Selby Nicholas M, Francis Susan T
Centre for Kidney Research and Innovation, Academic Unit for Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, UK.
Department of Renal Medicine, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK.
J Magn Reson Imaging. 2025 Jan;61(1):25-41. doi: 10.1002/jmri.29281. Epub 2024 Feb 9.
There has been growing interest in using quantitative magnetic resonance imaging (MRI) to describe and understand the pathophysiology of acute kidney injury (AKI). The ability to assess kidney blood flow, perfusion, oxygenation, and changes in tissue microstructure at repeated timepoints is hugely appealing, as this offers new possibilities to describe nature and severity of AKI, track the time-course to recovery or progression to chronic kidney disease (CKD), and may ultimately provide a method to noninvasively assess response to new therapies. This could have significant clinical implications considering that AKI is common (affecting more than 13 million people globally every year), harmful (associated with short and long-term morbidity and mortality), and currently lacks specific treatments. However, this is also a challenging area to study. After the kidney has been affected by an initial insult that leads to AKI, complex coexisting processes ensue, which may recover or can progress to CKD. There are various preclinical models of AKI (from which most of our current understanding derives), and these differ from each other but more importantly from clinical AKI. These aspects are fundamental to interpreting the results of the different AKI studies in which renal MRI has been used, which encompass different settings of AKI and a variety of MRI measures acquired at different timepoints. This review aims to provide a comprehensive description and interpretation of current studies (both preclinical and clinical) in which MRI has been used to assess AKI, and discuss future directions in the field. LEVEL OF EVIDENCE: 1 TECHNICAL EFFICACY: Stage 3.
使用定量磁共振成像(MRI)来描述和理解急性肾损伤(AKI)的病理生理学已引起越来越多的关注。在多个时间点评估肾脏血流、灌注、氧合以及组织微观结构变化的能力极具吸引力,因为这为描述AKI的性质和严重程度、追踪恢复或进展为慢性肾脏病(CKD)的时间进程提供了新的可能性,并且最终可能提供一种非侵入性评估新疗法反应的方法。考虑到AKI很常见(每年全球有超过1300万人受影响)、有害(与短期和长期的发病率及死亡率相关)且目前缺乏特效治疗方法,这可能具有重大的临床意义。然而,这也是一个具有挑战性的研究领域。肾脏在受到导致AKI的初始损伤后,会随之出现复杂的共存过程,这些过程可能恢复或进展为CKD。有多种AKI的临床前模型(我们目前的大部分认识都源于此),它们彼此不同,但更重要的是与临床AKI不同。这些方面对于解释使用肾脏MRI的不同AKI研究结果至关重要,这些研究涵盖了不同的AKI情况以及在不同时间点获取的各种MRI测量值。本综述旨在全面描述和解释目前使用MRI评估AKI的研究(包括临床前和临床研究),并讨论该领域的未来方向。证据水平:1 技术效能:3级