Korean J Radiol.  2019 Jun;20(6):894-908. 10.3348/kjr.2018.0540.

Multiparametric Functional Magnetic Resonance Imaging for Evaluating Renal Allograft Injury

Affiliations
  • 1Department of Medical Imaging, Jinling Hospital, Clinical School of Southern Medical University, Nanjing, China.
  • 2Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, China. kevinzhlj@163.com
  • 3Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA.
  • 4Medical Imaging Teaching and Research Office, Nanfang Hospital, Southern Medical University, Guangzhou, China.

Abstract

Kidney transplantation is the treatment of choice for patients with end-stage renal disease, as it extends survival and increases quality of life in these patients. However, chronic allograft injury continues to be a major problem, and leads to eventual graft loss. Early detection of allograft injury is essential for guiding appropriate intervention to delay or prevent irreversible damage. Several advanced MRI techniques can offer some important information regarding functional changes such as perfusion, diffusion, structural complexity, as well as oxygenation and fibrosis. This review highlights the potential of multiparametric MRI for noninvasive and comprehensive assessment of renal allograft injury.

Keyword

Multiparametric magnetic resonance imaging; Functional MRI; Kidney transplantation; Allograft fibrosis; Allograft dysfunction

MeSH Terms

Allografts*
Diffusion
Fibrosis
Humans
Kidney Failure, Chronic
Kidney Transplantation
Magnetic Resonance Imaging*
Oxygen
Perfusion
Quality of Life
Transplants
Oxygen

Figure

  • Fig. 1 Comparison of diffusion images (ADCT, FP, and FA color-coded maps) between patients with poor and good renal allograft function.Top images (A–C): ADCT map (A), FP map (B), and FA map (C) of 18-year-old male with poor allograft function 1 year after transplantation (eGFR = 20 mL/min/1.73 m2). Bottom images (D–F): ADCT map (D), FP map (E), and FA map (F) of 35-year-old woman with good allograft function 14 months after transplantation (eGFR = 100 mL/min/1.73 m2). Lower ADCT, FP, and FA values were obtained in allograft with poor function. ADC = apparent diffusion coefficient, ADCT = total ADC, eGFR = estimated glomerular filtration rate, FA = fractional anisotropy, FP = perfusion fraction

  • Fig. 2 Comparison of diffusion tensor images (b0 images, FA maps, and whole-kidney tractography images) between patients with poor renal allograft function and those with and good renal allograft function.Top images (A–C): b0 image (A), FA map (B), and whole-kidney tractography image (C) of 28-year-old woman with poor allograft function (eGFR = 10 mL/min/1.73 m2). Bottom images (D–F): b0 image (D), FA map (E), and whole-kidney tractography image (F) of 22-year-old man with good allograft function (eGFR = 99 mL/min/1.73 m2) (Image courtesy of Wenjun Fan, Lihua Chen, Wen Shen. Department of Radiology, Tianjin First Center Hospital, China).

  • Fig. 3 DKI images and MK, κǁ, and κ⊥color-coded maps of 35-year-old woman with good renal allograft function (eGFR = 100 mL/min/1.73 m2).DKI images (A) with b-value of 0 s/mm2 and MK maps (B) of renal allograft. C, D. κǁ maps (C) and κ⊥ maps (D) of renal allograft. DKI= diffusion kurtosis imaging, MK = mean kurtosis

  • Fig. 4 Comparison of blood oxygen-level-dependent signals between patients with AR and good allograft function.A, B. Images of 28-year-old woman with AR 7 months after transplantation (eGFR = 86 mL/min/1.73 m2). C, D. Images of 58-year-old man with normal graft function 15 months after transplantation (eGFR = 72 mL/min/1.73 m2). Higher R2* values are calculated in medulla of normal functioning allograft compared with that with AR. Panel B shows AR on histology, while panel D shows histology of normally functioning allograft (periodic sciff-acid stain; original magnification, × 200). AR = acute rejection

  • Fig. 5 Comparison of ASL perfusion between patients with good and poor renal allograft function.A, C. Images from 35-year-old woman with good allograft function 14 years after transplantation (eGFR = 100 mL/min/1.73 m2). B, D. Images from 31-year-old woman with poor function allograft 5 months after transplantation (eGFR = 45 mL/min/1.73 m2). A, B. ASL images of renal allograft; C, D color-coded ASL maps, where blue color represents low perfusion and red represents high perfusion. Lower perfusion values are shown in allograft with poor function. ASL= arterial spin labeling

  • Fig. 6 MRE images demonstrate heterogeneous distribution of stiffness in kidney.A, B. Images from 49-year-old man with poor allograft function 12 years after transplantation (eGFR = 15 mL/min/1.73 m2). C, D. Images from 32-year-old man with good functioning allograft 4 years after transplantation (eGFR = 89 mL/min/1.73 m2). A, C. Anatomic T2 weighted images of kidney allografts; B, D MRE stiffness maps, where blue color represents softer tissue and red represents stiffer tissue. MRE= magnetic resonance elastography


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