Multi-slice Perfusion MR Imaging of the Human Kidney

描述（由申请人提供）：肾移植是终末期肾病最具成本效益的治疗方法。然而，急性排斥反应（AR）、移植肾功能延迟恢复（DGF）和免疫抑制剂肾毒性仍然是常见的并发症。区分AR与DGF和免疫抑制药物毒性是很重要的，因为每种药物的治疗选择可能有很大不同。血清肌酐、血尿素氮（BUN）和尿量的生物测定可指示肾功能不全的发生，但不能指示类型。活检仍然是金标准，但具有侵入性和高度局部性。肾灌注可以是排斥反应过程的敏感和区分参数。AR的特征是肾脏灌注和功能显着、突然下降，而DGF和免疫抑制药物毒性通常在定性MRI研究中显示正常或轻微减少的灌注。灌注MRI可以识别肾脏的空间和时间灌注变化，这将有助于AR的诊断。我们研究的具体目的是：1）开发和改进使用同时近端和远端照射（SPDI）的非侵入性多层ASL灌注MRI; 2）使用SPDI测量健康和移植志愿者的灌注率。SPDI使用连续动脉自旋标记（CASL）的变体标记内源性动脉水。MR图像将使用超快快照技术（例如，EPI）。本研究旨在测试SPDI检测局部灌注变化的灵敏度和可靠性，并将SPDI与定量多层动态磁化率对比（DSC）测量进行比较。灌注MRI技术将在移植后的前三个月内在健康和移植肾中进行两次测试。移植肾的状况将被分类（例如，正常、AR和DGF）。该研究将测试以下假设：1）使用SPDI的多层MRI可以可靠和准确地测量人体肾皮质灌注率，系统误差小于0.6 ml/g-min，以及2）移植后3个月内肾皮质灌注率变化大于1 ml/g-min可以与MR血管造影、生化、和活组织检查数据来区分AR与DGF和免疫抑制药物毒性。

DESCRIPTION (provided by applicant): Kidney transplantation is the most cost-effective therapy for end-stage renal disease. However, acute rejection (AR), delayed graft function (DGF) and immunosuppressive drug nephrotoxicity remain common complications. It is important to distinguish AR from DGF and immunosuppressive drug toxicity, since the therapeutic options for each may differ significantly. Bioassays of serum creatinine, blood urea nitrogen (BUN), and urine output may indicate the occurrence of renal dysfunction but not the type. Biopsy remains the gold standard, but is invasive and highly localized. Renal perfusion can be a sensitive and distinguishing parameter of the rejection process. AR is characterized by a marked, sudden decrease in both perfusion and function of the kidney while DGF and immunosuppressive drug toxicity typically show normal or slightly reduced perfusion in qualitative MRI studies. Perfusion MRI can identify spatial and temporal perfusion changes in the kidney that will aid in the diagnosis of AR. The specific aims of our research are: 1) to develop and improve non-invasive multi-slice ASL perfusion MRI using simultaneous proximal and distal irradiation (SPDI) and 2) to use SPDI to measure perfusion rates in healthy and transplant volunteers. SPDI labels endogenous arterial water using a variant of continuous arterial spin labeling (CASL). MR images will be acquired with ultra-fast snapshot techniques (e.g., EPI). The research is designed to test the sensitivity and reliability of SPDI for detecting regional perfusion variations, and compare SPDI with quantitative multi-slice dynamic susceptibility contrast (DSC) measurements. The perfusion MRI technique will be tested in healthy and transplanted kidneys twice during the first three months following transplantation. The condition of the transplanted kidneys will be categorized (e.g., normal, AR, and DGF) based on bioassay and biopsy results. The study will test the hypotheses that 1) multi-slice MRI using SPDI can reliably and accurately measure renal cortical perfusion rates in humans with a systematic error of less than 0.6 ml/g-rain, and 2) changes in renal cortical perfusion rates of greater than 1 ml/g-min in the period within 3 months after transplantation can be used in association with MR angiographic, biochemical, and biopsy data to distinguish AR from DGF and immunosuppressive drug toxicity.