European Radiology

, Volume 26, Issue 6, pp 1732–1741 | Cite as

Elevated global cerebral blood flow, oxygen extraction fraction and unchanged metabolic rate of oxygen in young adults with end-stage renal disease: an MRI study

  • Gang Zheng
  • Jiqiu Wen
  • Hanzhang Lu
  • Yaxian Lou
  • Zhiying Pan
  • Wei Liu
  • Hui Liu
  • Xue Li
  • Zhe Zhang
  • Huijuan Chen
  • Xiang Kong
  • Song Luo
  • Xiaolu Jiang
  • Ya Liu
  • Zongjun Zhang
  • Long Jiang ZhangEmail author
  • Guang Ming LuEmail author



To noninvasively assess global cerebral blood flow (CBF), oxygen extraction fraction (OEF) and cerebral metabolic rate of oxygen (CMRO2) in young adults with end-stage renal disease (ESRD).


Thirty-six patients and 38 healthy volunteers were included and took part in MR examinations, blood and neuropsychological tests. CBF and OEF were measured by phase-contrast and T2-relaxation-under-spin-tagging MRI techniques, respectively. CMRO2 was computed from CBF, OEF and hematocrit according to Fick’s principle. Correlations were performed between MR measurements, blood biochemistry measurements and neuropsychological test scores.


Compared with controls, ESRD patients had elevated CBF (72.9 ± 12.5 vs. 63.8 ± 8.5 ml min−1 100 g−1, P < 0.001), elevated OEF (47.2 ± 10.2 vs. 35.8 ± 5.4 %, P < 0.001), but unaffected CMRO2 (199.5 ± 36.4 vs. 193.8 ± 28.6 μmol O2 min−1 100 g−1, P = 0.879). Hematocrit negatively correlated with CBF (r = −0.640, P < 0.001) and OEF (r = −0.701, P < 0.001), but not with CMRO2. Altered neuropsychological test scores of ESRD patients were associated with OEF and CBF, but not with CMRO2. There were weak relationships between eGFR and hematocrit (r = 0.308, P = 0.068) or CBF (r = 0.318, P = 0.059).


Our findings suggested that anaemic young adults with ESRD may afford higher CBF and OEF to maintain a normal CMRO2. Despite this compensatory process, however, cognitive function was still impaired and its severity was correlated with their CBF and OEF abnormality.

Key Points

• Anaemic young adults with ESRD may afford higher CBF and OEF.

• Anaemic young adults with ESRD maintain a normal CMRO 2 .

• Cognitive function was still impaired in young ESRD adults.

• The severity of cognitive dysfunction correlated with CBF and OEF changes.


End-stage renal disease Cerebral blood flow Oxygen extract fraction Cerebral metabolic rate of oxygen Uremic encephalopathy 



Cerebral blood flow


Cerebral metabolic rate of oxygen


Digit symbol test


End-stage renal disease


Line-tracing test


Montreal cognitive assessment


Mini mental state examination


Number connection test type A


Self-rating anxiety scale


Self-rating depression scale


Serial-dotting test




Oxygen extraction fraction



The scientific guarantor of this publication is Guang Ming Lu. This study has received funding by grants from National Natural Science Foundation of China (grant Nos. 81471644 and 81101039 to G.Z., grants Nos. 81322020, 81230032, and 81171313 to L.J.Z.), the Program for New Century Excellent Talents in the University (NCET-12-0260 to L.J.Z.), and the Special Grant from the China Postdoctoral Science Foundation (grant No. 2014 T71014 to G.Z.). No complex statistical methods were necessary for this paper.

Institutional review board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. No study subjects or cohorts have been previously reported. Methodology:prospective, observable study, performed at one centre.


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Copyright information

© European Society of Radiology 2015

Authors and Affiliations

  • Gang Zheng
    • 1
    • 2
  • Jiqiu Wen
    • 3
  • Hanzhang Lu
    • 4
  • Yaxian Lou
    • 1
    • 2
  • Zhiying Pan
    • 1
    • 2
  • Wei Liu
    • 5
  • Hui Liu
    • 6
  • Xue Li
    • 3
  • Zhe Zhang
    • 3
  • Huijuan Chen
    • 1
  • Xiang Kong
    • 1
  • Song Luo
    • 1
  • Xiaolu Jiang
    • 1
  • Ya Liu
    • 1
    • 2
  • Zongjun Zhang
    • 1
  • Long Jiang Zhang
    • 1
    Email author
  • Guang Ming Lu
    • 1
    Email author
  1. 1.Department of Medical Imaging, Jinling HospitalMedical School of Nanjing UniversityNanjingChina
  2. 2.College of Aivil AviationNanjing University of Aeronautics and AstronauticsNanjingChina
  3. 3.National Clinical Research Center of Kidney Diseases, Jinling HospitalMedical School of Nanjing UniversityNanjingChina
  4. 4.Advanced Imaging Research CenterUniversity of Texas Southwestern Medical CenterDallasUSA
  5. 5.Siemens Shenzhen Magnetic Resonance Ltd.ShenzhenChina
  6. 6.Siemens MR NEA Collaboration, Siemens Ltd.ShanghaiChina

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