Future directions of renal MRI - University of Nottingham€¦ · Future directions of renal MRI 3d...

www.renalmri.org

Future directions of renal MRI

3d international conference of functional renal imaging

Steven Sourbron

www.renalmri.org 2Steven Sourbron, Nottingham, 2019.10.17

Growth of renal MRI (2015 - 2020)

Bordeaux

Oct 2015

Berlin Oct

Oct 2017

Nottingham

Oct 2019

??? Oct 2021 ???

Drivers for growth of renal MRI

Promises of renal MRI

ISRMR 2029 award ceremony

8th international conference on renal MRI

Category I: Novel technologies and contrast

mechanisms in renal MRI

Category II: How reliable are MRI

biomarkers of the kidney?

Category III: What does renal MRI tell us

about kidney structure and function?

Category IV: How are renal MRI biomarkers

useful?

Category I. Novel technologies and contrast mechanisms

Silver

Bronze

Silver

Bronze

A 10-minute MRI acquisition protocol for renal anatomy, diffusion-tensor

imaging, tractography, intravoxel incoherent motion, blood oxygenation-

level dependent imaging, T1- and T2 mapping, magnetisation transfer

contrast, chemical exchange saturation transfer, angiography, phase

contrast, hyperpolarised MRI, MR renography, multiple inversion time

arterial spin labelling, elastin expression, time-resolved MRI

spectroscopy, Sodium MRI, quantitative susceptibility mapping and MR

urography.

Silver

Bronze

urography.

Silver

A dedicated low-field MRI scanner for AKI assessment on the intensive

care ward.

Bronze

urography.

6.5 mT 3.0T

Silver

care ward.

Bronze

urography.

A novel MRI method for the prenatal measurement of single-kidney

function.

Silver

care ward.

Bronze

urography.

• 25% of all prenatal US detect congenital

abnormalities of the genitourinary tract.

• The impact on kidney function is difficult to

determine (no blood & urine)

• Fetal MRI is very difficult (size, motion)

Category II. Accuracy and precision of renal MRI biomarkers

Silver

Bronze

Silver

Bronze

Normal reference ranges for 45 renal MRI biomarkers: a UKRIN imaging

biobank study in 5000 healthy subjects

45 yr old, male, healthy 74 yr old, male, Type 2 diabetes 72 yr old, male, Healthy

Silver

Bronze

Silver

Patient-specific error estimates in cortical fractional anisotropy with a 5%

confidence.

Bronze

MRI Biomarker Panel TEST RESULT UNIT FLAG

Volumetry

Kidney Volume 250 ml

Cystic volume 70 % High?

Renography

SK-GFR: 65 ml/min

Blood Flow: 644 ml/min

Extraction Fraction: 18 %

Blood Volume: 22 % Low?

Transit Time: 2.2 min

Functional Volume: 212 ml

Diffusion

ADC (medulla): 2.84 10-3 mm2/s

ADC (cortex): 2.55 10-3 mm2/s

FA (medulla): 39 %

FA (cortex): 22 %

T2* (medulla) 54 ms High?

T2* (cortex) 66 ms

Reserve (medulla) 13 %

Reserve (cortex) 12 %

Silver

confidence.

Bronze

Implementation of renal MRI biomarker results traceable to the SRMR

international reference standard.

Silver

confidence.

Bronze

• Is my new machine (assay) well calibrated?

• Is my machine (assay) still accurate?

• Has my software upgrade affected accuracy?

• Is this new product accurate?

• Should I buy machine A or machine B?

• Are the values from lab A and B comparable?

“Authority”

Reference

Lab 1Reference

Reference

LabLocal

Category III. Biological sensitivity & specificity of renal MRI

Silver

Bronze

Silver

Bronze

A non-invasive MRI biomarker shows 95% specificity to tubulo-interstitial

fibrosis.

Friedli 2016

Fibrosis changes => Biomarker changes

Biomarker changes => fibrosis changes

“Fibrosis reduces

extracellular water

=> reduces ADC”

“Fibrosis increases

extracellular water

=> increases T1”

Silver

Bronze

fibrosis.

Silver

Dual-agent MRI of the ultrafiltrate measures elevated albumin in normo-

albuminuric diabetic nephropathy.

Bronze

fibrosis.

Mapping single nephron GFR across the human kidney: a validation study.

Silver

Dual-agent MRI of the ultrafiltrate measures elevated albumin in normo-

albuminuric diabetic nephropathy.

Bronze

fibrosis.

Category IV. Utility of renal MRI in drug development and clinical

practice

Silver

Bronze

practice

Silver

Bronze

Virtual MRI biopsy distinguishes diabetic glomerulosclerosis from

hypertensive microvascular disease.

Vascular wall thickeningDiabetic glomerulosclerosis

Courtesy Loreto Gesualdo

practice

Silver

Bronze

practice

Silver

FDA qualification of a fibrosis-specific MRI contrast agent as surrogate

endpoint in clinical trials.

Bronze

practice

Silver

Bronze

practice

MRI biomarkers improve the prediction of eGFR decline in patients with

Type 2 diabetes – the iBEAt study

Silver

Bronze

Fourth international

renal imaging meeting 2021

2021 International Meeting

Suraj Seraj

Pottumarthi

Prasad

Plenary discussion

Location next meeting (2021)?

● Somewhere in US (ASN satellite)

● Sweden, Uppsala

Frequency of future meetings?

● Continue with October time bi-annual meetings?

● Ad-hoc planning?

Thank you to the organisers!!

Francis

Maarten

Future directions of renal MRI - University of Nottingham€¦ · Future directions of renal MRI 3d...

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