"skipMainNavigation"
closeDrawerMenuopenDrawerMenu
Search
Quick Search in Journals
Quick Search anywhere
Advanced Search
Radiology
Menu
  • Information
    • Previous
    Next
    Original Research

    Kidney Function: Glomerular Filtration Rate Measurement with MR Renography in Patients with Cirrhosis

    Published Online:May 1 2011https://doi.org/10.1148/radiol.11101338

    Abstract

    Requiring less than 10 minutes of imaging time with no radiation exposure, glomerular filtration rate determination during routine liver MR imaging may improve the clinical management of patients with cirrhosis.

    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 (99mTc) 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 99mTc-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 99mTc-DTPA clearance, was 74.9 mL/min/1.73 m2 ± 27.7 (standard deviation) (range, 10.3–120.7 mL/min/1.73 m2). 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.

    © RSNA, 2011

    Supplemental material: http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.11101338/-/DC1

    References

    • 1 Ginès P, Schrier RW. Renal failure in cirrhosis. N Engl J Med 2009;361(13):1279–1290. Crossref, Medline, Google Scholar
    • 2 Mackelaite L, Alsauskas ZC, Ranganna K. Renal failure in patients with cirrhosis. Med Clin North Am 2009;93(4):855–869, viii. Crossref, Medline, Google Scholar
    • 3 Wiesner R, Edwards E, Freeman R, et al.. Model for end-stage liver disease (MELD) and allocation of donor livers. Gastroenterology 2003;124(1):91–96. Crossref, Medline, Google Scholar
    • 4 Caregaro L, Menon F, Angeli P, et al.. Limitations of serum creatinine level and creatinine clearance as filtration markers in cirrhosis. Arch Intern Med 1994;154(2):201–205. Crossref, Medline, Google Scholar
    • 5 Cholongitas E, Shusang V, Marelli L, et al.. Review article: renal function assessment in cirrhosis—difficulties and alternative measurements. Aliment Pharmacol Ther 2007;26(7):969–978. Crossref, Medline, Google Scholar
    • 6 Sherman DS, Fish DN, Teitelbaum I. Assessing renal function in cirrhotic patients: problems and pitfalls. Am J Kidney Dis 2003;41(2):269–278. Crossref, Medline, Google Scholar
    • 7 Papadakis MA, Arieff AI. Unpredictability of clinical evaluation of renal function in cirrhosis: prospective study. Am J Med 1987;82(5):945–952. Crossref, Medline, Google Scholar
    • 8 Cockcroft DW, Gault MH. Prediction of creatinine clearance from serum creatinine. Nephron 1976;16(1):31–41. Crossref, Medline, Google Scholar
    • 9 Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation—Modification of Diet in Renal Disease Study Group. Ann Intern Med 1999;130(6):461–470. Crossref, Medline, Google Scholar
    • 10 Henriksen JH, Brøchner-Mortensen J, Malchow-Møller A, Schlichting P. Over-estimation of glomerular filtration rate by single injection [51Cr]EDTA plasma clearance determination in patients with ascites. Scand J Clin Lab Invest 1980;40(3):279–284. Crossref, Medline, Google Scholar
    • 11 Skluzacek PA, Szewc RG, Nolan CR, Riley DJ, Lee S, Pergola PE. Prediction of GFR in liver transplant candidates. Am J Kidney Dis 2003;42(6):1169–1176. Crossref, Medline, Google Scholar
    • 12 Lee VS, Rusinek H, Johnson G, Rofsky NM, Krinsky GA, Weinreb JC. MR renography with low-dose gadopentetate dimeglumine: feasibility. Radiology 2001;221(2):371–379. Link, Google Scholar
    • 13 Zhang JL, Rusinek H, Bokacheva L, et al.. Functional assessment of the kidney from magnetic resonance and computed tomography renography: impulse retention approach to a multicompartment model. Magn Reson Med 2008;59(2):278–288. Crossref, Medline, Google Scholar
    • 14 Teh HS, Ang ES, Wong WC, et al.. MR renography using a dynamic gradient-echo sequence and low-dose gadopentetate dimeglumine as an alternative to radionuclide renography. AJR Am J Roentgenol 2003;181(2):441–450. Crossref, Medline, Google Scholar
    • 15 Pugh RN, Murray-Lyon IM, Dawson JL, Pietroni MC, Williams R. Transection of the oesophagus for bleeding oesophageal varices. Br J Surg 1973;60(8):646–649. Crossref, Medline, Google Scholar
    • 16 MELD/PELD calculator. MELD/PELD Calculator Documentation Web site, 2009. http://optn.transplant.hrsa.gov/resources/MeldPeldCalculator.asp?index=97. Published January 28, 2009. Google Scholar
    • 17 Olsen SK, Brown RS Live donor liver transplantation: current status. Curr Gastroenterol Rep 2008;10(1):36–42. Crossref, Medline, Google Scholar
    • 18 Rusinek H, Boykov Y, Kaur M, et al.. Performance of an automated segmentation algorithm for 3D MR renography. Magn Reson Med 2007;57(6):1159–1167. Crossref, Medline, Google Scholar
    • 19 Vivier PH, Dolores M, Gardin I, Zhang P, Petitjean C, Dacher JN. In vitro assessment of a 3D segmentation algorithm based on the belief functions theory in calculating renal volumes by MRI. AJR Am J Roentgenol 2008;191(3):W127–W134. Crossref, Medline, Google Scholar
    • 20 Rohrer M, Bauer H, Mintorovitch J, Requardt M, Weinmann HJ. Comparison of magnetic properties of MRI contrast media solutions at different magnetic field strengths. Invest Radiol 2005;40(11):715–724. Crossref, Medline, Google Scholar
    • 21 Koh TS, Zhang JL, Ong CK, Shuter B. A biphasic parameter estimation method for quantitative analysis of dynamic renal scintigraphic data. Phys Med Biol 2006;51(11):2857–2870. Crossref, Medline, Google Scholar
    • 22 Levey AS, Greene T, Schluchter MD, et al.. Glomerular filtration rate measurements in clinical trials: Modification of Diet in Renal Disease Study Group and the Diabetes Control and Complications Trial Research Group. J Am Soc Nephrol 1993;4(5):1159–1171. Crossref, Medline, Google Scholar
    • 23 Rusinek H, Lee VS, Johnson G. Optimal dose of Gd-DTPA in dynamic MR studies. Magn Reson Med 2001;46(2):312–316. Crossref, Medline, Google Scholar
    • 24 Levey AS, Coresh J, Greene T, et al.. Expressing the Modification of Diet in Renal Disease Study equation for estimating glomerular filtration rate with standardized serum creatinine values. Clin Chem 2007;53(4):766–772. Crossref, Medline, Google Scholar
    • 25 Lin LI. A concordance correlation coefficient to evaluate reproducibility. Biometrics 1989;45(1):255–268. Crossref, Medline, Google Scholar
    • 26 National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis 2002;39(2 Suppl 1):S1–S266. Crossref, Medline, Google Scholar
    • 27 Pomfret EA, Fryer JP, Sima CS, Lake JR, Merion RM. Liver and intestine transplantation in the United States, 1996-2005. Am J Transplant 2007;7(5 Pt 2):1376–1389. Crossref, Medline, Google Scholar
    • 28 de Bazelaire CM, Duhamel GD, Rofsky NM, Alsop DC. MR imaging relaxation times of abdominal and pelvic tissues measured in vivo at 3.0 T: preliminary results. Radiology 2004;230(3):652–659. Link, Google Scholar
    • 29 Jones RA, Ries M, Moonen CT, Grenier N. Imaging the changes in renal T1 induced by the inhalation of pure oxygen: a feasibility study. Magn Reson Med 2002;47(4):728–735. Crossref, Medline, Google Scholar
    • 30 Guo JY, Kim SE, Parker DL, Jeong EK, Zhang L, Roemer RB. Improved accuracy and consistency in T1 measurement of flowing blood by using inversion recovery GE-EPI. Med Phys 2005;32(4):1083–1093. Crossref, Medline, Google Scholar
    • 31 Barth M, Moser E. Proton NMR relaxation times of human blood samples at 1.5 T and implications for functional MRI. Cell Mol Biol (Noisy-le-grand) 1997;43(5):783–791. Medline, Google Scholar
    • 32 Grobner T. Gadolinium: a specific trigger for the development of nephrogenic fibrosing dermopathy and nephrogenic systemic fibrosis? Nephrol Dial Transplant 2006;21(4):1104–1108. Crossref, Medline, Google Scholar
    • 33 Perazella MA. How should nephrologists approach gadolinium-based contrast imaging in patients with kidney disease? Clin J Am Soc Nephrol 2008;3(3):649–651. Crossref, Medline, Google Scholar
    • 34 Reilly RF. Risk for nephrogenic systemic fibrosis with gadoteridol (ProHance) in patients who are on long-term hemodialysis. Clin J Am Soc Nephrol 2008;3(3):747–751. Crossref, Medline, Google Scholar
    • 35 Balci NC, Semelka RC. Contrast agents for MR imaging of the liver. Radiol Clin North Am 2005;43(5):887–898, viii. Crossref, Medline, Google Scholar
    • 36 Bruix J, Sherman M. Management of hepatocellular carcinoma: an update. http://www.aasld.org/practiceguidelines/Documents/Bookmarked%20Practice%20Guidelines/HCCUpdate2010.pdf. Accessed July 28, 2010. Google Scholar

    Article History

    Received July 20, 2010; revision requested August 23; revision received December 6; accepted December 14; final version accepted December 28.
    Published online: May 2011
    Published in print: May 2011