Centre for Kidney Research and Innovation, Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, UK.
Department of Anesthesiology and Intensive Care, Paris-Saclay University, Bicêtre Hospital, Assistance Publique Hôpitaux de Paris (AP-HP), Le Kremlin-Bicêtre, France.
Curr Opin Crit Care. 2020 Dec;26(6):543-548. doi: 10.1097/MCC.0000000000000768.
Acute kidney injury (AKI) is a common complication in critically ill patients. Understanding the pathophysiology of AKI is essential to guide patient management. Imaging techniques that inform the pathogenesis of AKI in critically ill patients are urgently needed, in both research and ultimately clinical settings. Renal contrast-enhanced ultrasonography (CEUS) and multiparametric MRI appear to be the most promising imaging techniques for exploring the pathophysiological mechanisms involved in AKI.
CEUS and MRI can be used to noninvasively and safely evaluate renal macrocirculation and microcirculation and oxygenation in critical ill patients. These techniques show that a decrease in renal blood flow, particularly cortical blood flow, may be observed in septic AKI and may contribute to its development. MRI may be a valuable method to quantify long-term renal damage after AKI that cannot currently be detected using standard clinical approaches.
CEUS and multiparametric renal MRI are promising imaging techniques but more evidence is needed to show how they can first be more widely used in a research setting to test key hypotheses about the pathophysiology and recovery of AKI, and then ultimately be adopted in clinical practice to guide patient management.
急性肾损伤（AKI）是危重症患者的常见并发症。了解 AKI 的病理生理学对于指导患者管理至关重要。在研究和最终的临床环境中，都迫切需要能够阐明危重症患者 AKI 发病机制的影像学技术。肾脏对比增强超声（CEUS）和多参数 MRI 似乎是探索 AKI 相关病理生理机制最有前途的影像学技术。
CEUS 和 MRI 可用于无创、安全地评估危重症患者的肾脏大循环和微循环及氧合情况。这些技术表明，脓毒症性 AKI 可能观察到肾血流量，尤其是皮质血流量减少，这可能与其发病机制有关。MRI 可能是一种有价值的方法，可以定量评估 AKI 后的长期肾损伤，而目前标准的临床方法无法检测到这种损伤。
CEUS 和多参数肾脏 MRI 是很有前途的影像学技术，但需要更多证据表明如何首先在研究环境中更广泛地应用这些技术，以检验 AKI 的病理生理学和恢复的关键假设，然后最终在临床实践中采用这些技术来指导患者管理。
