Sadick Maliha, Schock Daniel, Kraenzlin Bettina, Gretz Norbert, Schoenberg Stefan O, Michaely Henrik J
Institute of Clinical Radiology and Nuclear Medicine, University Hospital Mannheim, University of Heidelberg, Mannheim, Germany.
Invest Radiol. 2009 Aug;44(8):469-75. doi: 10.1097/RLI.0b013e3181a8afa1.
OBJECTIVE Morphologic and dynamic renal imaging is necessary for characterization of kidney function in renal insufficiency. Assessment of renal perfusion and the glomerular filtration rate (GFR) are essential, as the serum creatinine level and urea are not sensitive at an early stage of kidney damage. Currently available GFR estimation methods are time consuming, expensive, and lead to radiation exposure for the patient. Therefore, the aim was to determine the feasibility of morphologic and contrast-enhanced dynamic magnetic resonance imaging for GFR assessment in pcy (polycystic kidneys and fibrosis) mice, using a clinical 3.0 Tesla scanner.
Fourteen pcy-mice were anesthetized and an internal jugular vein catheter was implanted to which a dedicated extension tube with a 0.28 mm inner diameter was connected, filled with 1:100 microL diluted gadobutrol (Gadovist Bayer Schering Pharma, Berlin, Germany). Imaging of the mice was performed with a dedicated 8-element mouse coil (Rapid Biomedical, Rimpar, Germany) plugged into a clinical 32-channel 3.0 Tesla magnetic resonance-scanner (Magnetom Verio, Siemens Medical Solution, Erlangen, Germany). In this study, different morphologic sequences comprising a T1-w 3D volume-interpolated breathhold examination, T2-w 2D half-Fourier acquired turbo spin echo (HASTE), T2-w 2D BLADE-TSE with fat saturation, and a T2-w 3D SPACE were acquired. The dynamic sequence performed for assessment of GFR, was a 2D SR-Turbo FLASH sequence. Image analysis and data assessment was performed by 2 radiologists who were experienced in assessment of human kidney disease. A 3-point scale for visual assessment of renal cystic changes in the pcy-mice was applied. The appearance of cysts, considering a detailed demarcation of the cyst with an enhancing rim and a hypointense core, were assessed as detailed: (1) faint (2) and not to be differentiated, (3) findings in the morphologic sequences. Quantitative parameters of renal function (cortex plasma flow mL/100 mL/min, cortex plasma volume mL/100 mL, and PT sec) were fitted to a 2-compartment model and compared with blood samples of creatinine and urea. Histologic progression of cysts and fibrosis in the pcy-mice was analyzed.
The T2-w 3D SPACE and T1-w 3D volume-interpolated breathhold examination sequence post contrast with thinnest slice thickness of 1 to 1.2 mm were well suited for delineation of the kidneys with detailed demarcation of the cysts (image quality score: 1.14 +/- 0.37 and 1.2 +/- 0.70, respectively). The T2-w 2D BLADE-TSE proved feasible, too (image quality score: 1.28 +/- 0.59). The T2-w 2D HASTE sequence with minimally achievable slice thickness of 2 mm was not suitable for morphologic assessment (image quality score: 2.9 +/- 0.37). The HASTE sequence suffered from blurring artifacts which further decreased the conspicuity of small cystic changes. The 2D SR-Turbo FLASH sequence showed the renal first pass of the contrast agent and enabled assessment of GFR. The data after time resolved 2D SR-Turbo FLASH perfusion analysis was used for GFR evaluation and demonstrated better GFR values in the young pcy-mice (0.558 mL/min) compared with the older pcy-mice (0.066 mL/min).
Application of dedicated coils with a clinical 3.0 Tesla magnetic resonance-scanner have proved feasible for morphologic and dynamic renal imaging with assessment of GFR in pcy-mice.
目的 形态学和动态肾脏成像对于肾功能不全时肾功能的评估至关重要。肾灌注和肾小球滤过率(GFR)的评估必不可少,因为血清肌酐水平和尿素在肾脏损伤早期并不敏感。目前可用的GFR估算方法耗时、昂贵且会使患者受到辐射暴露。因此,本研究旨在使用临床3.0特斯拉扫描仪,确定形态学和对比增强动态磁共振成像在多囊肾和纤维化(pcy)小鼠中评估GFR的可行性。
对14只pcy小鼠进行麻醉,并植入颈内静脉导管,连接一根内径为0.28 mm的专用延长管,管内充满1:100微升稀释的钆布醇(德国柏林拜耳先灵医药公司的加乐显)。使用插入临床32通道3.0特斯拉磁共振扫描仪(德国西门子医疗解决方案公司的Magnetom Verio)的专用8元素小鼠线圈对小鼠进行成像。在本研究中,采集了不同的形态学序列,包括T1加权3D容积内插屏气检查序列、T2加权2D半傅里叶采集快速自旋回波(HASTE)序列、带有脂肪抑制的T2加权2D刀锋式快速自旋回波(BLADE-TSE)序列以及T2加权3D空间分辨快速成像序列(SPACE)。用于评估GFR的动态序列是2D单次激发快速小角度激发(SR-Turbo FLASH)序列。由2名有评估人类肾脏疾病经验的放射科医生进行图像分析和数据评估。应用3分制对pcy小鼠的肾囊性改变进行视觉评估。考虑到囊肿有强化边缘和低信号核心的详细边界,对囊肿外观进行如下详细评估:(1)模糊;(2)难以区分;(3)形态学序列中的表现。将肾功能的定量参数(皮质血浆流量mL/100 mL/min、皮质血浆容积mL/100 mL和通过时间sec)拟合到二室模型中,并与肌酐和尿素的血样进行比较。分析了pcy小鼠囊肿和纤维化的组织学进展情况。
T2加权3D空间分辨快速成像序列和T1加权3D容积内插屏气检查序列在注射造影剂后,最薄切片厚度为1至1.2 mm,非常适合清晰描绘肾脏并详细区分囊肿(图像质量评分分别为:1.14±0.37和1.2±0.70)。T2加权2D刀锋式快速自旋回波序列也被证明是可行的(图像质量评分:1.28±0.59)。T2加权2D半傅里叶采集快速自旋回波序列最小可实现切片厚度为2 mm,不适合形态学评估(图像质量评分:2.9±0.37)。该序列存在模糊伪影,进一步降低了小囊性改变的清晰度。2D单次激发快速小角度激发序列显示了造影剂的肾脏首过效应,并能够评估GFR。时间分辨2D单次激发快速小角度激发灌注分析后的数据用于GFR评估,结果显示年轻pcy小鼠(0.558 mL/min)的GFR值优于老年pcy小鼠(0.066 mL/min)。
已证明将专用线圈与临床3.0特斯拉磁共振扫描仪联用,对于pcy小鼠进行形态学和动态肾脏成像以及评估GFR是可行的。