Measurement of glomerular filtration rate using dynamic magnetic resonance imaging in patients with chronic kidney disease.
BACKGROUND
Determination of glomerular filtration rate (GFR) using plasma disappearance curves requires the injection of a filtration marker and repeated timed blood collections. Gadolinium-containing contrast media are excreted exclusively by glomerular filtration and could provide a novel approach to quantifying GFR using magnetic resonance (MR) imaging. The aim of this study was to demonstrate the feasibility of measuring GFR by the clearance of gadolinium-containing contrast medium in patients with chronic kidney disease (CKD).


METHODS
Informed consent was obtained from stable CKD patients in stages 1, 2 or 3 (n=16; 5 women, 11 men; median age 54 years). GFR was measured after a bolus injection of gadobutrol (4 mL, approximately 0.05 mmol/kg) and calculated from the washout of the signal intensity obtained over the liver. The obtained MR-GFR was compared with simultaneously measured plasma clearance of inulin and gadobutrol.


RESULTS
Technical failure occurred in 2 patients. The mean obtained MR-GFR was 71 ± 25 (SD) mL/min per 1.73 m² and agreed well with the mean inulin-GFR (70 ± 24 mL/min per 1.73 m²). Pearson's correlation coefficient was r=0.91. The mean of the paired differences was 1 ± 10 mL/min per 1.73 m² and not significantly different from zero. GFR obtained from gadobutrol plasma clearance also agreed well with inulin-GFR and MR-GFR (r=0.92 and r=0.75, respectively).


CONCLUSIONS
We describe a novel method of determining GFR from MR imaging using a low dose of gadobutrol in patients with reduced GFR that enables the absolute quantification of GFR after routine contrast-enhanced MR imaging.
Department of Internal Medicine IV, Section of Nephrology and Hypertension, University of Tuebingen, Tuebingen, Germany. ferruh.artunc@med.uni-tuebingen.de
Ferruh
F
Artunc
Serdar
S
Yildiz
Andreas
A
Boss
Thomas
T
Frenzel
Heinz-Peter
HP
Schlemmer
Fritz
F
Schick
Teut
T
Risler
Hans-Ulrich
HU
Häring
Cristina
C
Rossi
D003287:Contrast Media; D005240:Feasibility Studies; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology*; D006801:Humans; D007444:Inulin / Q000097:blood; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009942:Organometallic Compounds / Q000097:blood; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis / Q000503:physiopathology*
D003287:Contrast Media; D009942:Organometallic Compounds; C090600:gadobutrol; D007444:Inulin