MR Angiography and Renography for Renovascular Disease

描述（由申请人提供）： 肾血管疾病（RVD）是美国高血压和肾衰竭最常见的潜在可逆原因。解剖学研究，如X线血管造影是侵入性的，使用肾毒性造影剂，不能准确预测血运重建的反应。功能研究，如血管紧张素转换酶（ACE）抑制剂（卡托普利）放射性核素肾显像，可以预测反应血运重建，但不提供重要的解剖信息的治疗计划。缺乏准确的诊断测试也排除了对RVD最佳治疗策略的明确评价。磁共振（MR）成像提供了独特的潜力，结合联合收割机的解剖评价与肾缺血和功能障碍的功能信息，在一个单一的临床检查有关RAS。广泛的长期目标：通过正确诊断疾病并确定哪些患者可能从血运重建治疗中获益以及哪些患者应单独接受药物治疗，降低与RVD引起的高血压和肾衰竭相关的发病率和死亡率。具体目标/方法：（1）与常规99 mTc-DTPA核医学肾显像比较，验证超低剂量3D-Gd-DTPA MR肾显像结合T1标测技术对单肾GFR及其他示踪动力学参数的测量价值。还将完成新开发的自动配准和半自动分割算法的开发和测试。(2)前瞻性评价MRA联合ACE抑制剂MR肾造影在单次检查中诊断RVD的准确性，使用高血压和肌酐清除率作为反应指标，以及单肾功能的改善（见目的3）。多房室示踪剂动力学模型也将应用于肾造影结果，以确定对治疗反应的更敏感的预测因子。(3)使用MR肾造影进行纵向研究，以测量与整体肾功能或肌酐清除率相比，单肾功能改善对血运重建的反应。在其结论，我们的研究有很大的可能性表明，MRA和MR肾造影的组合，通过独特的提供解剖和功能信息，在一个单一的检查，将准确地诊断RVD，并提供一个全面的工具，测量治疗后的结果。

DESCRIPTION (provided by applicant): Renovascular disease (RVD) is the most common potentially reversible cause of hypertension and renal failure in the US. Anatomic studies such as x-ray angiography are invasive, use nephrotoxic contrast agents, and do not accurately predict response to revascularization. Functional studies, such as angiotensin-converting enzyme (ACE) inhibitor (captopril) radionuclide renography, can predict response to revascularization, but do not provide important anatomic information for treatment planning. The lack of an accurate diagnostic test has also precluded definitive evaluation of optimal treatment strategies for RVD. Magnetic resonance (MR) imaging offers the unique potential to combine anatomic evaluation about RAS with functional information about renal ischemia and dysfunction in a single clinical examination. Broad, long-term objectives: To reduce the morbidity and mortality associated with hypertension and renal failure due to RVD by correctly diagnosing the disease and by determining which patients are likely to benefit from revascularization therapy and which patients should be treated with medication alone. Specific Aims/Methods: (1) To validate ultra-low dose 3D Gd-DTPA MR renography combined with T1 mapping for the measurement of single kidney GFR and other tracer kinetic parameters as compared with conventional nuclear medicine renography using 99mTc-DTPA. Development and testing of a newly developed automated registration and semiautomated segmentation algorithm will also be completed. (2) To evaluate prospectively the accuracy of MRA combined with ACE-inhibitor MR renography, performed in a single exam, for the diagnosis of RVD, using hypertension and creatinine clearance as measures of response, as well as improvements in single kidney function (see Aim 3). A multi-compartmental tracer kinetic model will also be applied to renography results to identify more sensitive predictors of response to therapy. (3) To conduct a longitudinal study using MR renography to measure response to revascularization in terms of improvements in single kidney function as compared to global kidney function or creatinine clearance. At its conclusion, our study has a high likelihood of showing that the combination of MRA and MR renography, by uniquely providing both anatomic and functional information in a single examination, will accurately diagnose RVD and provide a comprehensive tool for measuring outcomes following therapy.