Temporally Resolved Electrocardiogram-Triggered Diffusion-Weighted Imaging of the Human Kidney Correlation Between Intravoxel Incoherent Motion Parameters and Renal Blood Flow at Different Time Points of the Cardiac Cycle
To evaluate the influence of pulsatile blood flow on apparent diffusion coefficients (ADC) and the fraction of pseudodiffusion (F(P)) in the human kidney.
The kidneys of 6 healthy volunteers were examined by a 3-T magnetic resonance scanner. Electrocardiogram (ECG)-gated and respiratory-triggered diffusion-weighted imaging (DWI) and phase-contrast flow measurements were performed. Flow imaging of renal arteries was carried out to quantify the dependence of renal blood flow on the cardiac cycle. ECG-triggered DWI was acquired in the coronal plane with 16 b values in the range of 0 s/mm(2) and 750 s/mm(2) at the time of minimum (MIN) (20 milliseconds after R wave) and maximum renal blood flow (MAX) (197 ± 24 milliseconds after R wave). The diffusion coefficients were calculated using the monoexponential approach as well as the biexponential intravoxel incoherent motion model and correlated to phase-contrast flow measurements.
Flow imaging showed pulsatile renal blood flow depending on the cardiac cycle. The mean flow velocity at MIN was 45 cm/s as compared with 61 cm/s at MAX. F(p) at MIN (0.29) was significantly lower than at MAX (0.40) (P = 0.001). Similarly, ADC(mono), derived from the monoexponential model, also showed a significant difference (P < 0.001) between MIN (ADC(mono) = 2.14 ± 0.08 × 10(-3) mm(2)/s) and MAX (ADC(mono) = 2.37 ± 0.04 × 10(-3) mm(2)/s). The correlation between renal blood flow and F(p) (r = 0.85) as well as ADC(mono) (r = 0.67) was statistically significant.
Temporally resolved ECG-gated DWI enables for the determination of the diffusion coefficients at different time points of the cardiac cycle. ADC(mono) and FP vary significantly among acquisitions at minimum (diastole) and maximum (systole) renal blood flow. Temporally resolved ECG-gated DWI might therefore serve as a novel technique for the assessment of pulsatility in the human kidney.
"In the pancreas, the IVIM perfusion parameters nearly vanished under blood suppression . In the kidney, a correlation between f and phase-contrast flow has been demonstrated over the cardiac cycle . In the brain, a gradual increase of the IVIM perfusion parameters under a gradually increased hypercapnia challenge, known to increase cerebral perfusion, has also been demonstrated . "
[Show abstract][Hide abstract] ABSTRACT: Measurement of microvascular perfusion with Intravoxel Incoherent Motion (IVIM) MRI is gaining interest. Yet, the physiological influences on the IVIM perfusion parameters ("pseudo-diffusion" coefficient D*, perfusion fraction f, and flow related parameter fD*) remain insufficiently characterized. In this article, we hypothesize that D* and fD*, which depend on blood speed, should vary during the cardiac cycle. We extended the IVIM model to include time dependence of D* = D*(t), and demonstrate in the healthy human brain that both parameters D* and fD* are significantly larger during systole than diastole, while the diffusion coefficient D and f do not vary significantly. The results non-invasively demonstrate the pulsatility of the brain's microvasculature.
PLoS ONE 08/2013; 8(8):e72856. DOI:10.1371/journal.pone.0072856 · 3.23 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: In functional renal magnetic resonance imaging (MRI), advanced techniques are applied to obtain information on a functional and molecular level from the kidney tissue beyond pure morphology. Techniques such as diffusion-weighted and diffusion tensor imaging, arterial spin labelling, and blood oxygenation level-dependent imaging provide potential biomarkers of organ function. Moreover, dynamic contrast-enhanced techniques after the intra-venous injection of gadolinium-chelates may be used to assess glomerular filtration and urinary excretion. This review summarizes recent developments of contrast- and non-contrast-enhanced MRI techniques for assessment of renal function in a clinical setting. The physiological background and the sequence techniques are described in detail. Potential clinical applications of the different techniques are discussed regarding their potential usefulness in the assessment of parenchymal diseases, urinary tract anomalies, transplant kidney function, and renal masses.
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to investigate whether magnetic resonance (MR) diffusion tensor imaging (DTI) allows assessment of renal pathologies in a rat model of diabetic nephropathy.
Twenty-one male Sprague-Dawley rats were divided into 3 groups: (1) untreated controls, (2) diabetes (DM), (3) diabetes with uninephrectomy (DM UNX) to accelerate renal impairment. Eight weeks after diabetes induction with streptozotocin, MR imaging was performed in a 1.5-T scanner using an 8-channel wrist coil. Morphological proton density images and echoplanar DTI were obtained (b = 0 and 300 s/mm, 6 diffusion directions). Renal apparent diffusion coefficient (ADC) and fractional anisotropy (FA) values were calculated for each of the different anatomical layers of the kidney. Imaging results, laboratory parameters of diabetic state and kidney function, and renal histopathological changes (glomerulosclerosis, tubular dilatation, and renal fibrosis) were compared between groups. Correlations between FA and histopathological changes were evaluated.
All diabetic animals developed hyperglycemia and hypoinsulinemia. Uremia, albuminuria, and histopathological changes were most pronounced in DM UNX animals. Fractional anisotropy was significantly reduced in DM UNX animals in the cortex (CO) (0.167; confidence interval [CI], 0.151-0.184; P < 0.001), outer stripe of the outer medulla (OS) (0.254; CI, 0.225-0.283; P = 0.038), and inner medulla (IM) (0.459; CI, 0.395-0.523; P = 0.008) compared with control animals (CO, 0.251; CI, 0.224-0.277; OS, 0.309; CI, 0.267-0.350; IM, 0.559; CI, 0.515-0.603). In DM-without-UNX animals, only cortical FA was significantly lower than in controls (P < 0.001). Between groups, ADC values were not different, except for cortical ADC, which was higher in DM UNX animals than in controls. Significant negative correlations were observed between the FA of different anatomical layers and the extent of glomerulosclerosis (CO, P = 0.003, r = -0.65; and OS, P = 0.022, r = -0.52), tubulointerstitial fibrosis (IM, P = 0.028, r = -0.50), and tubular dilatation (CO, P = 0.015, r = -0.55; and IM, P = 0.006, r = -0.61), respectively.
Magnetic resonance DTI by reduction of FA identified renal pathologies of diabetic nephropathy such as glomerulosclerosis, interstitial fibrosis, and tubular damage. Representing different stages of disease, DM and DM UNX animals could be differentiated. Thus, MR DTI may be valuable for noninvasive detection and monitoring of renal pathology in patients with diabetes.
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