Phase-contrast magnetic resonance imaging to assess renal perfusion: a systematic review and statement paper

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Abstract

Objective

Phase-contrast magnetic resonance imaging (PC-MRI) is a non-invasive method used to compute blood flow velocity and volume. This systematic review aims to discuss the current status of renal PC-MRI and provide practical recommendations which could inform future clinical studies and its adoption in clinical practice.

Methodology

A comprehensive search of all the PC-MRI studies in human healthy subjects or patients related to the kidneys was performed.

Results

A total of 39 studies were included in which PC-MRI was used to measure renal blood flow (RBF) alongside other derivative hemodynamic parameters. PC-MRI generally showed good correlation with gold standard methods of RBF measurement, both in vitro and in vivo, and good reproducibility. Despite PC-MRI not being routinely used in clinical practice, there are several clinical studies showing its potential to support diagnosis and monitoring of renal diseases, in particular renovascular disease, chronic kidney disease and autosomal dominant polycystic kidney disease.

Discussion

Renal PC-MRI shows promise as a non-invasive technique to reliably measure RBF, both in healthy volunteers and in patients with renal disease. Future multicentric studies are needed to provide definitive normative ranges and to demonstrate the clinical potential of PC-MRI, likely as part of a multi-parametric renal MRI protocol.

Electronic supplementary material

The online version of this article (10.1007/s10334-019-00772-0) contains supplementary material, which is available to authorized users.

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Most cited references 70

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Revascularization versus medical therapy for renal-artery stenosis.

Keith Wheatley, Natalie Ives, Richard Gray … (2009)

Percutaneous revascularization of the renal arteries improves patency in atherosclerotic renovascular disease, yet evidence of a clinical benefit is limited. In a randomized, unblinded trial, we assigned 806 patients with atherosclerotic renovascular disease either to undergo revascularization in addition to receiving medical therapy or to receive medical therapy alone. The primary outcome was renal function, as measured by the reciprocal of the serum creatinine level (a measure that has a linear relationship with creatinine clearance). Secondary outcomes were blood pressure, the time to renal and major cardiovascular events, and mortality. The median follow-up was 34 months. During a 5-year period, the rate of progression of renal impairment (as shown by the slope of the reciprocal of the serum creatinine level) was -0.07x10(-3) liters per micromole per year in the revascularization group, as compared with -0.13x10(-3) liters per micromole per year in the medical-therapy group, a difference favoring revascularization of 0.06x10(-3) liters per micromole per year (95% confidence interval [CI], -0.002 to 0.13; P=0.06). Over the same time, the mean serum creatinine level was 1.6 micromol per liter (95% CI, -8.4 to 5.2 [0.02 mg per deciliter; 95% CI, -0.10 to 0.06]) lower in the revascularization group than in the medical-therapy group. There was no significant between-group difference in systolic blood pressure; the decrease in diastolic blood pressure was smaller in the revascularization group than in the medical-therapy group. The two study groups had similar rates of renal events (hazard ratio in the revascularization group, 0.97; 95% CI, 0.67 to 1.40; P=0.88), major cardiovascular events (hazard ratio, 0.94; 95% CI, 0.75 to 1.19; P=0.61), and death (hazard ratio, 0.90; 95% CI, 0.69 to 1.18; P=0.46). Serious complications associated with revascularization occurred in 23 patients, including 2 deaths and 3 amputations of toes or limbs. We found substantial risks but no evidence of a worthwhile clinical benefit from revascularization in patients with atherosclerotic renovascular disease. (Current Controlled Trials number, ISRCTN59586944.) 2009 Massachusetts Medical Society

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Stenting and medical therapy for atherosclerotic renal-artery stenosis.

Christopher J. Cooper, Timothy P Murphy, Donald E Cutlip … (2014)

Atherosclerotic renal-artery stenosis is a common problem in the elderly. Despite two randomized trials that did not show a benefit of renal-artery stenting with respect to kidney function, the usefulness of stenting for the prevention of major adverse renal and cardiovascular events is uncertain. We randomly assigned 947 participants who had atherosclerotic renal-artery stenosis and either systolic hypertension while taking two or more antihypertensive drugs or chronic kidney disease to medical therapy plus renal-artery stenting or medical therapy alone. Participants were followed for the occurrence of adverse cardiovascular and renal events (a composite end point of death from cardiovascular or renal causes, myocardial infarction, stroke, hospitalization for congestive heart failure, progressive renal insufficiency, or the need for renal-replacement therapy). Over a median follow-up period of 43 months (interquartile range, 31 to 55), the rate of the primary composite end point did not differ significantly between participants who underwent stenting in addition to receiving medical therapy and those who received medical therapy alone (35.1% and 35.8%, respectively; hazard ratio with stenting, 0.94; 95% confidence interval [CI], 0.76 to 1.17; P=0.58). There were also no significant differences between the treatment groups in the rates of the individual components of the primary end point or in all-cause mortality. During follow-up, there was a consistent modest difference in systolic blood pressure favoring the stent group (-2.3 mm Hg; 95% CI, -4.4 to -0.2; P=0.03). Renal-artery stenting did not confer a significant benefit with respect to the prevention of clinical events when added to comprehensive, multifactorial medical therapy in people with atherosclerotic renal-artery stenosis and hypertension or chronic kidney disease. (Funded by the National Heart, Lung and Blood Institute and others; ClinicalTrials.gov number, NCT00081731.).

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Age, kidney function, and risk factors associate differently with cortical and medullary volumes of the kidney

Xiangling Wang, Terri J. Vrtiska, Ramesh Avula … (2013)

The kidney atrophies in patients with advanced chronic kidney disease (CKD) but factors influencing kidney size in normal adults are less clear. To help define this we measured kidney volumes on contrast-enhanced CT images from 1344 potential kidney donors (ages 18 to 75 years). Cortical volume per body surface area progressively declined in both genders with increased age. Statistically, this was primarily dependent on the age-related decline in glomerular filtration rate (GFR). Independent predictors of increased cortical volume per body surface area were male gender, increased GFR, increased 24-hour urine albumin, current smoker, and decreased high-density lipid cholesterol. Medullary volume per body surface area increased with age in men while it increased with age in women until age 50 followed by a subsequent decline. Independent predictors of increased medullary volume per body surface area were older age, male gender, increased GFR, increased 24-hour urine albumin, increased serum glucose, and decreased serum uric acid. Thus, while cortical volume declines with age along the same biological pathway as the age-related decline in GFR and albuminuria some CKD risk factors are actually associated with increased cortical or medullary volume among relatively healthy adults. Underlying hypertrophy or atrophy of different nephron regions may explain these findings.

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Author and article information

Contributors

Anna Caroli:

ORCID: http://orcid.org/0000-0002-4130-4663

acaroli@marionegri.it

Journal

Journal ID (nlm-ta): MAGMA

Journal ID (iso-abbrev): MAGMA

Title: Magma (New York, N.y.)

Publisher: Springer International Publishing (Cham )

ISSN (Print): 0968-5243

ISSN (Electronic): 1352-8661

Publication date (Electronic): 17 August 2019

Publication date PMC-release: 17 August 2019

Publication date (Print): 2020

Volume: 33

Issue: 1

Pages: 3-21

Affiliations

[1 ]GRID grid.4527.4, ISNI 0000000106678902, Department of Biomedical Engineering, , Istituto di Ricerche Farmacologiche Mario Negri IRCCS, ; Bergamo, Italy

[2 ]GRID grid.7048.b, ISNI 0000 0001 1956 2722, MR Center, Institute of Clinical Medicine, , Aarhus University, ; Aarhus, Denmark

[3 ]GRID grid.7700.0, ISNI 0000 0001 2190 4373, Computer Assisted Clinical Medicine, Medical Faculty Mannheim, , Heidelberg University, ; Mannheim, Germany

[4 ]GRID grid.4563.4, ISNI 0000 0004 1936 8868, Centre for Kidney Research and Innovation, , University of Nottingham, ; Royal Derby Hospital Campus, Nottingham, UK

[5 ]Department of Diagnostic Radiology, Azienda Socio-Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy

[6 ]GRID grid.154185.c, ISNI 0000 0004 0512 597X, Department of Renal Medicine, , Aarhus University Hospital, ; Aarhus, Denmark

[7 ]GRID grid.4563.4, ISNI 0000 0004 1936 8868, Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, , University of Nottingham, ; Nottingham, UK

[8 ]GRID grid.33236.37, ISNI 0000000106929556, Department of Management, Information and Production Engineering, , University of Bergamo, ; Dalmine, BG Italy

Author information

Anna Caroli http://orcid.org/0000-0002-4130-4663

Article

Publisher ID: 772

DOI: 10.1007/s10334-019-00772-0

PMC ID: 7210220

PubMed ID: 31422518

SO-VID: b169597e-fdb9-42e9-84a0-693b7a6049f2

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by/4.0/), which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made.The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

History

Date received : 16 May 2019

Date revision received : 9 July 2019

Date accepted : 1 August 2019

Custom metadata

ScienceOpen disciplines: Radiology & Imaging

Keywords: phase-contrast mri,renal disease,renal blood flow,biomarker

Data availability:

ScienceOpen disciplines: Radiology & Imaging

Keywords: phase-contrast mri, renal disease, renal blood flow, biomarker

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Phase-contrast magnetic resonance imaging to assess renal perfusion: a systematic review and statement paper

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Abstract

Objective

Methodology

Results

Discussion

Electronic supplementary material

Related collections

Probing cerebral hemodynamics with BOLD fMRI

Most cited references 70

Revascularization versus medical therapy for renal-artery stenosis.

Stenting and medical therapy for atherosclerotic renal-artery stenosis.

Age, kidney function, and risk factors associate differently with cortical and medullary volumes of the kidney

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Author information

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Cited by 10

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