Inter-study reproducibility of arterial spin labelling magnetic resonance imaging for measurement of renal perfusion in healthy volunteers at 3 Tesla

BackgroundMeasurement of renal perfusion is a crucial part of measuring kidney function. Arterial spin labelling magnetic resonance imaging (ASL MRI) is a non-invasive method of measuring renal perfusion using magnetised blood as endogenous contrast. We studied the reproducibility of ASL MRI in normal volunteers.MethodsASL MRI was performed in healthy volunteers on 2 occasions using a 3.0 Tesla MRI scanner with flow-sensitive alternating inversion recovery (FAIR) perfusion preparation with a steady state free precession (True-FISP) pulse sequence. Kidney volume was measured from the scanned images. Routine serum and urine biochemistry were measured prior to MRI scanning.Results12 volunteers were recruited yielding 24 kidneys, with a mean participant age of 44.1 ± 14.6 years, blood pressure of 136/82 mmHg and chronic kidney disease epidemiology formula estimated glomerular filtration rate (CKD EPI eGFR) of 98.3 ± 15.1 ml/min/1.73 m2. Mean kidney volumes measured using the ellipsoid formula and voxel count method were 123.5 ± 25.5 cm3, and 156.7 ± 28.9 cm3 respectively. Mean kidney perfusion was 229 ± 41 ml/min/100 g and mean cortical perfusion was 327 ± 63 ml/min/100 g, with no significant differences between ASL MRIs. Mean absolute kidney perfusion calculated from kidney volume measured during the scan was 373 ± 71 ml/min. Bland Altman plots were constructed of the cortical and whole kidney perfusion measurements made at ASL MRIs 1 and 2. These showed good agreement between measurements, with a random distribution of means plotted against differences observed. The intra class correlation for cortical perfusion was 0.85, whilst the within subject coefficient of variance was 9.2%. The intra class correlation for whole kidney perfusion was 0.86, whilst the within subject coefficient of variance was 7.1%.ConclusionsASL MRI at 3.0 Tesla provides a repeatable method of measuring renal perfusion in healthy subjects without the need for administration of exogenous compounds. We have established normal values for renal perfusion using ASL MRI in a cohort of healthy volunteers.

[1]  T. Grist,et al.  Comparing Kidney Perfusion Using Noncontrast Arterial Spin Labeling MRI and Microsphere Methods in an Interventional Swine Model , 2011, Investigative radiology.

[2]  Georgios D. Evangelidis,et al.  Parametric Image Alignment Using Enhanced Correlation Coefficient Maximization , 2008, IEEE Transactions on Pattern Analysis and Machine Intelligence.

[3]  W. Bautz,et al.  Measurement of kidney perfusion by magnetic resonance imaging: comparison of MRI with arterial spin labeling to para-aminohippuric acid plasma clearance in male subjects with metabolic syndrome. , 2010, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[4]  F. Duck.  Physical properties of tissue , 1990 .

[5]  A. Jardine,et al.  Gadolinium-enhanced MR imaging and nephrogenic systemic fibrosis: retrospective study of a renal replacement therapy cohort. , 2007, Radiology.

[6]  M. Brezis,et al.  Determinants of intrarenal oxygenation: factors in acute renal failure. , 1992, Renal failure.

[7]  E E de Lange,et al.  Renal volume measurements: accuracy and repeatability of US compared with that of MR imaging. , 1999, Radiology.

[8]  Francis A. Duck,et al.  Physical properties of tissue : a comprehensive reference book , 1990 .

[9]  D. Bluemke,et al.  Myocardial T1 mapping with MRI: Comparison of look‐locker and MOLLI sequences , 2011, Journal of magnetic resonance imaging : JMRI.

[10]  Petros Martirosian,et al.  Perfusion MR imaging with FAIR true FISP spin labeling in patients with and without renal artery stenosis: initial experience. , 2006, Radiology.

[11]  T. Grist,et al.  Reproducibility of renal perfusion MR imaging in native and transplanted kidneys using non‐contrast arterial spin labeling , 2011, Journal of magnetic resonance imaging : JMRI.

[12]  X Golay,et al.  Non-invasive Measurement of Perfusion: a Critical Review of Arterial Spin Labelling Techniques , 2022 .

[13]  David L. Thomas,et al.  Repeatability of renal arterial spin labelling MRI in healthy subjects , 2012, Magnetic Resonance Materials in Physics, Biology and Medicine.

[14]  C. Schmid,et al.  A new equation to estimate glomerular filtration rate. , 2009, Annals of internal medicine.

[15]  S. Francis,et al.  Multislice perfusion of the kidneys using parallel imaging: Image acquisition and analysis strategies , 2010, Magnetic resonance in medicine.

[16]  T. Grist,et al.  Arterial spin labeling MRI for assessment of perfusion in native and transplanted kidneys. , 2011, Magnetic resonance imaging.

[17]  J. Ingelfinger,et al.  Measurement of renal function without urine collection. A critical evaluation of the constant-infusion technic for determination of inulin and para-aminohippurate. , 1972, The New England journal of medicine.

[18]  R. Bellomo,et al.  Renal blood flow, fractional excretion of sodium and acute kidney injury: time for a new paradigm? , 2012, Current opinion in critical care.

[19]  M. Uder,et al.  Vascular and renal hemodynamic changes after renal denervation. , 2013, Clinical journal of the American Society of Nephrology : CJASN.

[20]  N. Rofsky,et al.  MR imaging relaxation times of abdominal and pelvic tissues measured in vivo at 3.0 T: preliminary results. , 2004, Radiology.

[21]  D. Bluemke,et al.  Modified look-locker inversion recovery T1 mapping indices: assessment of accuracy and reproducibility between magnetic resonance scanners , 2013, Journal of Cardiovascular Magnetic Resonance.

[22]  Renovascular hypertension and ischemic nephropathy. , 2010, American journal of hypertension.

[23]  F. Schick,et al.  High Resolution MR Perfusion Imaging of the Kidneys at 3 Tesla without Administration of Contrast Media , 2005, RoFo : Fortschritte auf dem Gebiete der Rontgenstrahlen und der Nuklearmedizin.

[24]  R. Evans,et al.  Evidence that renal arterial-venous oxygen shunting contributes to dynamic regulation of renal oxygenation. , 2007, American journal of physiology. Renal physiology.

[25]  Ivan Pedrosa,et al.  Arterial spin-labeling MR imaging of renal masses: correlation with histopathologic findings. , 2012, Radiology.

[26]  M. Uder,et al.  Reversibility of the effects of aliskiren in the renal versus systemic circulation. , 2012, Clinical journal of the American Society of Nephrology : CJASN.

[27]  M. Su,et al.  Renal perfusion 3-T MR imaging: a comparative study of arterial spin labeling and dynamic contrast-enhanced techniques. , 2011, Radiology.

[28]  Joseph A Maldjian,et al.  Arterial spin-labeled MR perfusion imaging: clinical applications. , 2009, Magnetic resonance imaging clinics of North America.

[29]  M. Gheorghiade,et al.  The role of the kidney in heart failure. , 2012, European heart journal.

[30]  D. Weinberger,et al.  Correction for vascular artifacts in cerebral blood flow values measured by using arterial spin tagging techniques , 1997, Magnetic resonance in medicine.

[31]  E. Schnurr,et al.  Measurement of renal clearance of inulin and PAH in the steady state without urine collection. , 1980, Clinical nephrology.

[32]  U. Klose,et al.  FAIR true‐FISP perfusion imaging of the kidneys , 2004, Magnetic resonance in medicine.