Kidney function: glomerular filtration rate measurement with MR renography in patients with cirrhosis.
Kidney function: glomerular filtration rate measurement with MR renography in patients with cirrhosis.
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DOI：
10.1148/radiol.11101338
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发表时间：
2011-05
期刊：
影响因子：
19.7
通讯作者：
P. Vivier;P. Storey;H. Rusinek;Jeff L Zhang;A. Yamamoto;K. Tantillo;U. Khan;R. Lim;J. Babb;D. John;L. Teperman;H. Chandarana;K. Friedman;J. Benstein;E. Skolnik;V. Lee
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作者：
P. Vivier;P. Storey;H. Rusinek;Jeff L Zhang;A. Yamamoto;K. Tantillo;U. Khan;R. Lim;J. Babb;D. John;L. Teperman;H. Chandarana;K. Friedman;J. Benstein;E. Skolnik;V. Lee
目的评价低对比剂剂量动态对比剂增强磁共振(MR)肾成像测量肝硬变患者肾小球滤过率(GFR)的准确性，并以99m~(99m)Tc-戊酸(DTPA)尿清率为参照标准。材料和方法这项符合HIPAA标准的研究获得了机构审查委员会的批准。获得患者书面知情同意。前瞻性纳入20例肝硬变患者(男14例，女6例；年龄41-70岁，平均54.6岁)，在6个月的时间内接受常规1.5-T肝脏磁共振检查以筛查肝细胞癌。使用3毫升剂量的加多特利多进行5分钟的MR肾成像，而不是常规的测试剂量计时检查。使用两个动力学模型在MR成像时估计GFR。在一个模型中，只考虑了主动脉和肾实质的信号强度，而在另一个模型中，分别处理了肾皮质和髓质的信号强度。根据Cockcroft-Gault公式和肾脏疾病饮食(MDRD)公式计算肾小球滤过率。所有患者在同一天接受(99m)Tc-DTPA尿清除量检查，以获得参考的GFR测量。使用Wilcoxon符号等级检验比较所有基于MR和肌酐的GFR估计的准确性。结果平均参考肾小球滤过率为74.9m L/m in/1.73m(2)±27.7(标准差)(范围10.3~120.7 m L/m in/1.73m(2))。在这两个动力学模型中，95%的基于MR的GFR在参考值的30%以内，而基于Cockcroft-Gault和MDRD的GFR分别只有40%和60%在这个范围内。基于MR的GFR估计明显比基于肌酐水平的估计更准确(P<；.001)。结论磁共振成像对GFR的评估优于Cockcroft-Gault和MDRD公式，在没有电离辐射的情况下，临床显示的肝脏MR检查增加了不到10分钟的就诊时间。补充材料http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.11101338/-/DC1.
PURPOSE To assess the accuracy of glomerular filtration rate (GFR) measurements obtained with low-contrast agent dose dynamic contrast material-enhanced magnetic resonance (MR) renography in patients with liver cirrhosis who underwent routine liver MR imaging, with urinary clearance of technetium 99m ((99m)Tc) pentetic acid (DTPA) as the reference standard. MATERIALS AND METHODS This HIPAA-compliant study was institutional review board approved. Written informed patient consent was obtained. Twenty patients with cirrhosis (14 men, six women; age range, 41-70 years; mean age, 54.6 years) who were scheduled for routine 1.5-T liver MR examinations to screen for hepatocellular carcinoma during a 6-month period were prospectively included. Five-minute MR renography with a 3-mL dose of gadoteridol was performed instead of a routine test-dose timing examination. The GFR was estimated at MR imaging with use of two kinetic models. In one model, only the signal intensities in the aorta and kidney parenchyma were considered, and in the other, renal cortical and medullary signal intensities were treated separately. The GFR was also calculated by using serum creatinine levels according to the Cockcroft-Gault and modification of diet in renal disease (MDRD) formulas. All patients underwent a (99m)Tc-DTPA urinary clearance examination on the same day to obtain a reference GFR measurement. The accuracies of all MR- and creatinine-based GFR estimations were compared by using Wilcoxon signed rank tests. RESULTS The mean reference GFR, based on (99m)Tc-DTPA clearance, was 74.9 mL/min/1.73 m(2) ± 27.7 (standard deviation) (range, 10.3-120.7 mL/min/1.73 m(2)). With both kinetic models, 95% of MR-based GFRs were within 30% of the reference values, whereas only 40% and 60% of Cockcroft-Gault- and MDRD-based GFRs, respectively, were within this range. MR-based GFR estimates were significantly more accurate than creatinine level-based estimates (P < .001). CONCLUSION GFR assessment with MR imaging, which outperformed the Cockcroft-Gault and MDRD formulas, adds less than 10 minutes of table time to a clinically indicated liver MR examination without ionizing radiation. SUPPLEMENTAL MATERIAL http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.11101338/-/DC1.