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Arterial spin labeling and blood oxygenation level-dependent MRI to detect early kidney injury in chronic kidney disease
chengli gu1, xue li1, minghui zhou1, aoran yang1, chen zhang2, Kühn Bernd3, and yu shi1
1China Medical University, shenyang, China, 2MR Research Collaboration, Siemens Healthineers., Beijing, China, 3MR Application Predevelopment, Siemens Healthineers AG, Erlangen, Germany

Synopsis

Keywords: fMRI Acquisition, Kidney, arterial spin labeling ,chronic kidney disease , blood oxygen level-dependent

Motivation: Multiparametric magnetic resonance imaging (mpMRI) provides the potential for a more comprehensive noninvasive assessment of organ structure and function .however few studies have combined arterial spin labelling (ASL) and blood oxygen level-dependent (BOLD) to assess the kidney.

Goal(s): To detect early kidney injury in chronic kidney disease(CKD) by ASL and BOLD MRI.

Approach: This study assessed CKD patients and healthy volunteers by combining ASL and BOLD imaging.

Results: mpMRI distinguishes well between healthy people and patients with CKD patients, especially ASL.

Impact: Our study found that ASL and BOLD are potentially useful in identifying CKD patients who require renal biopsy. Additionally, these noninvasive techniques show promise in detecting underlying pathological injuries in early-stage CKD patients.

Introduction: Glomerular filtration rate (eGFR) is widely used in the clinical assessment for chronic kidney disease (CKD). However, eGFR can be normal due to renal compensation in patients with early-stage CKD. Renal biopsy is the gold standard for assessing CKD, but it is invasive, prone to sampling bias, and is not conducive to long-term follow-up. Therefore, there is an urgent need for a non-invasive and comprehensive method to evaluate renal function. Functional MRI has shown promise in assessing renal pathophysiology〔1-3〕, but few studies have combined multiparametric Magnetic Resonance Imaging (mpMRI) to assess the kidney. This study aims to combine arterial spin labeling (ASL)and blood oxygen level-dependent (BOLD) imaging to assess the extent of chronic renal changes in perfusion and oxygenation in patients with CKD.

Methods and Materials: 20 patients(age:18-65 years, 12femles, 8 males) diagnosed with chronic kidney disease (CKD) by renal biopsy were enrolled in this study. (normal eGFR group [eGFR ≥ 90 mL/min/1.73 m2]: n = 10; abnormal eGFR group [eGFR < 90 mL/min/1.73 m2]: n =10). Additionally, healthy volunteers (HV)(age:21-54 years, 6femles, 4males): n =10. All subjects were examined by research sequence body ASL and BOLD imaging on a 3T MR scanner (MAGNETOM Prisma, Siemens Healthineers AG, Erlangen,Germany). The study will involve the calculation of RBF and R2*for the cortex by two senior radiologists . The correlation between eGFR and MRI parameters was assessed by Spearman correlation analysis. The diagnostic performance of MRI parameters for detecting kidney injury was assessed by receiver operating characteristic (ROC) curves.

Results: The differences in RBF values among the three groups were statistically significant.(Figure 1)eGFR was correlated with MRI parameters (RBF: r = 0.7212，R2*: r =-0.6651). (Figure 2)The areas under the curve (AUCs) for discriminating CKD patients from HV were 0.925 and 0.705 by RBF and R*, respectively. RBF and R* identified CKD patients with normal eGFR with AUCs of 0.950 and 0.845.(Figure 3)
Discussions and Conclusions: mpMRI is a very promising method for assessing the degree of chronic renal changes in patients with CKD. ASL and BOLD were useful in detecting underlying pathologic injury in early CKD patients with normal eGFR, especially ASL.

Acknowledgements

Acknowledgements: We would like to express our gratitude to the par-ticipants and all the staff members for their cooperation to help finishthe study.Thanks to Siemens Healthineers.

Funding This study has received funding by the National NaturalScience Foundation of China (grant no. 80271885)and Support Programme for Young and Middle-aged Talents in Science and Technology Innovation in Shenyang (RC210265).

References

1. Lu F, Yang J, Yang S, Bernd K, Fu C, Yang C, Xu H, Liu M, Zhan S, Wang C, Guo R, Wu Y. Use of Three-Dimensional Arterial Spin Labeling to Evaluate Renal Perfusion in Patients With Chronic Kidney Disease. J Magn Reson Imaging. 2021 Oct;54(4):1152-1163.

2. Hua C, Qiu L, Zhou L, Zhuang Y, Cai T, Xu B, Hao S, Fang X, Wang L, Jiang H. Value of multiparametric magnetic resonance imaging for evaluating chronic kidney disease and renal fibrosis. Eur Radiol. 2023 Aug;33(8):5211-5221.

3. ugiyama K, Inoue T, Kozawa E, Ishikawa M, Shimada A, Kobayashi N, Tanaka J, Okada H. Reduced oxygenation but not fibrosis defined by functional magnetic resonance imaging predicts the long-term progression of chronic kidney disease. Nephrol Dial Transplant. 2020 Jun 1;35(6):964-970.

Figures

Figure 1: Comparison of MRI parameters among healthy volunteers,normal eGFR and abnormal eGFR group. RBF (a), R* (b).

Figure 2: Scatter plots of the correlation of the MRI parameters and eGFR. RBF (a),R* (b).

Figure 3 : Receiver operating characteristic curve analyses for discriminating CKD patients from HV using MRI parameters(a).Receiver operating characteristic curve analyses for identified CKD patients with normal eGFR using MRI parameters(b).

Figure 4: a, b, c are Health Volunteer Group; d, e, f are normal eGFR group; g,h,i are abnormal eGFR group. RBFvalues :b>e>h; R* values:c>f>i.

Proc. Intl. Soc. Mag. Reson. Med. 32 (2024)
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DOI: https://doi.org/10.58530/2024/4402