Quantitative in vivo ²³Na MR imaging of the healthy human kidney: determination of physiological ranges at 3.0T with comparison to DWI and BOLD

Abstract

Objectives

The purpose of this prospective study was to assess the normal physiologic ranges of the renal corticomedullary ²³Na-concentration ([²³Na]) gradient at 3.0T in healthy volunteers. The corticomedullary [²³Na] gradient was correlated with other functional MR imaging parameters—blood oxygenation level dependent (BOLD) and diffusion-weighted imaging (DWI)—and to individual and physiologic parameters—age, gender, estimated glomerular filtration rate (eGFR), body mass index (BMI), and blood serum sodium concentration ([²³Na]_serum).

Methods and materials

50 healthy volunteers (30 m, 20 w; mean age: 29.2 years) were included in this IRB-approved study, without a specific a priori preparation in regard to water or food intake. For ²³Na-imaging a 3D density adapted, radial gradient echo (GRE)-sequence (spatial resolution = 5 × 5 × 5 mm³) was used in combination with a dedicated ²³Na-coil and ²³Na-reference phantoms. [²³Na] values of the corticomedullary [²³Na] gradient were measured by placement of a linear region of interest (20 × 1 mm²) from the renal cortex in the direction of the renal medulla. By using external standard reference phantoms, [²³Na] was calculated in mmol/L of wet tissue volume (mmol/l WTV). Axial diffusion-weighted images (spatial resolution = 1.7 × 1.7 × 5.0 mm³) and 2D GRE BOLD images (spatial resolution = 1.2 × 1.2 × 4.0 mm³) were acquired. Mean values ± standard deviations for [²³Na], apparent diffusion coefficient (ADC) values, and R2* values were computed for each volunteer. The corticomedullary ²³Na-concentration gradient (in mmol/l/mm) was calculated along the area of linear concentration increase from the cortex in the direction of the medulla. Correlations between the [²³Na] and DWI, BOLD, and the physiologic parameters were assessed with Pearson correlation coefficients.

Results

The mean corticomedullary [²³Na] for all healthy volunteers increased from the renal cortex (58 ± 17 mmol/l WTV) in the direction of the medulla (99 ± 18 mmol/l WTV). The inter-individual differences ranged from respective cortical and medullary values of 27 and 63 mmol/L WTV to 126 and 187 mmol/L WTV. No statistically significant differences in renal [²³Na] were found based on differences in individual or physiologic parameters (age, gender, [²³Na]_serum, BMI, GFR). No ADC or R2* gradients were identified, and [²³Na] did not correlate with these parameters.

Conclusion

Renal corticomedullary [²³Na] values increase from the cortex in the direction of the medullary pyramid, demonstrating wide inter-individual ranges and no significant correlations with age, gender, [²³Na]_serum, BMI, GFR, ADC, or R2* values. For future clinical evaluations, an approach relying on renal stimulation (e.g. pharmacologically induced diuresis) may be applicable to account for wide inter-individual ranges of normal [²³Na].