Detection of Acute Tubular Necrosis Using Blood Oxygenation Level-Dependent (BOLD) MRI.

BACKGROUND/AIMS: To date, there is no imaging technique to assess tubular function in vivo. Blood oxygen level-dependent magnetic resonance imaging (BOLD MRI) measures tissue oxygenation based on the transverse relaxation rate (R2*). The present study investigates whether BOLD MRI can assess tubular function using a tubule-specific pharmacological maneuver. METHODS: Cross sectional study with 28 participants including 9 subjects with ATN-induced acute kidney injury (AKI), 9 healthy controls, and 10 subjects with nephron sparing tumor resection (NSS) with clamping of the renal artery serving as a model of ischemia/reperfusion (I/R)-induced subclinical ATN (median clamping time 15 min, no significant decrease of eGFR, p=0.14). BOLD MRI was performed before and 5, 7, and 10 min after intravenous administration of 40 mg furosemide. RESULTS: Urinary neutrophil gelatinase-associated lipocalin was significantly higher in ATN-induced AKI and NSS subjects than in healthy controls (p=0.03 and p=0.01, respectively). Before administration of furosemide, absolute medullary R2*, cortical R2*, and medullary/cortical R2* ratio did not significantly differ between ATN-induced AKI vs. healthy controls and between NSS-I/R vs. contralateral healthy kidneys (p>0.05 each). Furosemide led to a significant decrease in the medullary and cortical R2* of healthy subjects and NSS contralateral kidneys (p<0.05 each), whereas there was no significant change of R2* in ATN-induced AKI and the NSS-I/R kidneys (p>0.05 each). CONCLUSION: BOLD-MRI is able to detect even mild tubular injury but necessitates a tubule-specific pharmacological maneuver, e.g. blocking the Na+-K+-2Cl- transporter by furosemide.

Prospective registration of human head magnetic resonance images for reproducible slice positioning using localizer images.

PURPOSE: To facilitate assessing brain tumor growth and progression of stroke lesions by reproducible slice positioning in human head magnetic resonance (MR) images, a method for prospective registration is proposed that adjusts the image slice position without moving the patient and with no additional scans. MATERIALS AND METHODS: The gradient reference frame of follow-up examinations was adjusted to achieve the same image slice positioning relative to the patient as in the previous examination. The three-dimensional geometrical transformation parameters for the gradients were determined using two-dimensional image registration of three orthogonal localizer images. The method was developed and evaluated using a phantom with arbitrarily adjustable position. Feasibility for in vivo applications was demonstrated with brain MR imaging (MRI) of healthy volunteers. RESULTS: Standard retrospective registration was used for assessing the quality of the method. The accuracy of the realignment was 0.0 mm +/- 1.2 mm and -0.2 degrees +/- 0.9 degrees (mean +/- SD) in phantom experiments. In 10 examinations of volunteers, misalignments up to 49.2 mm and 21 degrees were corrected. The accuracy of the realignment after prospective registration was 0.1 mm +/- 1.5 mm and 0.2 degrees +/- 1.5 degrees. CONCLUSION: Image-based prospective registration using localizer images of the pre- and postexaminations is a robust method for reproducible slice positioning.