obtained with radionuclide renography. Good correlation (Pearson's correlation coefficient, r = 0.97, p < 0.001) was observed when the volume-corrected split renal function acquired with MR renography was compared with that obtained with radionuclide renography. There was also good agreement in the excretory curve patterns (weighted kappa(observer 1) = 0.77 and kappa(observer 2) = 0.81) between the two techniques. Dynamic MR gradient-echo imaging with a low-dose gadopentetate dimeglumine technique can produce an intensity-time curve and serial dynamic images of the urinary system, in a way similar to that of radionuclide renography. This technique allows assessment of split renal function and urinary excretory status and is a feasible alternative to radionuclide renography.

Automated quantitative evaluation of diseased and nondiseased renal transplants with MR renography.

To present a method of automated parametric quantification of dynamic MR enhancement curves of renal transplants and evaluate the disease-discriminating properties of the resulting MR renography (MRR) data. This study included 27 patients with nondiseased renal transplants and eight patients with diseased renal transplants. The examination was repeated in 10 patients and the reproducibility of the enhancement parameters was estimated by analysis of variance (ANOVA). The disease-discriminating properties of the transplant volumes and enhancement parameters were tested with t-tests and logistic regression analysis. The enhancement parameters were reproducible. The mean medullary nephronal washout rate (lambda1) and cortical arterial blood volume (mu0) were lower in diseased renal transplants. The combination of these parameters was a strong predictor of renal transplant disease (area under ROC curve 0.98; 95% confidence interval 0.96-1.0). Automated parametric quantification of cortical and medullary enhancement is feasible and allows the accurate detection of nonsurgical disease in renal transplants by MRR.

Quantitative MR renography using a calibrated internal signal (ERETIC)

To measure MR renograms, cortical and medullary kidney signal intensity evolution is followed after contrast agent injection. To obtain an accurate quantitative signal measurement, the use of a reference signal is necessary to correct the potential MRI system variations in time. The ERETIC method (Electronic Reference To access In vivo Concentrations) provides an electronic reference signal. It is synthesized as an amplitude modulated RF pulse applied during the acquisition. The ERETIC method was as precise as the external tube reference method but presents major advantages like its free adjustability (shape, location and magnitude) to the characteristics of the organ studied as well as its not taking room inside the magnet. Even though ERETIC showed a very good intrinsic stability, systems’ variations still affect its signal in the same way as real NMR signals are affected. This method can be easily implemented on any imaging system with two RF channels.

MR renography by semiautomated image analysis: performance in renal transplant recipients.

We evaluated a method of semiautomated analysis of dynamic MR image series in renal transplants. Nine patients were studied twice, with an average time interval of 7 days. MR examination consisted of a run of 256 T1-weighted coronal scans (GE; TR/TE/flip: = 11/3.4/60 degrees; slice thickness = 6 mm; temporal resolution = 2 seconds). Gadolinium-DTPA (0.05 mmol/kg) was injected with an injector pump (5 ml/seconds). MR renographs of the cortex and medulla were obtained by segmentation of the renal transplant and placement of two regions of interest (ROIs) overlying the peripheral and central renal parenchyma. In the first 100 frames of the renographs, analysis of variance (ANOVA) demonstrated significant intraclass correlation coefficients with mean values for the cortex and medulla of 0.47 and 0.59, respectively. We conclude that the procedure is a robust technique that generates meaningful signal curves.

Quantitative recording of renal function with magnetic resonance tomography

To show the potential of various methods in magnetic resonance imaging for the evaluation of renal function. A combined assessment of renal morphology, renal hemodynamics and function is proposed. Various techniques are explained, including multiphasic 3D gadolinium MR angiography, MR phase-contrast flow measurements, quantitative perfusion measurements with intravascular contrast agents, and MR renography and MR urography. The use of these techniques is demonstrated for renovascular diseases. The combined use of these techniques allows renal artery stenosis to be accurately detected and evaluation of renal blood flow, perfusion, glomerular filtration rate, and renal excretion. Based on true quantitative parameters, the hemodynamic and functional significance of the stenosis can be assessed. Renovascular diseases can be differentiated from renoparenchymal disease. For the assessment of renal function, functional magnetic resonance imaging techniques are an important alternative to nuclear medicine. The predictive value regarding the effect of revascularization is currently under investigation.