Biomarkers Renal
The table is adapted from Table 1 in Selby et al (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6106645/), distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/). Adaptations include changes in the text of various entries and a new column with recommendations for use by EIBALL
|
Technique |
Recommendations for use |
Description of MRI technique |
Pathophysiological process informed by MRI biomarker |
Biomarker measured |
Units of measurement |
|
Volumetry1-4! |
Enrichment biomarker / primary endpoint |
measured from T1- and/or T2-weighted structural images |
Key measure in patients with ADPKD but may also be important in CKD |
TKV |
mL |
|
Diffusion weighted imaging (DWI)5,6! |
Secondary endpoint |
True diffusion (D), pseudo-diffusion (tubular/vascular flow, D*) and flowing fraction (F) |
Changes in renal micro- structure, oedema, or changes in renal perfusion and in water handling in the tubular compartment. |
ADC |
mm2/s |
|
DCE MRI (MR renograophy)7! |
Secondary endpoint |
Gadolinium-based contrast agents to change the T1 relaxation time of water in tissues. Allows measurement of perfusion and GFR. |
Perfusion and filtration per unit tissue, vascularity and tubular transit times. Gd not recommended where renal function compromised. |
Single kidney GFR |
mL/min |
|
T1 mapping8,9! |
Secondary endpoint |
Provides a quantitative map over the whole kidney for T1 values. T1 is a tissue-specific time variable that can distinguish different tissues. |
Changes in the molecular environment, for example, water content, viscosity, temperature, fibrosis, interstitial oedema, cellular swelling. |
T1 |
ms |
|
T2 mapping9,10! |
Secondary endpoint |
As with T1 mapping, provides quantification of T2 as a tissue-specific time parameter. Changes with tissue water content. |
Changes in the molecular environment but assumed to be more sensitive to the effects of oedema and/ or inflammation. Limited experience in human kidney disease to date. |
T2 |
ms |
|
Diffusion-tensor imaging (DTI)5,7! |
Secondary endpoint |
Assesses directionality of diffusion [fractional anisotropy (FA)] and allows assessment of the degree of organization in space of oriented tissues |
Changes in the microstructure that lead to a change in the preferred direction of water diffusion, for instance, tubular dilatation, tubular obstruction or a loss in the organization of medullary tubules. |
FA
|
Scale value between 0 and 1, where 0 = isotropic diffusion (equal in all directions) and 1 = complete anisotropy (diffusion in a single axis) mm2/s |
|
BOLD MRI11,12! |
Secondary endpoint |
Indirect assessment of oxygenation. Deoxygenated haemoglobin shortens the transverse relaxation time constant (T2*). | Changes in renal oxygenation or changes in the microstructure of the capillary bed. | T2* R2* (1/ T2*) |
ms s-1 |
|
ASL13-17! |
Secondary endpoint |
Magnetically labelled water protons in blood that act as a endogenous tracer. Labelled images are subtracted from control images to generate perfusion maps. |
Cortical perfusion |
Tissue blood flow |
mL/min/100g |
|
Phase contrast MRI18,19! |
Secondary endpoint |
Measures blood flow in renal arteries: ‘phase shift’ is proportional to its proton velocity, allowing calculation of flow. |
Resistance to flow due to downstream obstruction, or changes in systemic haemodynamics. |
Renal artery blood flow (flux) |
mL/s |
|
Magnetization transfer (MT)20! |
Exploratory endpoint |
The fraction of large macromolecules or immobilized cell membranes in tissue. |
Shown to correlate with fibrosis in the kidney |
MT ratio |
% |
|
Elastography, hyperpolarization, and 23-sodium MRI.21-23! |
Exploratory endpoint |
Technique dependent |
Technique dependent |
Technique dependent |
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- Adler J, Swanson SD, Schmiedlin-Ren P et al. Magnetization transfer helps detect intestinal fibrosis in an animal model of Crohn disease. Radiology 2011; 259: 127–135
- Francis S, Buchanan CE, Prestwich B et al. Sodium MRI:a new frontier in imaging in nephrology. Curr Opin Nephrol Hypertens 2017; 26: 435–441 Schroeder M, Laustsen C. Imaging oxygen metabolism with hyperpolarized magnetic
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- Leung G, Kirkpalani A, Szeto SG et al. Could MRI Be Used To Image Kidney Fibrosis? A Review of Recent Advances and Remaining Barriers. Clin J Am Soc Nephrol 2017; 6: 1019-1028