title: Quantitative evaluation of acute renal transplant dysfunction with low-dose three-dimensional MR renography.
abstract: OBJECTIVE
  To assess prospectively the ability of quantitative low-dose three-dimensional magnetic resonance (MR) renography to help identify the cause of acute graft dysfunction.
  
  
  METHODS
  This HIPAA-compliant study was approved by the institutional review board, and written informed consent was obtained. Between December 2001 and May 2009, sixty patients with transplanted kidneys (41 men and 19 women; mean age, 49 years; age range, 22-71 years) were included. Thirty-one patients had normal function and 29 had acute dysfunction due to acute rejection (n = 12), acute tubular necrosis (ATN) (n = 8), chronic rejection (n = 6), or drug toxicity (n = 3). MR renography was performed at 1.5 T with three-dimensional gradient-echo imaging. With use of a multicompartment renal model, the glomerular filtration rate (GFR) and the mean transit time (MTT) of the tracer for the vascular compartment (MTT(A)), the tubular compartment (MTT(T)), and the collecting system compartment (MTT(C)) were calculated. Also derived was MTT for the whole kidney (MTT(K) = MTT(A) + MTT(T) + MTT(C)) and fractional MTT of each compartment (MTT(A/K) = MTT(A)/MTT(K), MTT(T/K) = MTT(T)/MTT(K), MTT(C/K) = MTT(C)/MTT(K)). These parameters were compared in patients in the different study groups. Statistical analysis was performed by using analysis of covariance.
  
  
  RESULTS
  There were significant differences in GFR and MTT(K) between the acute dysfunction group (36.4 mL/min ± 20.8 [standard deviation] and 177.1 seconds ± 46.8, respectively) and the normal function group (65.9 mL/min ± 27.6 and 140.5 seconds ± 51.8, respectively) (P < .001 and P = .004). The MTT(A/K) was significantly higher in the acute rejection group (mean, 12.7% ± 2.9) than in the normal function group (mean, 8.3% ± 2.2; P < .001) or in the ATN group (mean, 7.1% ± 1.4; P < .001). The MTT(T/K) was significantly higher in the ATN group (mean, 83.2% ± 9.2) than in the normal function group (mean, 72.4% ± 10.2; P = .031) or in the acute rejection group (mean, 69.2% ± 6.1; P = .003).
  
  
  CONCLUSIONS
  Low-dose MR renography analyzed by using a multicompartmental tracer kinetic renal model may help to differentiate noninvasively between acute rejection and ATN after kidney transplantation.
authors.affiliation: Department of Radiology, New York University School of Medicine, 660 First Ave, 4th Floor, New York, NY 10016, USA. akira.yamamoto0420@gmail.com
authors.forename: Akira
authors.initials: A
authors.lastname: Yamamoto
authors.forename: Jeff L
authors.initials: JL
authors.lastname: Zhang
authors.forename: Henry
authors.initials: H
authors.lastname: Rusinek
authors.forename: Hersh
authors.initials: H
authors.lastname: Chandarana
authors.forename: Pierre-Hugues
authors.initials: PH
authors.lastname: Vivier
authors.forename: James S
authors.initials: JS
authors.lastname: Babb
authors.forename: Thomas
authors.initials: T
authors.lastname: Diflo
authors.forename: Devon G
authors.initials: DG
authors.lastname: John
authors.forename: Judith A
authors.initials: JA
authors.lastname: Benstein
authors.forename: Laura
authors.initials: L
authors.lastname: Barisoni
authors.forename: David R
authors.initials: DR
authors.lastname: Stoffel
authors.forename: Vivian S
authors.initials: VS
authors.lastname: Lee
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology* / Q000473:pathology*; D000328:Adult; D000368:Aged; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D066298:In Vitro Techniques; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000473:pathology*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008875:Middle Aged; D011829:Radiation Dosage; D011866:Radioisotope Renography / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D017211:Treatment Failure; D055815:Young Adult