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  • Review Article
  • Published:

Radiologic imaging of the renal parenchyma structure and function

Nature Reviews Nephrology volume 12, pages 348–359 (2016)Cite this article

Subjects

Key Points

  • Radiologic techniques can be used to assess gross renal morphology, but morphological changes at this level show poor correlation with renal function and the changes over time are often nonspecific

  • Dynamic contrast-enhanced CT or MRI can provide haemodynamic information, such as renal blood flow or tissue perfusion, which can facilitate personalized patient management

  • Information obtained from blood oxygen level-dependent MRI could contribute to the understanding of chronic kidney disease pathophysiology, but technical issues remain to be solved before large-scale clinical use

  • MRI and renal scintigraphy can both provide a measure of split renal function in moderately dilated kidneys, but radiological measurement of single kidney glomerular filtration rate requires further development

  • The ability to identify fibrotic changes and inflammatory components in damaged renal tissue by radiologic imaging is a major goal for future research

Abstract

Radiologic imaging has the potential to identify several functional and/or structural biomarkers of acute and chronic kidney diseases that are useful diagnostics to guide patient management. A renal ultrasound examination can provide information regarding the gross anatomy and macrostructure of the renal parenchyma, and ultrasound imaging modalities based on Doppler or elastography techniques can provide haemodynamic and structural information, respectively. CT is also able to combine morphological and functional information, but the use of CT is limited due to the required exposure to X-ray irradiation and a risk of contrast-induced nephropathy following intravenous injection of a radio-contrast agent. MRI can be used to identify a wide range of anatomical and physiological parameters at the tissue and even cellular level, such as tissue perfusion, oxygenation, water diffusion, cellular phagocytic activity, tissue stiffness, and level of renal filtration. The ability of MRI to provide valuable information for most of these parameters within a renal context is still in development and requires more clinical experience, harmonization of technical procedures, and an evaluation of reliability and validity on a large scale.

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Figure 1: Sonographic changes in autosomal recessive polycystic kidney disease.
Figure 2: Visualization of intrarenal post-inflammatory phagocytic activity with ultrasmall supermagnetic iron oxide (USPIO)-enhanced T2*-weighted magnetic resonance sequences.
Figure 3: Diffusion-weighted MRI and diffusion tensor imaging in a kidney transplant.
Figure 4: Ultrasound-elastography using shear wave imaging technique on a renal allograft.
Figure 5: Principles of quantitative dynamic contrast-enhanced (DCE)–MRI applied to a kidney transplant.
Figure 6: Intrarenal blood oxygen level-dependent MRI in a patient with a small tumour in the upper pole of the left kidney.

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Acknowledgements

This work was achieved within the context of the Laboratory of Excellence TRAIL ANR-10-LABX-57. The authors would like to thank Pippa McKelvie-Sebileau, University of Bordeaux, France, for her editorial assistance prior to submission.

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Authors and Affiliations

  1. Service d'Imagerie Diagnostique et Interventionnelle de l'Adulte, Centre Hospitalier Universitaire de Bordeaux, Groupe Hospitalier Pellegrin, Place Amélie Raba-Léon, Bordeaux, 33076, Cedex, France

    Nicolas Grenier

  2. University of Bordeaux, Rue Léo Saignat, Bordeaux, 33076, Cedex, France

    Pierre Merville

  3. Service de Néphrologie Transplantation Dialyse, Centre Hospitalier Universitaire de Bordeaux, Groupe Hospitalier Pellegrin, Place Amélie Raba-Léon, Bordeaux, 33076, Cedex, France

    Christian Combe

Authors
  1. Nicolas Grenier
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  2. Pierre Merville
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  3. Christian Combe
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Contributions

N.G. and C.C. researched the data and wrote the article. N.G., C.C. P.M. made substantial contributions to discussion of the content and reviewed and/or edited the manuscript before submission.

Corresponding author

Correspondence to Nicolas Grenier.

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Competing interests

N.G. is a member of the advisory board of Supersonic Imagine, Aix-en-Provence, France. P.M. and C.C. declare no competing interests.

Supplementary information

Supplementary S1 (figure)

Automatic segmentation of the renal parenchyma and renal cortex for automatic volume assessment of the entire kidney or the entire cortex, respectively. (PDF 522 kb)

Supplementary S2 (figure)

MRI of the homing effect of superparamagnetic iron oxide particle-labelled mesenchymal stem cells. (PDF 339 kb)

Supplementary S3 (figure)

Dynamic contrast-enhanced ultrasound of a segmental renal infarction. (PDF 611 kb)

Supplementary S4 (figure)

Principles of renal blood oxygen level-dependent MRI demonstrated in a rabbit kidney. (PDF 283 kb)

Supplementary S5 (figure)

Evaluation of split renal function in a patient with renal atrophy, 1 year after bilateral dissection of the renal arteries. (PDF 450 kb)

PowerPoint slides

Glossary

MRI

Imaging modality that uses a strong oscillating magnetic field to induce endogenous atoms to emit radiowaves that are detected and used to generate 2D and 3D images of a living subject.

CT

An imaging modality that processes and combines X-ray images to produce tomographic (slice) images. CT provides cross sectional images of organs, bones, soft tissues in multiple planes.

Doppler ultrasonography

Doppler ultraound estimates blood flow through vessels by bouncing high-frequency sound waves off circulating red blood cells.

Corticomedullary differentiation

(CMD). Visualizes the differences in intensity, echogenity, or attenuation between cortical and medullary compartments of the kidney, and can be a biomarker of renal insufficiency.

Ultrasonography

Visualization of deep body structures based on a recording of the reflections or echoes of ultrasonic pulses directed into the tissue. Frequencies of the pulses typically range from 1.6 MHz to 10 MHz.

Tesla (T)

Unit of measurement to quantify the strength of a magnetic field. Clinical MRI scanners operate at a level of 1.5T or 3T.

Superparamagnetic iron oxide particles (SPIO)

Iron oxide (magnetite and maghemite) particles 150 nm in size that exhibit superparamagnetism and can be used to label cells and monitor them in real time.

Apparent diffusion coefficient (ADC)

A measure of the magnitude of diffusion of water molecules within a tissue that is calculated using MRI with diffusion weighted imaging. The ADC provides an assessment of tissue integrity.

Diffusion tensor imaging (DTI)

A technique to measure the restricted diffusion of water according to the major direction of tissue architecture. DTI enables characterization of microstructural changes by measuring the fractional anisotropy and orientation of the diffusion tensor

Fractional anisotropy

Indicates the percentage of a tissue that displays oriented diffusion axes and is a reflection of tissue microstructure.

Shear wave velocity (SWV)

Shear waves are an elastic waveform that move as a shear or transverse wave through the body of an object. The SWV is a measure of tissue stiffness in m/s.

Transient elastography

An ultrasound-based form of transient elastography developed by FibroScan that measures the extent of fibrosis and quantifies steatosis.

Acoustic radiation force impulse (ARFI)

A form of ultrasound elastography that uses acoustic radiation forces (<1 ms) to assess tissue stiffness and stage fibrosis.

Supersonic shear imaging (SSI)

An ultrasound-based technique for real time visualization of soft tissue viscoelastic properties. SSI provides a measure of tissue stiffness.

Relaxation time (T2*)

Time constant for signal decay in MRI that uses a T2*-weighted gradient-echo sequence. T2* is the inverse of the rate of signal decay R2*.

Dynamic contrast-enhanced (DCE)

Intravenous administration of a contrast agent prior to MRI or CT to facilitate quantification of physiological parameters in comparison to baseline (no contrast) images. Functional information such as perfusion, permeability, and renal filtration can be obtained through the acquisition of high resolution parametric images.

Blood oxygen level-dependent MRI (BOLD-MRI)

Method used in functional MRI to observe variations in oxygen concentration within tissues based on the oxy-deoxyhaemoglobin ratio.

Relaxation rate (R2*)

Rate of signal decay in MRI using a T2*-weighted gradient-echo sequence, and is the inverse of the time constant T2*. R2* is sensitive to tissue oxygenation levels and the presence of iron oxide particles.

Scintigraphy

2D imaging of the distribution of radioactivity after administration of a radio-pharmaceutical imaging agent with affinity for the organ of interest. Scintigraphy enables evaluation of kidney function.

Magnetic resonance spectroscopy (MRS)

A complement to MRI that uses information derived from different atoms to determine the concentration of metabolites in the tissue examined.

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Grenier, N., Merville, P. & Combe, C. Radiologic imaging of the renal parenchyma structure and function. Nat Rev Nephrol 12, 348–359 (2016). https://doi.org/10.1038/nrneph.2016.44

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