Sir Peter Mansfield Imaging Centre, School of Physics & Astronomy, University of Nottingham, Nottingham; NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, University of Nottingham, Nottingham.
Centre for Kidney Research and Innovation, Academic Unit for Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham; Department of Renal Medicine, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, United Kingdom.
Am J Kidney Dis. 2023 Oct;82(4):491-504. doi: 10.1053/j.ajkd.2023.02.007. Epub 2023 May 13.
Recent advances in multiparametric magnetic resonance imaging (MRI) allow multiple quantitative measures to assess kidney morphology, tissue microstructure, oxygenation, kidney blood flow, and perfusion to be collected in a single scan session. Animal and clinical studies have investigated the relationship between the different MRI measures and biological processes, although their interpretation can be complex due to variations in study design and generally small participant numbers. However, emerging themes include the apparent diffusion coefficient derived from diffusion-weighted imaging, T and T mapping parameters, and cortical perfusion being consistently associated with kidney damage and predicting kidney function decline. Blood oxygen level-dependent (BOLD) MRI has shown inconsistent associations with kidney damage markers but has been predictive of kidney function decline in several studies. Therefore, multiparametric MRI of the kidneys has the potential to address the limitations of existing diagnostic methods to provide a noninvasive, noncontrast, and radiation-free method to assess whole kidney structure and function. Barriers to be overcome to facilitate widespread clinical application include improved understanding of biological factors that impact MRI measures, development of a larger evidence base for clinical utility, standardization of MRI protocols, automation of data analysis, determining optimal combination of MRI measures, and health economic evaluation.
近年来，多参数磁共振成像（MRI）的进展使得可以在单次扫描中收集多个定量指标，以评估肾脏形态、组织微观结构、氧合、肾脏血流和灌注。动物和临床研究已经研究了不同 MRI 指标与生物学过程之间的关系，尽管由于研究设计和参与者数量普遍较少的差异，其解释可能较为复杂。然而，新出现的主题包括来自扩散加权成像的表观扩散系数、T1 和 T2 映射参数以及皮质灌注与肾脏损伤一致相关，并预测肾功能下降。血氧水平依赖（BOLD）MRI 与肾脏损伤标志物的相关性不一致，但在几项研究中预测了肾功能下降。因此，肾脏的多参数 MRI 有可能克服现有诊断方法的局限性，提供一种非侵入性、非对比和无辐射的方法来评估整个肾脏的结构和功能。为了促进广泛的临床应用，需要克服的障碍包括更好地了解影响 MRI 指标的生物学因素、为临床应用提供更大的证据基础、标准化 MRI 协议、数据分析自动化、确定 MRI 指标的最佳组合以及健康经济评估。
