ISMRM 24th Annual Meeting & Exhibition • 07-13 May 2016 • Singapore

Combined Educational & Scientific Session: Quantitative Biomarkers in Renal MRI: Adding Physiologic Information to the Morphologic Assessment

Skill Level: Intermediate

Organizers: Ivan Pedrosa, M.D., Lorenzo Mannelli, M.D., Ph.D., Scott B. Reeder, M.D., Ph.D. & Edwin J.R. van Beek, M.D., Ph.D., M.Ed., FRCR

Monday 09 May 2016

This two-hour course focuses on quantitative MRI biomarkers for the evaluation of the kidney. State-of-the-art approaches for characterization of renal physiology including blood flow, oxygenation, and water diffusion will be described. The applicability of these quantitative biomarkers for the assessment of renal disease in both native kidneys and renal transplant will be presented. Didactic presentations and scientific abstracts on each area of interest will be presented to enhance the educational and scientific value of this course on each specific area of interest.

Target Audience
This course is aimed at radiologists, imaging scientists and MR technologists who wish to review the state-of-art MRI methods for quantification of renal physiology, and to learn about the potential use of these methods for the characterization of renal disease.

Educational Objectives
Upon completion of this course, participants should be able to:

  • Illustrate the potential role of MRI biomarkers of renal disease;
  • Convey the relationship between emerging quantitative MRI biomarkers and renal physiology; and
  • Implement novel applications of MRI for diagnosis of renal disease.

Moderators: Sooah Kim, S. Sendhil Velan
Introduction by Moderator
Arterial Spin Labeled Measurement of Renal Perfusion
Ananth J Madhuranthakam1
1Radiology, UT Southwestern Medical Center, Dallas, TX, United States
ASL has become a mainstream application for brain perfusion, but still has challenges for renal perfusion. Various improvements including pseudo-continuous labeling combined with background suppression and timed-breathing approaches have enabled robust renal perfusion imaging. This presentation will discuss different types of arterial spin labeling technique along with the acquisition methods and strategies for robust renal perfusion imaging without the administration of exogeneous contrast agent.  

Assessing longitudinal renal blood flow changes in children following renal replacement therapy using Arterial Spin Labelling MRI
Fábio Nery1, Enrico De Vita2,3, Chris A. Clark1, Isky Gordon1, and David L. Thomas3
1UCL Institute of Child Health, Developmental Imaging and Biophysics Section, LONDON, United Kingdom, 2National Hospital for Neurology and Neurosurgery, Lysholm Department of Neuroradiology, LONDON, United Kingdom, 3UCL Institute of Neurology, Department of Brain Repair and Rehabilitation, LONDON, United Kingdom
Arterial spin labelling (ASL) is a contrast-free MRI technique that allows for the quantitative measurement of organ perfusion. In this study, we non-invasively evaluated renal perfusion changes in sixteen children within the first year following renal replacement therapy using ASL. Each child was scanned in three occasions : (A) immediately post-transplant; (B) “1 month” post-transplant and (C) “1 year” post-transplant. The highest renal cortical blood flow was seen on the first scan in the majority of children while in later scans equilibrium between child and kidney was reached. 

Noninvasive Measurement of Single Renal Oxygen Extraction Fraction using Focused Asymmetric Spin Echo Approach - a feasibility study
CY Wang1, R Zhang2, L Jiang3, R Wang4, XD Zhang4, H Wang3, K Zhao4, LX Jin3, J Zhang1,2, XY Wang1,4, and J Fang1,2
1Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, China, People's Republic of, 2College of Engineering, Peking University, Beijing, China, People's Republic of, 3Philips Healthcare, Suzhou, China, People's Republic of, 4Department of Radiology, Peking University First Hospital, Beijing, China, People's Republic of
This study demonstrates the feasibility of combining 2D-RF excitation pulse and ASE sequence (focused ASE sequence, FASE) for single renal OEF measurement. Comparison between images acquired with full-FOV ASE and focused ASE was conducted to confirm the advantages of the focused ASE sequence for single renal imaging.  The new technique could reduce artifacts and distortion caused by susceptibility differences, and limit spatial blurring due to T2-decay, which is promising for diagnosis of some renal diseases.

How Bold is BOLD MRI of the Kidney: Detailing Renal Hypoxia with MRI, Electrochemical Physiological Methods and Optical Imaging
Thoralf Niendorf1
1Berlin Ultrahigh Field Facility (B.U.F.F.), Max-Delbrück Center for Molecular Medicine, Berlin

This presentation is designed to inspire the preclinical and clinical imaging, renal physiology, and nephrology communities to foster explorations into the assessment of renal oxygenation and haemodynamics by exploiting the powers of MRI. For this purpose the merits and limitations of renal BOLD-MRI are surveyed together with their implications. Explorations into detailing the relation between renal T2* and renal tissue partial pressure of oxygen (pO2) are discussed. Multi-modality in vivo approaches suitable for detailing the role of the confounding factors that govern T2* are considered. Future directions of MRI assessment of renal oxygenation and perfusion are explored.


Quantitative MRI of Renal Function in a Mouse Model of Unilateral Ureteral Obstruction
Haiying Tang1, Matthew Fronheiser1, Guoqiang Zhang2, Adrienne Pena1, Daniel Kukral1, Cindy Cai2, Rachel Zebo2, Jeff L L Zhang3, Bradley Zinker2, Anthony Azzara2, Patrick Chow1, Feng Luo4, and Wendy Hayes1
1Bristol Myers Squibb, Princeton, NJ, United States, 2Bristol Myers Squibb, Hopewell, NJ, United States, 3Radiology, University of Utah, Salt Lake City, UT, United States, 4Bristol Myers Squibb, Wallingford, CT, United States
Recent advances in magnetic resonance imaging (MRI) allow the development of non-invasive and quantitative tools to assess renal function. DCE-MRI using low dose Gd-based contrast has been established as a reliable technique for measuring glomerular filtration rate (GFR) in individual kidneys. Other promising markers for renal function include R2* measured with BOLD MRI, and the longitudinal relaxation time T1. Unilateral ureteral obstruction (UUO) has been developed in rodents as a model of renal fibrosis. The purpose of the study is to evaluate the various MRI techniques in assessing kidney tissue properties and renal function in the UUO mouse model.

Determination of Parameters Variation in DTI, BOLD, and ASL MRI for Transplanted Kidneys
Maryam Seif1, Laila Yasmin Mani2, Chris Boesch1, Bruno Vogt2, and Peter Vermathen1
1Depts. Radiology and Clinical Research, University of Bern, Bern, Switzerland, 2Dept. Nephrology, Hypertension and Clinical Pharmacology, Hospital University of Bern, Bern, Switzerland
DTI, BOLD and ASL MRI techniques have gained acceptance to evaluate different physiological aspects of the renal function both in research and clinics. However, there are not yet sufficient studies available investigating the accuracy and repeatability of renal MRI techniques. The main aim of this study was therefore to evaluate the reproducibility of DTI, BOLD MRI and ASL parameters derived from two scans and to investigate whether there are significant correlations  between renal parameters obtained from these MR techniques in transplanted kidneys.

Hersh Chandarana1
1NYU School of Medicine
Conventional methods of measuring renal function including estimated GFR are insensitive to early renal dysfunction and cannot assess single kidney function/dysfunction. Advance MR imaging techniques including diffusion weighted imaging (DWI) are being investigated to study renal microstructure and function in health and disease. Various flavors of diffusion weighted imaging including intra-voxel incoherent motion (IVIM) and diffusion tensor imaging (DTI) have shown considerable promise in evaluation of kidney structure and function. 

Diffusion Tensor Imaging (DTI) of the kidneys incorporating advanced geometric distortion correction using reversed phase encoding images.
Jose Teruel1,2, Jeremy C. Lim3, Eric E. Sigmund4, Elissa Botterill5, Jas-mine Seah6, Shawna Farquharson7, Elif E. Ekinci6,8, and Ruth P. Lim5,9
1Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway, 2St. Olavs University Hospital, Trondheim, Norway, 3Department of Radiology, The Royal Melbourne Hospital, Melbourne, Australia, 4Department of Radiology, NYU Langone Medical Center, New York, NY, United States, 5Department of Radiology, Austin Health, Melbourne, Australia, 6Department of Endocrinology, Austin Health, Melbourne, Australia, 7Florey Neuroscience Institute, Melbourne, Australia, 8Department of Endocrinology, The University of Melbourne, Melbourne, Australia, 9Departments of Radiology and Surgery, The University of Melbourne, Melbourne, Australia
Diffusion tensor imaging is emerging as a promising technique for structural and functional evaluation of the kidneys. However, diffusion sequences employing echo planar imaging readout are prone to geometric distortions due to static field inhomogeneities arising from different magnetic susceptibilities from adjacent tissues and bowel gas. In this study, we evaluated the efficacy of distortion correction using a reversed phase encoding approach for diffusion tensor imaging of healthy controls and patients with Type 1 diabetes.

Kidney diffusion-weighted imaging based on multi-band multi-shot DW-EPI acquisition and multi-band multiplexed sensitivity encoding (MB-MUSE) reconstruction
Hing-Chiu Chang1,2, Arnaud Guidon3, Mustafa R. Bashir4, Dan Xu5, Lloyd Estkowski6, Ersin Bayram7, Allen W. Song2, and Nan-Kuei Chen2
1Department of Diagnostic Radiology, The University of Hong Kong, Hong Kong, Hong Kong, 2Brain Imaging and Analysis Center, Duke University Medical Center, Durham, NC, United States, 3Global MR Application and Workflow, GE Healthcare, Boston, MA, United States, 4Department of Radiology, Duke University Medical Center, Durham, NC, United States, 5Global MR Application and Workflow, GE Healthcare, Waukesha, WI, United States, 6Global MR Application and Workflow, GE Healthcare, Menlo Park, CA, United States, 7Global MR Application and Workflow, GE Healthcare, Houston, TX, United States
DWI has been shown to be useful in characterizing renal carcinoma with quantitative measurement of ADC. However, with echo-planar imaging (EPI) based DWI protocols, the application of body DWI remains limited due to suboptimal EPI image quality. The multi-band multi-shot EPI with multiplexed sensitivity encoding (MB-MUSE) has been developed and shown to be useful in achieving high-resolution and high-quality DWI and DTI of brains, with improved scan throughput. In this study, we propose to use MB multi-shot EPI to acquire kidney DWI data with reduced geometric distortion and bilateral coverage, demonstrating the feasibility of MB multi-shot DWI of body applications.

Adjournment & Meet the Teachers

The International Society for Magnetic Resonance in Medicine is accredited by the Accreditation Council for
Continuing Medical Education to provide continuing medical education for physicians.