NSF & Functional Renal
Wednesday 22 April 2009
Room 316A 10:30-12:30


Diego R. Martin and Jeffrey Weinreb

10:30  400. 2008 ISMRM Grant Recipient:  The Biodistribution of [153Gd]Gd-Labeled DTPA-BMA and DOTA in a Transgenic Mouse Model of Renal Failure Differs Greatly from Wild-Type Mice

Thaddeus J. Wadas1, Christopher D. Sherman1, Jeffrey H. Miner2, Jeffrey J. Brown2, James R. Duncan1, Carolyn J. Anderson1
Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA; 2Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO, USA

10:50 401. Postmortem ICP-MS and MR Analysis of Gadolinium Concentration and Distribution in Three Confirmed NSF Cases

Peter Caravan1, Aashiyana Koreishi2, Jonathan Kay3
Radiology, Massachusetts General Hospital, Charlestown, MA, USA; 2Pathology, Massachusetts General Hospital, Boston, MA, USA; 3Rheumatology, Massachusetts General Hospital, Boston, MA, USA

    Nephrogenic systemic fibrosis (NSF) is a debilitating fibrosing disorder that can occur in renally compromised patients and has been linked to gadolinium (Gd) based contrast agents. We analyzed autopsy tissue from 3 confirmed NSF subjects. Gd was quantifiable in all tissues assayed and very high concentrations of Gd were observed in the kidney and the heart. High resolution relaxation time (T1, T2, T2*) maps suggest a heterogeneous distribution in kidney cortex. In the heart, the Gd had little T1 effect but a strong T2* effect suggesting an insoluble deposit and/or sequestration inside an endosome.
11:02 402. Incidence of Nephrogenic Systemic Fibrosis (NSF) in Dialysis Patients Receiving Either a Standard or a High-Relaxivity Gadolinium Chelate Contrast Agent: A Single Center Study
    Saravanan Kokila Krishnamoorthy1, Diego Martin1, Khalil Nabeel Salman1, Bobby Kalb1, John Carew2, Philip Andrew Martin3, Kenneth Kokko4, Christian Larsen5, Thomas Pearson5
Department of Radiology, Emory University, Atlanta, GA, USA; 2Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA, USA; 3University of West Georgia, Carrollton, GA; 4Department of Medicine, Emory University, Atlanta, GA, USA; 5Department of Surgery, Emory University, Atlanta, GA, USA
    Retrospective single center study measuring the incidence of Nephrogenic Systemic Fibrosis (NSF) in dialysis patients who were administered either gadodiamide or gadobenate dimeglumine. Mean cumulative dose of gadodiamide was 0.16 mmol/kg in 312 patients and 8 (2.6%) developed NSF. Mean cumulative dose of gadobenate dimeglumine was 0.11 mmol/kg in 603 patients and none developed NSF. The cause for this difference is not determined definitively but our results show that a change to a low dose higher relaxivity gadolinium chelate can significantly reduce NSF incidence and that the incidence in dialysis patients is less than 1 in 603 in our patients.
11:14 403.

Risk Factors for NSF: A Meta-Analysis

    Honglei Zhang1, Giles H. Roditi2, Rochelle Morgan1, Martin R. Prince1,3
Radiology, Weill Medical College of Cornell University, New York, NY, USA; 2Radiology, Glasgow Royal Infirmary, Glasgow, UK; 3Radiology, Columbia College of Physicians and Surgeons, New York, NY, USA
    From 260 NSF patients in 59 published papers, this meta-analysis explores the risk factors and demonstrates how risk can be minimized. It appears that eliminating even a single risk factor, such as the use of high dose can reduce NSF incidence/risk at least 10-fold. Elimination of multiple risk factors for example by using single dose GBCA, dialyzing dialysis patients with 24 hours following GBCA administration, avoiding GBCA in acute renal failure, avoiding non-ionic GBCA in renal failure patients can reduce NSF risk by orders of magnitude thereby allowing safe GBCA enhanced MRI in most patients.
11:26 404. Non-Contrast Enhanced Renal MR Angiography Using NATIVE TrueFISP Initial Experience for Clinical Imaging of Patients with Renovascular Disease
    Stephen J. Gandy1, Prasad Guntur Ramkumar2, Shelley A. Waugh1, R Stephen Nicholas1, Andrew W. Taylor2, Xiaoming Bi3, Peter Weale3, J Graeme Houston2
NHS Tayside Medical Physics, Ninewells Hospital, Dundee, Angus, UK; 2NHS Tayside Clinical Radiology, Ninewells Hospital, Dundee, Angus, UK; 3Cardiovascular Research and Development, Siemens Medical Solutions, Chicago, IL, USA
    The study aim was to compare a new steady-state gradient echo non-contrast MR angiography (NCE-MRA) sequence with contrast enhanced MRA (CE-MRA) for renal artery imaging. Fifty patients with suspected renovascular disease were scanned using non-contrast (NATIVE TrueFISP) and CE-MRA sequences. Resulting maximum intensity projection (MIP) images were compared and scored by two observers. Qualitative analysis revealed that NCE-MRA and CE-MRA were virtually equivalent for renal artery visualisation. Intra- and inter-observer scoring agreement was k=0.91 and 0.70 respectively. In conclusion, this NCE-MRA technique is comparable to CE-MRA and may provide an alternative for imaging patients at risk of Nephrogenic Systemic Fibrosis.


11:38 405. Understanding Renal DTI at 3T: FA and MD Changes with Water Loading
    Hersh Chandarana1, Vivian S. Lee1, Irina Barash2, Eric E. Sigmund1
Radiology, NYU Langone Medical Center, New York, NY, USA; 2Nephrology, NYU Langone Medical Center, New York, NY, USA
    Diffusion tensor imaging allows non-invasive evaluation of renal structure and function. Renal medulla has been shown to have higher fractional anisotropy (FA) compared to cortex, but it is unclear if medullary FA is predominantly a measure of tubular structural arrangement or if it is significantly influenced by tubular flow. We examined changes in renal FA prior to and in response to water loading. Our study demonstrates a trend to faster, more isotropic diffusion with water loading. Since water-loading is known to increase tubular flow, these results suggest that tubular flow plays little or no role in baseline medullary diffusion anisotropy.
11:50 406.  Kidney Stiffness Measured in an Animal Model of Unilateral Renal Arterial Stenosis Using 2D MR Elastography
    Lizette Warner1, Meng Yin2, Richard L. Ehman2, Lilach Orly Lerman3
Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA; 2Department of Radiology, Mayo Clinic, Rochester, MN, USA; 3Department of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
    Magnetic Resonance Elastography (MRE) is a modified phase contrast MRI technique for quantitatively assessing the mechanical properties of soft tissue by visualization of propagating shear waves. Both fibrosis and turgor may affect the mechanical properties of tissue and in the kidney may threaten the viability and ultimately lead to kidney failure. We have previously shown in a swine model of renal arterial stenosis, the stenotic kidney exhibits moderate but significant interstitial fibrosis. We quantitatively determine with 2D MRE in vivo the effect of renal arterial stenosis on the mechanical properties of swine kidney.
12:02 407. Effects of Ischemia-Reperfusion Injury on 23Na Relaxation Times and Its Implications on Quantification of Corticomedullary Sodium Concentration by 23Na MRI
    Bharath Atthe1, Andriy Babsky1, Navin Bansal1
Radiology, Indiana University School of Medicine, Indianapolis, IN, USA
    23Na MRI and MRS are applied to evaluate the effects of renal ischemia and reperfusion on 23Na MRI signal intensity (SI), relaxation times and [Na+] in the medulla and cortex of rat kidney. 23Na relaxation times were found to be similar in renal medulla and cortex in the normal kidney. Ischemia caused a significant decrease in the relaxation times which affected the calculation of [Na+] from MRI data. However, the changes in relaxation times for the medulla and cortex were identical, thus the medulla to cortex 23Na SI ratio represents [Na+] ratio in the two compartments during ischemia and reperfusion.
12:14 408. Estimating GFR from Early (Uptake) Portion of DCE MRI Renal Data, Using a 3-Compartment Model,  Improves Reproducibility and May Eliminate Need for Cortical Segmentation
    Paul S. Tofts1,2, Marica Cutajar1,3, Iosif Mendichovszky3, Isky Gordon3
Brighton and Sussex Medical School, Brighton, Sussex, UK; 2Institute of Neurology, University College London, London, UK; 3Institute of Child Health, University College London, UK