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Arterial Spin Labeled MRI for Quantitative Non-Contrast Perfusion Measurement of the Kidneys

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Advanced Clinical MRI of the Kidney

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Abstract

One of the major functions of the kidneys is to filter blood and control fluid balance by maintaining homeostasis. To maintain this functionality, approximately 25% of cardiac output goes to the kidneys at rest. Reduction in blood flow to the kidneys and the associated hypoxia may lead to the initiation and progression of acute kidney injury (AKI) and chronic kidney disease (CKD). The measurement of renal blood flow provides a means to understand the physiological regulation of renal perfusion and the role of its dysregulation in kidney disease and injury. Arterial spin labeled (ASL) magnetic resonance imaging (MRI) has emerged as a quantitative noninvasive method to measure renal perfusion. ASL-MRI is the only perfusion imaging modality that can be performed without the administration of exogenous contrast agent and has the ability to measure renal perfusion in physiological units of mL/100 g/min.

Over the past two decades, ASL-MRI has gone through several technical innovations and has become a mainstream method to measure renal perfusion. Renal ASL has been applied in a variety of kidney diseases including CKD, AKI, diabetes, hypertension, lupus nephritis, and renovascular disease. ASL has also been used to assess renal transplant function, to differentiate tumor types in primary renal cancer, and to assess therapy response in metastatic renal cancer. In this chapter, we will review the principles of ASL-MRI, followed by the acquisition protocol, post-processing and data analysis methods, and finally some clinical applications.

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Abbreviations

AKI:

Acute kidney injury

ASL:

Arterial spin labeling

BGS:

Background suppression

bSSFP:

Balanced steady state free precession

CASL:

Continuous arterial spin labeling

CKD:

Chronic kidney disease

DCE:

Dynamic contrast-enhanced

DSC:

Dynamic susceptibility contrast

FAIR:

Flow alternating inversion recovery

FOCI:

Frequency offset corrected inversion

FSE:

Fast spin echo

GraSE:

Gradient and spin echo

GRE:

Gradient echo

MRI:

Magnetic resonance imaging

NSF:

Nephrogenic systemic fibrosis

PASL:

Pulsed arterial spin labeling

pCASL:

Pseudo continuous arterial spin labeling

PET:

Positron emission tomography

PLD:

Post-label delay

RCC:

Renal cell carcinoma

SE-EPI:

Spin-echo echo-planar imaging

SNR:

Signal to noise ratio

SPECT:

Single photon emission computed tomography

SShTSE:

Single-shot turbo spin echo

TSE:

Turbo spin echo

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Authors and Affiliations

  1. Department of Radiology, UT Southwestern Medical Center, Dallas, TX, USA

    Ananth J. Madhuranthakam

  2. Radiology Department, Clínica Universidad de Navarra, University of Navarra, Pamplona, Spain

    Maria A. Fernandez-Seara

Authors
  1. Ananth J. Madhuranthakam
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  2. Maria A. Fernandez-Seara
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Correspondence to Ananth J. Madhuranthakam .

Editor information

Editors and Affiliations

  1. Department of Radiology, Children’s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

    Suraj D. Serai

  2. Department of Radiology, Children’s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

    Kassa Darge

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Madhuranthakam, A.J., Fernandez-Seara, M.A. (2023). Arterial Spin Labeled MRI for Quantitative Non-Contrast Perfusion Measurement of the Kidneys. In: Serai, S.D., Darge, K. (eds) Advanced Clinical MRI of the Kidney. Springer, Cham. https://doi.org/10.1007/978-3-031-40169-5_19

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  • DOI: https://doi.org/10.1007/978-3-031-40169-5_19

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