MRI Evaluation of Acute Renal Transplant Dysfunction

描述（由申请人提供）： 肾移植为终末期肾病患者提供了改善的生活质量，并使他们免于终身透析及其并发症。大约30-40%的移植受者遭受至少一次急性移植物功能障碍，其中一半经历重复事件。原因包括与血管和输尿管狭窄相关的手术并发症和内在病理学，如急性肾小管坏死、排斥反应和药物毒性。现有的监测移植物的方案依赖于不敏感的措施，如血清肌酐，和功能障碍的原因，特别是内在的疾病之间的临床区分是困难的。经常需要活检。磁共振成像（MRI）提供了独特的潜力，结合联合收割机的解剖评估移植与功能评估使用肾小球造影剂，如钆- DTPA。高分辨率Gd增强MR肾成像，当使用示踪剂动力学分析解释时，可以无创地检测和区分血管，肾小球和肾小管病变，并通过反映在组织病理学上看到的变化，可以使内在性肾脏疾病的准确诊断。广泛的长期目标：通过开发一种可用于监测和诊断移植物功能障碍的非侵入性检测来提高移植肾存活率。一种能够准确区分疾病内在原因的测试将确保及时和适当的治疗，并有助于避免侵入性活检程序。 具体目标/方法：（1）确定定量MR肾成像的诊断标准，采用血管-肾单位系统的示踪动力学模型分析，以诊断急性肾移植功能障碍患者。(2)开发用于肾移植MR肾成像的半自动图像处理和数据分析方法，使MR肾成像在临床环境中能够常规临床实施。(3)应用和测试定量MR肾成像标准，如（1）中确定的，用于诊断急性肾移植功能障碍患者。在结论中，我们的研究有很高的可能性表明，功能性磁共振肾成像用于区分内源性肾脏疾病，将是一个准确的工具，急性肾移植功能障碍。

DESCRIPTION (provided by applicant): Renal transplantation affords patients with end stage renal disease an improved quality of life and spares them from life-long dialysis and its complications. Approximately 30-40% of transplant recipients suffer at least one episode of acute graft dysfunction, and half of those experience repeated events. Causes include surgical complications related to vascular and ureteral anastomoses and intrinsic pathology such as acute tubular necrosis, rejection, and drug toxicity. Existing protocols for monitoring grafts rely on insensitive measures such as serum creatinine, and clinical differentiation between causes of dysfunction, particularly intrinsic diseases is difficult. Biopsy is frequently required. Magnetic resonance imaging (MRI) offers the unique potential to combine anatomic evaluation of transplants with a functional assessment using glomerular contrast agents such as Gd- DTPA. High resolution Gd-enhanced MR renography, when interpreted using tracer kinetic analyses, can noninvasively detect and differentiate vascular, glomerular, and tubular pathologies, and by reflecting changes seen at histopathology may enable accurate diagnosis of intrinsic renal diseases. Broad, long-term objectives: To improve renal graft survival by developing a noninvasive test that can be used to monitor and diagnose graft dysfunction. A test that can accurately distinguish intrinsic causes of disease would ensure prompt and appropriate therapy and help to obviate invasive biopsy procedures. Specific Aims/Methods: (1) To determine diagnostic criteria for quantitative MR renography, analyzed using a tracer kinetic model of the vascular-nephron system, to diagnose patients with acute renal transplant dysfunction. (2) To develop semi-automated image processing and data analysis methods for MR renography of renal transplants that will be enable routine clinical implementation of MR renography in the clinical setting. (3) To apply and test quantitative MR renography criteria, as determined in (1), for the diagnosis of patients with acute renal transplant dysfunction. At its conclusion, our study has a high likelihood of showing that functional MR renography for differentiating intrinsic renal diseases, will be an accurate tool for acute renal transplant dysfunction.