Radiology
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

Published online before print February 28, 2003, 10.1148/radiol.2271020383
This Article
Right arrow Abstract Freely available
Right arrow Figures Only
Right arrow Full Text (PDF)
Right arrow All Versions of this Article:
2271020383v1
227/1/289    most recent
Right arrow Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Lee, V. S.
Right arrow Articles by Kramer, E. L.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Lee, V. S.
Right arrow Articles by Kramer, E. L.
(Radiology 2003;227:289-294.)
© RSNA, 2003

Technical Developments

Dynamic Three-dimensional MR Renography for the Measurement of Single Kidney Function: Initial Experience1

Vivian S. Lee, MD, PhD, Henry Rusinek, PhD, Marilyn E. Noz, PhD, Peter Lee, MD, Meera Raghavan, MD and Elissa L. Kramer, MD

1 From the Department of Radiology-MRI, New York University Medical Center, 530 First Ave, HCC Basement, New York, NY 10016. From the 2001 RSNA scientific assembly. Received April 8, 2002; revision requested June 17; revision received June 28; accepted August 8. Supported by an RSNA Research and Education Foundation Seed Grant, National Institutes of Health K23-DK02814 grant, and Society of Computed Body Tomography/Magnetic Resonance Lauterbur and Junior Investigator Awards. Address correspondence to V.S.L. (e-mail: vivian.lee@med.nyu.edu).


   ABSTRACT
TOP
 ABSTRACT
INTRODUCTION
 MATERIALS AND METHODS
 Results
 DISCUSSION
 REFERENCES
 
A three-dimensional magnetic resonance (MR) renographic method to measure single kidney glomerular filtration rate (GFR) and split renal function was developed that is based on renal signal intensity measurements during 2–3 minutes after intravenous injection of a low dose (2 mL or 0.01 mmol/kg) of gadopentetate dimeglumine. In nine subjects, single kidney MR GFR indices correlated well with technetium 99m (99mTc) diethylenetriaminepentaacetic acid (DTPA) clearance (r = 0.7–0.8) for GFR values of 7–48 mL/min. MR right kidney split renal function values (range, 32%–59%) also correlated well with 99mTc-DTPA radionuclide measurements (r = 0.76); differences between the two methods averaged 0.8% ± 8. MR renography was performed along with contrast material–enhanced MR imaging of the kidneys and renal arteries and added 8 minutes or less to the total examination time.

© RSNA, 2003

Index terms: Kidney, function, 81.91 • Kidney, perfusion, 961.12943 • Magnetic resonance (MR), contrast enhancement, 81.12143 • Magnetic resonance (MR), perfusion study, 961.12943


   INTRODUCTION
TOP
 ABSTRACT
 INTRODUCTION
MATERIALS AND METHODS
 Results
 DISCUSSION
 REFERENCES
 
Magnetic resonance (MR) imaging studies of the kidneys and renal arteries are increasingly commonly performed clinical examinations. For many of the patients referred, such as renal transplant donors and recipients, patients suspected of having renovascular disease, and pediatric patients with renal dysfunction, the quantification of renal function could provide useful information supplemental to that of anatomic MR imaging. Of the tests available to measure renal function, the serum creatinine level, the most widely used test, is a relatively insensitive measure of diminished glomerular filtration rate (GFR) and provides information only about global renal function and not about individual kidney GFR. Single kidney clearance measurements of glomerularly filtered substances such as inulin are considered the most accurate for determining single kidney GFR; however, sampling methods are invasive and not feasible in the clinical setting.

Instead, radionuclide methods that use radioactive tracers such as technetium 99m (99mTc) diethylenetriaminepentaacetic acid (DTPA) have been implemented for determining single kidney GFR clinically. 99mTc-DTPA is freely filtered at the glomerulus without tubular secretion or resorption, and in 1982, Gates (1) demonstrated that the uptake of 99mTc-DTPA by each kidney during 2–3 minutes after intravenous injection was directly proportional to GFR. The scintigraphic method has the advantage of noninvasively providing information about single kidney function, but because of its reliance on absolute gamma camera counts, scintigraphy also has the disadvantages of requiring calibration on each imaging system and appropriate attenuation and background correction (1,2).

We investigated an approach for the measurement of single kidney function with MR imaging and gadopentetate dimeglumine. As a consequence of its high T1 relaxivity, gadopentetate dimeglumine can be used in tracer quantities for high spatial resolution dynamic imaging of the kidneys, an approach termed MR renography (3–16). We implemented a fast interpolated three-dimensional (3D) sequence to allow imaging of the aorta and both whole kidneys in 3 seconds with a voxel size of 2.9 x 1.5 x 3 mm. By using low doses of gadopentetate dimeglumine with dynamic 3D MR imaging, signal intensity measurements can be used to estimate whole kidney gadolinium uptake. Extrapolating from radionuclide renography and the results of early studies confirming the suitability of gadopentetate dimeglumine (or Gd-DTPA) as an analog for 99mTc-DTPA (17), we hypothesized that single kidney function measurements can be made noninvasively on the basis of whole kidney gadopentetate dimeglumine uptake during 2–3 minutes after injection and that this test can be performed as part of a routine contrast material–enhanced MR examination of the kidneys and renal arteries.

The purpose of this study was to evaluate the accuracy of a low-dose 3D MR renographic method for measuring parameters of kidney function, including single kidney GFR and split renal function.


   MATERIALS AND METHODS
TOP
 ABSTRACT
 INTRODUCTION
 MATERIALS AND METHODS
Results
 DISCUSSION
 REFERENCES
 
We studied nine consecutive patients (four women, five men; mean age ± SD, 62 years ± 17; range, 26–77 years) who were referred for MR angiography of the renal arteries for suspected renovascular disease and who agreed to undergo both radionuclide and MR renography during the same morning. After providing written informed consent, all patients underwent a protocol approved by our institutional review board.

99mTc-DTPA Renography
Reference values for single kidney GFR and split renal function were measured for all nine patients by using established 99mTc-DTPA renography and plasma clearance methods. At the start of the study, a 21-gauge butterfly needle was placed into an arm vein. After an intravenous bolus of 10 mCi (370 MBq) of 99mTc-DTPA (Tc-99m Pentetate; Mallinckrodt, Hazelwood, Mo) was administered, dynamic planar images were acquired with a large–field-of-view gamma camera and low-energy collimator with a 20% energy window centered at 140 keV. A planar matrix of 128 x 128 pixels was used, with a pixel size of 4.3 mm. One hundred twenty 2-second frames (4 minutes) were acquired, followed by 52 30-second frames, for a total of 30 minutes.

For measurements of global GFR from plasma clearance of 99mTc-DTPA, venous blood samples were collected at 1 and 3 hours after injection in all subjects from a site separate from that of the radionuclide injection (18). All samples were centrifuged and underwent ultrafiltration to correct for protein binding of the 99mTc-DTPA, according to a previously described method (19). Total GFR measurements were averaged from 1- and 3-hour plasma clearance values.

Split renal function was determined on the basis of background- and attenuation-corrected gamma camera imaging of renal uptake at 2–3 minutes (20). For attenuation correction, the mean depth of each kidney was determined by one investigator (V.S.L.) using MR images. We found that scintigraphic estimates of split renal function were extremely sensitive to the sizes of the regions of interest drawn around each kidney on gamma camera images. To reduce the variability, we relied on 3D MR imaging to determine the coronal cross-sectional area for each kidney. We used radionuclide renographic images to measure the mean number of counts per pixel for each kidney and normalized this to the size of the kidney as estimated from the MR images; that is, the average number of counts per pixel in the kidney was multiplied by the number of pixels corresponding to the area of the coronal projection of that kidney (as determined with MR) to determine whole kidney scintigraphic counts.

Split renal function is the fractional uptake (expressed as a percentage) by one kidney relative to total uptake by both kidneys, and we present results for right kidney measurements. Single kidney GFR was calculated by multiplying split renal function for each kidney by total GFR, with the latter determined on the basis of 99mTc-DTPA plasma clearance values.

MR Renography
Immediately after the radionuclide examinations, all subjects underwent MR imaging with a 1.5-T system (Magnetom Symphony with Quantum gradients; Siemens, Erlangen, Germany) and a torso phased-array coil. MR renography was performed by using a 3D spoiled gradient-echo sequence: 2.2/0.8 (repetition time msec/echo time msec), flip angle, 9°; matrix, 134 x 256; field of view, 380 mm; 12 (n = 3) or 16 (n = 6) partitions interpolated to 24 or 32, respectively, and 3-mm (n = 6) or 4-mm (n = 3) partition thickness, for a total slab thickness of 96 mm; bandwidth, 720 Hz/pixel; and acquisition time, 3 seconds. With improved interpolation methods, a modified version of the sequence with thinner partitions could be obtained in the same acquisition times and was implemented during the latter portion of this study.

Imaging was performed in the oblique coronal plane, with coverage to include the abdominal aorta and both kidneys. At least five nonenhanced 3D data sets were acquired first. Then, after a 2-mL bolus of gadopentetate dimeglumine (Magnevist; Berlex Laboratories, Wayne, NJ) was injected at 2 mL/sec, followed by 20 mL of saline, 18 3D image sets were acquired at the following times after an 8-second imaging delay after the intravenous injection: 0, 3, 6, 9, 12, 15, 18, 21, 24, 27, 45, 60, 90, 120, 150, 180, 210, and 240 seconds. The initial acquisition was performed 8 seconds after the start of injection to allow for circulation of the intravenously injected contrast material through the venous and pulmonary circulation. Patients were instructed to suspend respiration at end expiration during all 3D acquisitions, with the first breath hold lasting 30 seconds and subsequent breath holds 3 seconds each. Oxygen by nasal cannula was routinely offered to patients before the examination to facilitate breath holding.

In all cases, MR renography was performed in addition to a routine MR evaluation of the renal arteries, which included T1- and T2-weighted imaging of the kidneys and contrast-enhanced 3D MR angiography of the aorta and renal arteries with 22 mL of gadopentetate dimeglumine (approximately 0.1–0.15 mmol/kg of body weight). The timing of the MR angiographic acquisition was based on a modification of the test bolus approach (21,22), in which MR renography was used to determine patient circulation time (time from intravenous injection to peak aortic enhancement). MR renography added approximately 8 minutes to the imaging time, and the total examination time was less than 45 minutes. Three-dimensional MR renography was performed successfully in all subjects.

Image Analysis
Three-dimensional registration and segmentation of all images were performed separately for each kidney by two investigators (P.L. and V.S.L.). Left and right kidneys were first spatially aligned with the corresponding initial volume to facilitate later segmentation. To register 3D images, centroids, or centers of gravity of each kidney, were computed on the basis of contours defined around each kidney for all time points. Data sets were then automatically translated to align centers of gravity by using software developed locally (23). Next, anatomic regions of interest were manually defined for the renal cortex, medulla, and collecting system with the same software. Segmentation was facilitated by the ability to copy and combine regions of interest across registered 3D data volumes. The 3D data set with the greatest cortical-medullary contrast, typically 6–9 seconds after peak aortic enhancement, was used to define the cortex and medulla. The final 3D images (4 minutes after injection) were used to define contrast-enhanced collecting spaces. For each case, manual registration and segmentation required approximately 2–3 hours at the workstation.

After segmentation, the mean signal intensity for each region of interest at each time point was computed for each coronal section. The most anterior and posterior images that depicted renal parenchyma were not used for analysis because volume-averaging artifacts limited accurate definition of cortical and medullary regions. Even with use of a manufacturer-supplied uniformity correction algorithm, a similar pattern of image nonuniformity was observed across all images at all time points, with the strongest change observed in the anteroposterior direction. We have implemented an approximate correction scheme that is based on the section intensity profile. The profile was derived for all sections containing the kidneys by averaging the signal intensity across segmented renal cortex.

To convert measured signal intensities (S) to gadopentetate dimeglumine concentration, we used an approximate conversion: gadopentetate dimeglumine concentration = (S - S0)/S0, where S0 indicates nonenhanced values. On the basis of the S versus T1 relationship for our 3D spoiled gradient-echo sequence, which was determined by using phantom data, there is a monotonic relationship between the normalized ratio and gadopentetate dimeglumine concentrations within the 0–1-µmol/mL range of renal concentrations of gadolinium contrast material encountered in low-dose MR renography (24).

We applied the Gates scintigraphic method (20) to MR renography to estimate GFR and split renal function. From gadolinium concentration-time curves for whole kidney and renal cortex and medullary regions, we calculated average gadolinium concentrations (in micromoles per milliliter) between 2 and 3 minutes. Absolute gadopentetate dimeglumine uptake values (in micromoles) for each region were then determined by multiplying concentrations by the volumes of tissue in each region. We refer to the average total uptake in renal parenchyma during these times as the single kidney GFR index. The ratio of each 2–3-minute whole kidney uptake value to total uptake (sum of both kidneys) was used to determine MR values for split renal function and was expressed as a percentage.

Statistical Analysis
Using linear regression and correlation coefficients, we compared MR renographic measures of single kidney GFR indices with reference measurements that used 99mTc-DTPA–based values. For testing the agreement between measurements of split renal function obtained with MR and with radionuclide techniques, we also performed Bland and Altman analysis (25).


   Results
TOP
 ABSTRACT
 INTRODUCTION
 MATERIALS AND METHODS
 Results
DISCUSSION
 REFERENCES
 
Representative 3D MR renographic images for a single time point and at a single section position across time for one subject are shown in Figure 1, and representative concentration-time curves for one patient are given in Figure 2.



View larger version (207K):
[in this window]
[in a new window]
[Download PPT slide]
  		Figure 1A-D. Representative images from a dynamic gadolinium-enhanced 3D MR renographic study in a 55-year-old woman who was a potential renal transplant donor. A-D, Four selected oblique coronal MR images from a single 3D acquisition (2.2/0.8; flip angle, 9°) obtained 26 seconds after intravenous injection of 2 mL of gadopentetate dimeglumine. Images are from anterior (A) to posterior (D). Note that during the arterial phase of enhancement (prominent aortic enhancement [arrows in A]), there is marked cortical enhancement (white arrowheads). The relative lack of medullary enhancement (black arrowheads) during this phase indicates that the gadolinium-based contrast material has not yet passed into the loops of Henle of the medulla. E-H, Oblique coronal MR images from 3D acquisitions (2.2/0.8; flip angle, 9°) at 0 (E), 26 (F), 98 (G), and 248 (H) seconds after injection of contrast material in the same patient as in A-D. Section position corresponds to a position intermediate between images B and C.

 


View larger version (206K):
[in this window]
[in a new window]
[Download PPT slide]
  		Figure 1E-H. Representative images from a dynamic gadolinium-enhanced 3D MR renographic study in a 55-year-old woman who was a potential renal transplant donor. A-D, Four selected oblique coronal MR images from a single 3D acquisition (2.2/0.8; flip angle, 9°) obtained 26 seconds after intravenous injection of 2 mL of gadopentetate dimeglumine. Images are from anterior (A) to posterior (D). Note that during the arterial phase of enhancement (prominent aortic enhancement [arrows in A]), there is marked cortical enhancement (white arrowheads). The relative lack of medullary enhancement (black arrowheads) during this phase indicates that the gadolinium-based contrast material has not yet passed into the loops of Henle of the medulla. E-H, Oblique coronal MR images from 3D acquisitions (2.2/0.8; flip angle, 9°) at 0 (E), 26 (F), 98 (G), and 248 (H) seconds after injection of contrast material in the same patient as in A-D. Section position corresponds to a position intermediate between images B and C.

 


View larger version (28K):
[in this window]
[in a new window]
[Download PPT slide]
  		Figure 2. Results of 3D MR renography of the right kidney in a 59-year-old woman with hypertension (GFR = 31 mL/min on the basis of 99mTc-DTPA clearance and gamma camera split renal function). Measured 3D MR renographic signal intensities were converted to gadolinium (Gd) concentrations. Renal cortical, medullary, and collecting system enhancement curves are plotted along with measurements for the aorta. This case shows typical patterns of enhancement in each intrarenal compartment and illustrates the measurements during 2-3 minutes after injection that were used to compute split renal function and single kidney MR GFR index.

 
Single kidney GFR values obtained by using 99mTc-DTPA radionuclide renography ranged from 7 to 48 mL/min. Scintigraphic GFR measurements correlated well with MR single kidney GFR index values (r = 0.75, P < .002, Fig 3). The relationship between MR and reference scintigraphic values was fitted to the linear regression equation: y = 1.7x + 8.9, where y represents the single kidney MR GFR index (in micromoles of gadopentetate dimeglumine), and x represents the scintigraphic single kidney GFR reference value (in milliliters per minute). A separate analysis was performed by using cortical and medullary average uptake of gadolinium during 2–3 minutes. Correlation for medullary measurements (r = 0.79) was higher than for cortical measurements (r = 0.69), although the difference did not achieve statistical significance (P > .2).



View larger version (27K):
[in this window]
[in a new window]
[Download PPT slide]
  		Figure 3. Low-dose gadolinium-enhanced MR renographic single kidney GFR index based on whole kidney gadolinium uptake averaged during 2-3 minutes is compared with radionuclide measurements based on 99mTc-DTPA clearance and gamma camera methods; correlation is r = 0.75 (P < .002). Linear regression equation (dashed line) is y = 1.7x + 8.9, where y = single kidney MR GFR index, and x = single kidney GFR reference value based on radionuclide measurements. MR single kidney GFR index correlated well with reference scintigraphic values.

 
Split renal function was also compared by using MR and radionuclide renography (Fig 4). For the nine subjects, split renal functions for the right kidney ranged from 32% to 59% with radionuclide studies. Correlation between split renal function measurements obtained with the two methods was 0.76 (P < .02). The linear regression equation approached that of identity; y = 1.02x - 0.02, where y represents the MR right kidney split renal function, and x represents the corresponding radionuclide measurement. Bland and Altman analysis (Fig 5) demonstrated that differences between the MR and radionuclide measurements of split renal function were small (average, 0.8% ± 8).



View larger version (29K):
[in this window]
[in a new window]
[Download PPT slide]
  		Figure 4. MR renographic measurements compared with radionuclide measurements of split renal function for the right kidney (right kidney/[right + left kidney]) in nine patients. The correlation coefficient between MR and radionuclide renographic measurements of split renal function is 0.76 (P < .02), with a linear regression equation (dashed line) of y = 1.02x - 0.02, where y represents the MR right kidney split renal function, and x represents the corresponding radionuclide measurement. Agreement between MR measurements based on whole kidney gadolinium uptake and comparable scintigraphic measurements was good.

 


View larger version (27K):
[in this window]
[in a new window]
[Download PPT slide]
  		Figure 5. Bland and Altman plot of the difference in split renal function measurements (right kidney) between MR and radionuclide (Nucs) renography versus the average values. The Bland and Altman plot shows that the agreement between MR and scintigraphic measurements of split renal function is good, with the differences in the two measurements averaging 0.8% ± 8. std = standard deviation of difference between measurements.

 

   DISCUSSION
TOP
 ABSTRACT
 INTRODUCTION
 MATERIALS AND METHODS
 Results
 DISCUSSION
REFERENCES
 
We have developed a 3D MR renographic technique that uses a 2-mL dose (approximately 0.01 mmol/kg of body weight) of gadopentetate dimeglumine to provide noninvasive measurements of single kidney GFR and split renal function. Plasma clearance of gadopentetate dimeglumine, like 99mTc-DTPA, has been shown to be an accurate measure of GFR (17). However, plasma clearance methods with either agent require blood samples drawn up to 3 hours after injection (10) and provide only global measures of GFR without individual kidney function. We found good correlation (r = 0.7–0.8) between MR renographic single kidney GFR index values and reference radionuclide measurements of GFR. We found similarly high correlation between MR and radionuclide measurements of split renal function.

To our knowledge, MR renographic measurements of gadolinium uptake that are based on image signal intensities have not been reported for the measurement of single kidney GFR in humans. In a study of 11 pediatric patients examined after administration of an intravenous bolus of gadolinium-based contrast material of 0.035 mmol/kg, Fukuda et al (11) found that the delay in corticomedullary-junction time (reflecting delayed and diminished medullary enhancement) correlated well with 24-hour creatinine clearance values (r = -0.63). To date, attempts to quantify parameters of renal function with MR renography have been limited, primarily because of the relatively high doses of gadolinium-based contrast material used for renography (8–10,12–15). At doses of 0.1 mmol/kg (approximately 20 mL), the T2* effects of gadopentetate dimeglumine result in decreased rather than increased signal intensity in areas of concentrated contrast material such as the renal medulla (12). As a result, gadolinium concentrations are no longer simply determinable on the basis of image signal intensities.

An alternative approach to measuring single kidney GFR by using MR imaging was proposed by Dumoulin et al (26), who calculated GFR by multiplying renal plasma flow (determined with MR phase-contrast imaging) by gadopentetate dimeglumine extraction fraction (calculated by using T1 relaxation measurements of blood in the renal artery or aorta and renal vein or inferior vena cava during steady-state intravenous infusions of gadolinium-based contrast material). Niendorf et al (27) and Coulam et al (28) adapted this approach in pigs and found good correlation with inulin clearance measurements (r = 0.74– 0.89). This method faces several technical challenges, including the effects of volume averaging on flow measurements in small vessels such as the renal artery and vein.

By using an imaging method such as MR or radionuclide renography, an individual kidney GFR index can be measured noninvasively. One advantage of a relatively high spatial resolution 3D MR method over scintigraphy and other clearance measurements is the ability to assess also intrarenal regional function (12), which may be altered in diseases affecting segmental anatomy, such as fibromuscular dysplasia of the segmental renal arteries. Quantification of contrast material in multiple functional compartments, such as the cortex, medulla, and collecting system, may also be useful for a compartmental analysis of renal physiologic function (29).

This study has recognized limitations. Although plasma clearance measurements of 99mTc-DTPA were obtained within 3 hours of the MR renographic study, variability in GFR resulting from different physiologic states at different times could affect the use of this measure as a reference standard. Moreover, the high osmolarity of the MR contrast material, gadopentetate dimeglumine, has a known diuretic effect that could contribute a systematic overestimation of MR renographic measurements. However, the effects are not likely to be large, given that only 2 mL of gadolinium-based contrast material is administered intravenously for renography. Our method of analysis was labor intensive. Automated registration and segmentation techniques are being developed that may be applicable to 3D MR renography (30). We found our reference scintigraphic measures of renal function to be highly dependent on user-defined regions of interest, especially in atrophic and poorly functioning kidneys, and therefore we relied on MR imaging for more reliable estimates of kidney volumes. Similar observations about limitations of the Gates scintigraphic method (20) have been reported previously (2). More accurate single kidney GFR reference measurements, such as inulin clearance, require ureteral cannulization, an invasive procedure that would be unacceptable in our clinical environment.

To determine an MR GFR index, we computed the average kidney uptake of gadolinium during 2–3 minutes after injection. We found that this GFR index (units of micromoles) could be converted to single kidney GFR values (in milliliters per minute) according to the fitted line shown in Figure 3. Validation studies with larger sample sizes are needed to confirm this relationship. Because it relies on gadolinium concentration measurements rather than absolute signal intensity values, the technique should be applicable across different imaging units and in patients of varying body habitus. We estimated gadolinium concentrations on the basis of normalized ratios of signal intensities. With the development of new fast T1-mapping techniques, more precise quantification of gadolinium concentration from images may become feasible (31).

The low-dose 3D renographic approach enables measurements of renal function to be made in conjunction with conventional contrast-enhanced MR imaging of the kidneys and MR angiography of the renal arteries. The 2-mL dose used for renography did not interfere with subsequent MR angiography performed by using an additional standard dose of 22 mL of gadopentetate dimeglumine (approximately 0.1–0.15 mmol/kg). Moreover, MR renography added only approximately 8 minutes to the total examination time. By combining anatomic imaging and functional renography in a single setting, MR imaging has the potential to improve the diagnosis of renal dysfunction across a spectrum of diseases.


   FOOTNOTES
 
V.S.L. is a member of the Speakers’ Bureau for Berlex Laboratories, manufacturer of the contrast agent used in this study.

Abbreviations: DTPA = diethylenetriaminepentaacetic acid, GFR = glomerular filtration rate, 3D = three-dimensional

Author contributions: Guarantor of integrity of entire study, V.S.L.; study concepts and design, V.S.L., H.R., E.L.K.; literature research, V.S.L., H.R.; clinical studies, V.S.L., E.L.K.; data acquisition, V.S.L., E.L.K.; data analysis/interpretation, all authors; statistical analysis, H.R., V.S.L.; manuscript preparation, V.S.L., H.R.; manuscript definition of intellectual content, V.S.L., H.R., E.L.K.; manuscript editing and revision/review, all authors; manuscript final version approval, V.S.L., H.R., E.L.K.


   REFERENCES
TOP
 ABSTRACT
 INTRODUCTION
 MATERIALS AND METHODS
 Results
 DISCUSSION
 REFERENCES
 

  1. Gates GF. Glomerular filtration rate: estimation from fractional renal accumulation of 99mTc-DTPA (stannous). AJR Am J Roentgenol 1982; 138:565-570.[Abstract/Free Full Text]
  2. Goates JJ, Morton KA, Whooten WW, et al. Comparison of methods for calculating glomerular filtration rate: technetium-99m-DTPA scintigraphic analysis, protein-free and whole-plasma clearance of technetium-99m-DTPA and iodine-125-iothalamate clearance. J Nucl Med 1990; 31:424-429.[Abstract/Free Full Text]
  3. Wolf GL, Fobben ES. The tissue proton T1 and T2 response to gadolinium DTPA injection in rabbits: a potential renal contrast agent for NMR imaging. Invest Radiol 1984; 19:324-328.[CrossRef][Medline]
  4. Pettigrew RI, Avruch L, Dannels W, Coumans J, Bernardino ME. Fast-field-echo MR imaging with Gd-DTPA: physiologic evaluation of the kidney and liver. Radiology 1986; 160:561-563.[Abstract/Free Full Text]
  5. Kikinis R, von Schulthess GK, Jager P, et al. Normal and hydronephrotic kidney: evaluation of renal function with contrast-enhanced MR imaging. Radiology 1987; 165:837-842.[Abstract/Free Full Text]
  6. Carvlin MJ, Arger PH, Kundel HL, et al. Use of Gd-DTPA and fast gradient-echo and spin-echo MR imaging to demonstrate renal function in the rabbit. Radiology 1989; 170:705-711.[Abstract/Free Full Text]
  7. Frank JA, Choyke PL, Austin HA, III, et al. Gadopentetate dimeglumine as a marker of renal function: magnetic resonance imaging to glomerular filtration rates. Invest Radiol 1991; 26(suppl 1):S134-S136; discussion S137–S138.
  8. Laissy JP, Faraggi M, Lebtahi R, et al. Functional evaluation of normal and ischemic kidney by means of gadolinium-DOTA enhanced TurboFLASH MR imaging: a preliminary comparison with 99Tc-MAG3 dynamic scintigraphy. Magn Reson Imaging 1994; 12:413-419.[CrossRef][Medline]
  9. Wolf GL, Hoop B, Cannillo JA, et al. Measurement of renal transit of gadopentetate dimeglumine with echo-planar MR imaging. J Magn Reson Imaging 1994; 4:365-372.[Medline]
  10. Ros PR, Gauger J, Stoupis C, et al. Diagnosis of renal artery stenosis: feasibility of combining MR angiography, MR renography, and gadopentetate-based measurements of glomerular filtration rate. AJR Am J Roentgenol 1995; 165:1447-1451.[Abstract/Free Full Text]
  11. Fukuda Y, Watanabe H, Tomita T, et al. Evaluation of glomerular function in individual kidneys using dynamic magnetic resonance imaging. Pediatr Radiol 1996; 26:324-328.[CrossRef][Medline]
  12. Grenier N, Trillaud H, Combe C, et al. Diagnosis of renovascular hypertension: feasibility of captopril-sensitized dynamic MR imaging and comparison with captopril scintigraphy. AJR Am J Roentgenol 1996; 166:835-843.[Abstract/Free Full Text]
  13. Trillaud H, Roques F, Degreze P, et al. Gd-DOTA tubular transit asymmetry induced by angiotensin-converting enzyme inhibitor in experimental renovascular hypertension. J Magn Reson Imaging 1996; 6:149-155.[Medline]
  14. Vosshenrich R, Kallerhoff M, Grone HJ, et al. Detection of renal ischemic lesions using Gd-DTPA-enhanced turbo FLASH MRI: experimental and clinical results. J Comput Assist Tomogr 1996; 20:236-243.[CrossRef][Medline]
  15. Prasad PV, Goldfarb J, Sundaram C, Priatna A, Li W, Edelman RR. Captopril MR renography in a swine model: toward a comprehensive evaluation of renal arterial stenosis. Radiology 2000; 217:813-818.[Abstract/Free Full Text]
  16. Lee VS, Rusinek H, Johnson G, Rofsky NM, Krinsky GA, Weinreb JC. MR renography with low-dose gadopentetate dimeglumine: feasibility. Radiology 2001; 221:371-379.[Abstract/Free Full Text]
  17. Choyke PL, Austin HA, Frank JA, et al. Hydrated clearance of gadolinium-DTPA as a measurement of glomerular filtration rate. Kidney Int 1992; 41:1595-1598.[Medline]
  18. Russell CD, Rowell K, Scott JW. Quality control of technetium-99m DTPA: correlation of analytic tests with in vivo protein binding in man. J Nucl Med 1986; 27:560-562.[Abstract/Free Full Text]
  19. Rowell KL, Kontzen FN, Stutzman ME, et al. Technical aspects of a new technique for estimating glomerular filtration rate using technetium-99m-DTPA. J Nucl Med Technol 1986; 14:196-198.
  20. Gates GF. Split renal function testing using Tc-99m DTPA: a rapid technique for determining differential glomerular filtration. Clin Nucl Med 1983; 8:400-407.[Medline]
  21. Prince MR, Narasimham DL, Stanley JC, et al. Breath-hold gadolinium-enhanced MR angiography of the abdominal aorta and its major branches. Radiology 1995; 197:785-792.[Abstract/Free Full Text]
  22. Earls JP, Rofsky NM, DeCorato DR, Krinsky GA, Weinreb JC. Breath-hold single-dose gadolinium-enhanced three-dimensional MR aortography: usefulness of a timing examination and MR power injector. Radiology 1996; 201:705-710.[Abstract/Free Full Text]
  23. Tsui WH, Rusinek H, Van Gelder P, Lebedev S. Analyzing multimodality tomographic images and associated regions of interest with MIDAS. In: Sonka M, Hanson KM, eds. SPIE medical imaging 2001: image processing. Vol 4322. Bellingham, Wash: International Society for Optical Engineering, 2001; 1725-1734.
  24. Rusinek H, Lee VS, Johnson G. Optimal dose of Gd-DTPA in dynamic MR studies. Magn Reson Med 2001; 46:312-316.[CrossRef][Medline]
  25. Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1986; 1:307-310.[CrossRef][Medline]
  26. Dumoulin CL, Buonocore MH, Opsahl LR, et al. Noninvasive measurement of renal hemodynamic functions using gadolinium enhanced magnetic resonance imaging. Magn Reson Med 1994; 32:370-378.[Medline]
  27. Niendorf ER, Grist TM, Lee FT, Jr, Brazy PC, Santyr GE. Rapid in vivo measurement of single-kidney extraction fraction and glomerular filtration rate with MR imaging. Radiology 1998; 206:791-798.[Abstract/Free Full Text]
  28. Coulam CH, Lee JH, Wedding KL, et al. Noninvasive measurement of extraction fraction and single-kidney glomerular filtration rate with MR imaging in swine with surgically created renal arterial stenoses. Radiology 2002; 223:76-82.[Abstract/Free Full Text]
  29. Lumsden CJ, Silverman M, Zielinski A, et al. Vascular exchange in the kidney: regional characterization by multiple indicator tomography. Circ Res 1993; 72:1172-1180.[Abstract/Free Full Text]
  30. Boykov Y, Lee VS, Rusinek H, et al. Segmentation of dynamic N-D data sets via graph cuts using Markov models In: Proceedings of the 4th International Conference on Medical Image Computing and Computer-Assisted Intervention (MICCAI). Utrecht, the Netherlands: Springer-Verlag, 2001; 1058-1066.
  31. Scheffler K, Hennig J. T1 quantification with inversion recovery TrueFISP. Magn Reson Med 2001; 45:720-723.[CrossRef][Medline]



This article has been cited by other articles:


Home page
 Br. J. Radiol.Home page
M E ABOU EL-GHAR, A A SHOKEIR, H F REFAIE, and T A EL-DIASTY
MRI in patients with chronic obstructive uropathy and compromised renal function: a sole method for morphological and functional assessment
Br. J. Radiol., August 1, 2008; 81(968): 624 - 629.
[Abstract] [Full Text] [PDF]

Home page
 RadiologyHome page
D. R. Martin, P. Sharma, K. Salman, R. A. Jones, J. D. Grattan-Smith, H. Mao, T. C. Lauenstein, B. K. Burrow, D. L. Tudorascu, and J. R. Votaw
Individual Kidney Blood Flow Measured with Contrast-enhanced First-Pass Perfusion MR Imaging
Radiology, January 1, 2008; 246(1): 241 - 248.
[Abstract] [Full Text] [PDF]

Home page
 RadiologyHome page
J. K. Park, T. K. Rhee, T. A. Cashen, W. Shin, B. E. Schirf, J. A. Gehl, A. C. Larson, P. V. Prasad, D. Li, T. J. Carroll, et al.
Renal Artery Stenosis in Swine: Feasibility of MR Assessment of Renal Function during Percutaneous Transluminal Angioplasty
Radiology, July 1, 2007; 244(1): 144 - 150.
[Abstract] [Full Text] [PDF]

Home page
 Am. J. Physiol. Renal Physiol.Home page
V. S. Lee, H. Rusinek, L. Bokacheva, A. J. Huang, N. Oesingmann, Q. Chen, M. Kaur, K. Prince, T. Song, E. L. Kramer, et al.
Renal function measurements from MR renography and a simplified multicompartmental model
Am J Physiol Renal Physiol, May 1, 2007; 292(5): F1548 - F1559.
[Abstract] [Full Text] [PDF]

Home page
 RadiologyHome page
A. Boss, P. Martirosian, M. Gehrmann, F. Artunc, T. Risler, N. Oesingmann, C. D. Claussen, F. Schick, K. Kuper, and H.-P. Schlemmer
Quantitative Assessment of Glomerular Filtration Rate with MR Gadolinium Slope Clearance Measurements: A Phase I Trial
Radiology, March 1, 2007; 242(3): 783 - 790.
[Abstract] [Full Text] [PDF]

Home page
 RadiologyHome page
E. Daghini, L. Juillard, J. A. Haas, J. D. Krier, J. C. Romero, and L. O. Lerman
Comparison of Mathematic Models for Assessment of Glomerular Filtration Rate with Electron-Beam CT in Pigs
Radiology, February 1, 2007; 242(2): 417 - 424.
[Abstract] [Full Text] [PDF]

Home page
 Br. J. Radiol.Home page
S J Gandy, K Armoogum, R S Nicholas, T B McLeay, and J G Houston
A clinical MRI investigation of the relationship between kidney volume measurements and renal function in patients with renovascular disease
Br. J. Radiol., January 1, 2007; 80(949): 12 - 20.
[Abstract] [Full Text] [PDF]

Home page
 RadiologyHome page
H. J. Michaely, S. O. Schoenberg, N. Oesingmann, C. Ittrich, C. Buhlig, D. Friedrich, A. Struwe, J. Rieger, C. Reininger, W. Samtleben, et al.
Renal Artery Stenosis: Functional Assessment with Dynamic MR Perfusion Measurements--Feasibility Study
Radiology, February 1, 2006; 238(2): 586 - 596.
[Abstract] [Full Text] [PDF]

Home page
 RadiologyHome page
R. A. Jones, M. R. Perez-Brayfield, A. J. Kirsch, and J. D. Grattan-Smith
Renal Transit Time with MR Urography in Children
Radiology, October 1, 2004; 233(1): 41 - 50.
[Abstract] [Full Text] [PDF]

This Article
Right arrow Abstract Freely available
Right arrow Figures Only
Right arrow Full Text (PDF)
Right arrow All Versions of this Article:
2271020383v1
227/1/289    most recent
Right arrow Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Lee, V. S.
Right arrow Articles by Kramer, E. L.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Lee, V. S.
Right arrow Articles by Kramer, E. L.

HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
RADIOLOGY RADIOGRAPHICS RSNA JOURNALS ONLINE