| NSF & Functional Renal |
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Wednesday 22 April 2009 |
| Room 316A |
10:30-12:30 |
Moderators: |
Diego R. Martin and Jeffrey Weinreb |
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10:30 |
400. |
2008 ISMRM Grant Recipient:
The Biodistribution of [153Gd]Gd-Labeled DTPA-BMA
and DOTA in a Transgenic Mouse Model of Renal
Failure Differs Greatly from Wild-Type Mice |
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Thaddeus J. Wadas1, Christopher D.
Sherman1, Jeffrey H. Miner2,
Jeffrey J. Brown2, James R. Duncan1,
Carolyn J. Anderson1
1Mallinckrodt Institute of Radiology,
Washington University School of Medicine, St. Louis,
MO, USA; 2Department of Internal
Medicine, Washington University School of Medicine,
St. Louis, MO, USA |
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10:50 |
401. |
Postmortem ICP-MS and MR
Analysis of Gadolinium Concentration and
Distribution in Three Confirmed NSF Cases |
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Peter Caravan1, Aashiyana Koreishi2,
Jonathan Kay3
1Radiology, Massachusetts General Hospital,
Charlestown, MA, USA; 2Pathology,
Massachusetts General Hospital, Boston, MA, USA;
3Rheumatology, Massachusetts General
Hospital, Boston, MA, USA |
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Nephrogenic systemic
fibrosis (NSF) is a debilitating fibrosing disorder
that can occur in renally compromised patients and
has been linked to gadolinium (Gd) based contrast
agents. We analyzed autopsy tissue from 3 confirmed
NSF subjects. Gd was quantifiable in all tissues
assayed and very high concentrations of Gd were
observed in the kidney and the heart. High
resolution relaxation time (T1, T2, T2*) maps
suggest a heterogeneous distribution in kidney
cortex. In the heart, the Gd had little T1 effect
but a strong T2* effect suggesting an insoluble
deposit and/or sequestration inside an endosome. |
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11:02 |
402. |
Incidence of Nephrogenic
Systemic Fibrosis (NSF) in Dialysis Patients
Receiving Either a Standard or a High-Relaxivity
Gadolinium Chelate Contrast Agent: A Single Center
Study |
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Saravanan Kokila
Krishnamoorthy1, Diego Martin1,
Khalil Nabeel Salman1, Bobby Kalb1,
John Carew2, Philip Andrew Martin3,
Kenneth Kokko4, Christian Larsen5,
Thomas Pearson5
1Department of Radiology, Emory University,
Atlanta, GA, USA; 2Department of
Biostatistics and Bioinformatics, Emory University,
Atlanta, GA, USA; 3University of West
Georgia, Carrollton, GA; 4Department of
Medicine, Emory University, Atlanta, GA, USA; 5Department
of Surgery, Emory University, Atlanta, GA, USA |
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Retrospective single
center study measuring the incidence of Nephrogenic
Systemic Fibrosis (NSF) in dialysis patients who
were administered either gadodiamide or gadobenate
dimeglumine. Mean cumulative dose of gadodiamide was
0.16 mmol/kg in 312 patients and 8 (2.6%) developed
NSF. Mean cumulative dose of gadobenate dimeglumine
was 0.11 mmol/kg in 603 patients and none developed
NSF. The cause for this difference is not determined
definitively but our results show that a change to a
low dose higher relaxivity gadolinium chelate can
significantly reduce NSF incidence and that the
incidence in dialysis patients is less than 1 in 603
in our patients. |
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11:14 |
403. |
Risk Factors for NSF: A Meta-Analysis |
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Honglei Zhang1,
Giles H. Roditi2, Rochelle Morgan1,
Martin R. Prince1,3
1Radiology, Weill Medical College of Cornell
University, New York, NY, USA; 2Radiology,
Glasgow Royal Infirmary, Glasgow, UK; 3Radiology,
Columbia College of Physicians and Surgeons, New
York, NY, USA |
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From 260 NSF patients in
59 published papers, this meta-analysis explores the
risk factors and demonstrates how risk can be
minimized. It appears that eliminating even a single
risk factor, such as the use of high dose can reduce
NSF incidence/risk at least 10-fold. Elimination of
multiple risk factors for example by using single
dose GBCA, dialyzing dialysis patients with 24 hours
following GBCA administration, avoiding GBCA in
acute renal failure, avoiding non-ionic GBCA in
renal failure patients can reduce NSF risk by orders
of magnitude thereby allowing safe GBCA enhanced MRI
in most patients. |
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11:26 |
404. |
Non-Contrast Enhanced Renal MR
Angiography Using NATIVE TrueFISP – Initial
Experience for Clinical Imaging of Patients with
Renovascular Disease |
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Stephen J. Gandy1,
Prasad Guntur Ramkumar2, Shelley A. Waugh1,
R Stephen Nicholas1, Andrew W. Taylor2,
Xiaoming Bi3, Peter Weale3, J
Graeme Houston2
1NHS Tayside Medical Physics, Ninewells
Hospital, Dundee, Angus, UK; 2NHS Tayside
Clinical Radiology, Ninewells Hospital, Dundee,
Angus, UK; 3Cardiovascular Research and
Development, Siemens Medical Solutions, Chicago, IL,
USA |
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The study aim was to
compare a new steady-state gradient echo
non-contrast MR angiography (NCE-MRA) sequence with
contrast enhanced MRA (CE-MRA) for renal artery
imaging. Fifty patients with suspected renovascular
disease were scanned using non-contrast (NATIVE
TrueFISP) and CE-MRA sequences. Resulting maximum
intensity projection (MIP) images were compared and
scored by two observers. Qualitative analysis
revealed that NCE-MRA and CE-MRA were virtually
equivalent for renal artery visualisation. Intra-
and inter-observer scoring agreement was k=0.91 and
0.70 respectively. In conclusion, this NCE-MRA
technique is comparable to CE-MRA and may provide an
alternative for imaging patients at risk of
Nephrogenic Systemic Fibrosis. |
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11:38 |
405. |
Understanding Renal DTI at 3T:
FA and MD Changes with Water Loading |
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Hersh Chandarana1,
Vivian S. Lee1, Irina Barash2,
Eric E. Sigmund1
1Radiology, NYU Langone Medical Center, New
York, NY, USA; 2Nephrology, NYU Langone
Medical Center, New York, NY, USA |
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Diffusion tensor imaging
allows non-invasive evaluation of renal structure
and function. Renal medulla has been shown to have
higher fractional anisotropy (FA) compared to
cortex, but it is unclear if medullary FA is
predominantly a measure of tubular structural
arrangement or if it is significantly influenced by
tubular flow. We examined changes in renal FA prior
to and in response to water loading. Our study
demonstrates a trend to faster, more isotropic
diffusion with water loading. Since water-loading is
known to increase tubular flow, these results
suggest that tubular flow plays little or no role in
baseline medullary diffusion anisotropy. |
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11:50 |
406. |
Kidney Stiffness
Measured in an Animal Model of Unilateral Renal
Arterial Stenosis Using 2D MR Elastography |
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Lizette Warner1,
Meng Yin2, Richard L. Ehman2,
Lilach Orly Lerman3
1Department of Physiology and Biomedical
Engineering, Mayo Clinic, Rochester, MN, USA; 2Department
of Radiology, Mayo Clinic, Rochester, MN, USA;
3Department of Nephrology and Hypertension,
Mayo Clinic, Rochester, MN, USA |
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Magnetic Resonance
Elastography (MRE) is a modified phase contrast MRI
technique for quantitatively assessing the
mechanical properties of soft tissue by
visualization of propagating shear waves. Both
fibrosis and turgor may affect the mechanical
properties of tissue and in the kidney may threaten
the viability and ultimately lead to kidney failure.
We have previously shown in a swine model of renal
arterial stenosis, the stenotic kidney exhibits
moderate but significant interstitial fibrosis. We
quantitatively determine with 2D MRE in vivo
the effect of renal arterial stenosis on the
mechanical properties of swine kidney. |
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12:02 |
407. |
Effects of
Ischemia-Reperfusion Injury on 23Na
Relaxation Times and Its Implications on
Quantification of Corticomedullary Sodium
Concentration by 23Na MRI |
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Bharath Atthe1,
Andriy Babsky1, Navin Bansal1
1Radiology, Indiana University School of
Medicine, Indianapolis, IN, USA |
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23Na MRI and
MRS are applied to evaluate the effects of renal
ischemia and reperfusion on 23Na MRI
signal intensity (SI), relaxation times and [Na+]
in the medulla and cortex of rat kidney. 23Na
relaxation times were found to be similar in renal
medulla and cortex in the normal kidney. Ischemia
caused a significant decrease in the relaxation
times which affected the calculation of [Na+]
from MRI data. However, the changes in relaxation
times for the medulla and cortex were identical,
thus the medulla to cortex 23Na SI ratio
represents [Na+] ratio in the two
compartments during ischemia and reperfusion. |
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12:14 |
408. |
Estimating GFR from Early
(Uptake) Portion of DCE MRI Renal Data, Using a
3-Compartment Model, Improves Reproducibility and
May Eliminate Need for Cortical Segmentation |
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Paul S. Tofts1,2,
Marica Cutajar1,3, Iosif Mendichovszky3,
Isky Gordon3
1Brighton and Sussex Medical School, Brighton,
Sussex, UK; 2Institute of Neurology,
University College London, London, UK; 3Institute
of Child Health, University College London, UK |
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