Liu Xiaoxi, Lai Ying-Chieh, Cui Di, Kung Shiang-Cheng, Park Meyeon, Laszik Zoltan, Larson Peder E Z, Wang Zhen J
Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA.
Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.
J Magn Reson Imaging. 2025 Apr;61(4):1969-1978. doi: 10.1002/jmri.29580. Epub 2024 Sep 6.
Kidney transplant is the treatment of choice for patients with end-stage renal disease. Early detection of allograft injury is important to delay or prevent irreversible damage.
To investigate the feasibility of hyperpolarized (HP) [1-C]pyruvate MRI for assessing kidney allograft metabolism.
Prospective.
Six participants (mean age, 45.2 ± 12.4 years, two females) scheduled for kidney allograft biopsy and five patients (mean age, 59.6 ± 10.4 years, two females) with renal cell carcinoma (RCC).
FIELD STRENGTH/SEQUENCE: Three Tesla, T2-weighted fast spin echo, multi-echo gradient echo, single shot diffusion-weighted echo-planar imaging, and time-resolved HP C metabolite-selective imaging.
Five of the six kidney allograft participants underwent biopsy after MRI. Estimated glomerular filtration rate (eGFR) and urine protein-to-creatine ratio (uPCR) were collected within 4 weeks of MRI. Kidney metabolism was quantified from HP [1-C]pyruvate MRI using the lactate-to-pyruvate ratio in allograft kidneys and non-tumor bearing kidneys from RCC patients.
Descriptive statistics (mean ± SD).
Biopsy was performed a mean of 9 days (range 5-19 days) after HP [1-C]pyruvate MRI. Three biopsies were normal, one showed low-grade fibrosis and one showed moderate microvascular inflammation. All had stable functioning allografts with eGFR >60 mL/min/1.73 m and normal uPCR. One participant who did not undergo biopsy had reduced eGFR of 49 mL/min/1.73 m and elevated uPCR. The mean lactate-to-pyruvate ratio was 0.373 in participants with normal findings (N = 3) and 0.552 in participants with abnormal findings (N = 2). The lactate-to-pyruvate ratio was highest (0.847) in the participant with reduced eGFR and elevated uPRC. Native non-tumor bearing kidneys had a mean lactate-to-pyruvate ratio of 0.309.
Stable allografts with normal findings at biopsy showed lactate-to-pyruvate ratios similar to native non-tumor bearing kidneys, whereas allografts with abnormal findings showed higher lactate-to-pyruvate ratios.
2 TECHNICAL EFFICACY: Stage 2.
肾移植是终末期肾病患者的首选治疗方法。早期检测同种异体移植肾损伤对于延缓或预防不可逆损伤很重要。
探讨超极化（HP）[1-C]丙酮酸磁共振成像（MRI）评估同种异体移植肾代谢的可行性。
前瞻性研究。
计划进行同种异体移植肾活检的6名参与者（平均年龄45.2±12.4岁，2名女性）和5例肾细胞癌（RCC）患者（平均年龄59.6±10.4岁，2名女性）。
场强/序列：3特斯拉，T2加权快速自旋回波、多回波梯度回波、单次激发扩散加权回波平面成像和时间分辨HP C代谢物选择性成像。
6名同种异体移植肾参与者中的5名在MRI检查后进行了活检。在MRI检查后4周内收集估计肾小球滤过率（eGFR）和尿蛋白与肌酐比值（uPCR）。使用同种异体移植肾和RCC患者未患肿瘤的肾脏中的乳酸与丙酮酸比值，从HP [1-C]丙酮酸MRI中对肾脏代谢进行定量分析。
描述性统计（均值±标准差）。
在HP [1-C]丙酮酸MRI检查后平均9天（范围5 - 19天）进行了活检。3次活检结果正常，1次显示轻度纤维化，1次显示中度微血管炎症。所有患者的同种异体移植肾功能稳定，eGFR>60 mL/min/1.73 m²且uPCR正常。1名未进行活检的参与者eGFR降至49 mL/min/1.73 m²且uPCR升高。活检结果正常的参与者（N = 3）的平均乳酸与丙酮酸比值为0.373，活检结果异常的参与者（N = 2）为0.552。eGFR降低且uPRC升高的参与者中该比值最高（0.847）。未患肿瘤的正常肾脏的平均乳酸与丙酮酸比值为0.309。
活检结果正常的稳定同种异体移植肾的乳酸与丙酮酸比值与未患肿瘤的正常肾脏相似，而活检结果异常的同种异体移植肾该比值更高。
2级 技术效能：2级
