title: Determination of blood flow to the transplanted kidney. A novel application of phase-contrast, cine magnetic resonance imaging.
abstract: There is at present no noninvasive method that reliably measures blood flow in the poorly functioning renal allograft. The present study was designed to evaluate phase-contrast cine magnetic resonance imaging (PC-cine-MRI) for this purpose. We recruited for study 18 patients who had received kidney transplants 13-66 months earlier from closely related living donors. As judged by the glomerular filtration rate, which was elevated for a single kidney (76 +/- 4 ml/min 1.73 m2), allograft function was excellent, permitting the assumption of unimpaired renal extraction of paminohippuric acid (PAH). Allograft blood flow was determined consecutively on the same day, first by the standard PAH clearance technique and they by the product of the velocity of protons and renal vein cross-sectional area using PC-cine-MRI. MRI determinations could not be completed because of claustrophobia in two patients and failure to image the terminus of the allograft vein another two. Comparison of blood flow in the remaining 14 subjects revealed the two techniques to be strongly related (r = 0.91, P < 0.001). On the average, the renal blood flow rate was similar by each method; 732 +/- 62 by PAH clearance and 703 +/- 69 ml/min by PC-cine-MRI, but the agreement among individuals between the two methods was only modest, with a 95% confidence interval of agreement from -214 to +254 ml/min. We conclude that PC-cine-MRI provides a fairly accurate and noninvasive method for determining the rate of blood flow in the transplanted kidney. With further refinement it should permit the role of depressed blood flow in a variety of acute and chronic forms of human allograft dysfunction to be elucidated in humans for the first time.
authors.affiliation: Department of Medicine, Stanford University School of Medicine, California.
authors.forename: B D
authors.initials: BD
authors.lastname: Myers
authors.forename: F G
authors.initials: FG
authors.lastname: Sommer
authors.forename: K
authors.initials: K
authors.lastname: Li
authors.forename: S
authors.initials: S
authors.lastname: Tomlanovich
authors.forename: N
authors.initials: N
authors.lastname: Pelc
authors.forename: C
authors.initials: C
authors.lastname: McDonnell
authors.forename: E
authors.initials: E
authors.lastname: Pagtalunan
authors.forename: L
authors.initials: L
authors.lastname: Newton
authors.forename: R
authors.initials: R
authors.lastname: Jamison
mesh_terms: D005919:Glomerular Filtration Rate; D006801:Humans; D007668:Kidney / Q000098:blood supply*; D016030:Kidney Transplantation; D008279:Magnetic Resonance Imaging / Q000379:methods*; D012039:Regional Blood Flow; D010130:p-Aminohippuric Acid
chemical_list: D010130:p-Aminohippuric Acid