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肾脏血氧水平依赖(BOLD)磁共振成像的大胆探索:机遇、挑战与未来方向。

How bold is blood oxygenation level-dependent (BOLD) magnetic resonance imaging of the kidney? Opportunities, challenges and future directions.

机构信息

Berlin Ultrahigh Field Facility (B.U.F.F.), Max Delbrück Center for Molecular Medicine, Berlin, Germany.

出版信息

Acta Physiol (Oxf). 2015 Jan;213(1):19-38. doi: 10.1111/apha.12393. Epub 2014 Sep 30.

Abstract

Renal tissue hypoperfusion and hypoxia are key elements in the pathophysiology of acute kidney injury and its progression to chronic kidney disease. Yet, in vivo assessment of renal haemodynamics and tissue oxygenation remains a challenge. Many of the established approaches are invasive, hence not applicable in humans. Blood oxygenation level-dependent (BOLD) magnetic resonance imaging (MRI) offers an alternative. BOLD-MRI is non-invasive and indicative of renal tissue oxygenation. Nonetheless, recent (pre-) clinical studies revived the question as to how bold renal BOLD-MRI really is. This review aimed to deliver some answers. It is designed to inspire the renal physiology, nephrology and imaging communities to foster explorations into the assessment of renal oxygenation and haemodynamics by exploiting the powers of MRI. For this purpose, the specifics of renal oxygenation and perfusion are outlined. The fundamentals of BOLD-MRI are summarized. The link between tissue oxygenation and the oxygenation-sensitive MR biomarker T2∗ is outlined. The merits and limitations of renal BOLD-MRI in animal and human studies are surveyed together with their clinical implications. Explorations into detailing the relation between renal T2∗ and renal tissue partial pressure of oxygen (pO2 ) are discussed with a focus on factors confounding the T2∗ vs. tissue pO2 relation. Multi-modality in vivo approaches suitable for detailing the role of the confounding factors that govern T2∗ are considered. A schematic approach describing the link between renal perfusion, oxygenation, tissue compartments and renal T2∗ is proposed. Future directions of MRI assessment of renal oxygenation and perfusion are explored.

摘要

肾脏组织低灌注和缺氧是急性肾损伤及其向慢性肾脏病进展的病理生理学的关键因素。然而,体内评估肾脏血液动力学和组织氧合仍然是一个挑战。许多已建立的方法是侵入性的,因此不适用于人类。血氧水平依赖(BOLD)磁共振成像(MRI)提供了一种替代方法。BOLD-MRI 是一种非侵入性的方法,可以指示肾脏组织的氧合情况。尽管如此,最近(临床前)研究重新提出了一个问题,即 BOLD 肾脏 BOLD-MRI 到底有多准确。本综述旨在提供一些答案。它旨在激励肾脏生理学、肾脏病学和影像学社区通过利用 MRI 的力量来探索评估肾脏氧合和血液动力学的方法。为此,概述了肾脏氧合和灌注的具体情况。总结了 BOLD-MRI 的基本原理。概述了组织氧合与氧敏感磁共振生物标志物 T2之间的联系。调查了 BOLD-MRI 在动物和人体研究中的优缺点及其临床意义。探讨了详细描述肾脏 T2与肾脏组织氧分压(pO2)之间关系的方法,重点讨论了影响 T2与组织 pO2 关系的因素。考虑了适合详细描述影响 T2的混杂因素的多模态体内方法。提出了一种描述肾脏灌注、氧合、组织隔室和肾脏 T2*之间关系的示意图方法。探讨了 MRI 评估肾脏氧合和灌注的未来方向。

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