Functional Renal Imaging: New Trends in Radiology and Nuclear Medicine

doi:10.1053/j.semnuclmed.2010.08.003

Seminars in Nuclear Medicine

Volume 41, Issue 1, January 2011, Pages 61-72

https://doi.org/10.1053/j.semnuclmed.2010.08.003 Get rights and content

The objective of this work is to compare the characteristics of various techniques for functional renal imaging, with a focus on nuclear medicine and magnetic resonance imaging. Even with low spatial resolution and rather poor signal-to-noise ratio, classical nuclear medicine has the advantage of linearity and good sensitivity. It remains the gold standard technique for renal relative functional assessment. Technetium-99m (^99mTc)-labeled diethylenetriamine penta-acetate remains the reference glomerular tracer. Tubular tracers have been improved: ¹²³I- or ¹³¹I-hippuran, ^99mTc-MAG3 and, recently, ^99mTc-nitrilotriacetic acid. However, advancement in molecular imaging has not produced a groundbreaking tracer. Renal magnetic resonance imaging with classical gadolinated tracers probably has potential in this domain but has a lack of linearity and, therefore, its value still needs evaluation. Moreover, the advent of nephrogenic systemic fibrosis has delayed its expansion. Other developments, such as diffusion or blood oxygen level-dependent imaging, may have a role in the future. The other modalities have a limited role in clinical practice for functional renal imaging.

Section snippets

Imaging

Medical imaging encompasses 4 main techniques: radiology (including computed tomography [CT]), nuclear medicine (NM), including positron emission tomography (PET), ultrasound (US), and MRI. In addition, optical imaging (OI) can be considered for small animal imaging. In practice, renal functional imaging needs close follow-up over time with sequential imaging. Because of limitations attributable to radiation burden, this makes radiological techniques hardly suited to functional renal imaging.

Relationship Between Tracer and Signal

In NM, the image is the projection of tracer amount in each pixel, with a very good linearity between tracer activity and signal intensity. Radioactivity itself is independent from anything: no influence from chemical environment, pH, temperature, or any other physical parameter. This makes it very robust for quantification. A few corrections however must be made for proper quantification (gamma-ray attenuation, scattering, partial volume effect …) but in modern gamma-cameras, these techniques

Toxicity

GD-based contrast agents can induce CIN, which is identical to the CIN from iodinated contrast material.³¹ Although patients in renal failure are at risk for developing CIN with double dose of GD-based agents, they are probably not at risk with lower dosage.

NSF was first described in 1997 in patients with end-stage renal disease. It is characterized by scleroderma-like skin changes that mainly affect the limbs and trunk. The induration of the skin can progress to cause flexion contracture of

Available Parameters

Considering the various techniques and many available tracers, several parameters can be assessed with functional renal imaging.

New Imaging Agents

Molecular imaging is now clearly established as a cornerstone novel in science with a development driven by diverse modalities ranging from classical NM, PET, and MRI to OI techniques. Key points to be considered for development of new agents include the molecular imaging agent (probe or tracer), the localization of the target, which can be intracellular or cell surface proteins, and the performances of the detection system.

Current evaluation of radiopharmaceuticals requires a first step of

New Directions

Beyond these tubular tracers, other modern techniques can be used to target new CAs. Although no renal tracer obtained with these techniques is currently available, it may interest the reader to have an overview of what could provide us with new renal tracers tomorrow.

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Functional Renal Imaging: New Trends in Radiology and Nuclear Medicine

Section snippets

Imaging

Relationship Between Tracer and Signal

Toxicity

Available Parameters

New Imaging Agents

New Directions

Semin Nucl Med

Semin Nucl Med

Ultrasound Med Biol

Ultrasound Med Biol

Ultrasound Med Biol

J Diabetes Complications

J Am Coll Cardiol

Kidney Int

Semin Nucl Med

Semin Nucl Med

Semin Nucl Med

J Surg Res

Graphical evaluation of blood-to-brain transfer constants from multiple-time uptake data

J Cereb Blood Flow Metab

Dynamic contrast enhanced magnetic resonance imaging in oncology: theory, data acquisition, analysis, and examples

Curr Med Imaging Rev

Arterial input functions for dynamic susceptibility contrast MRI: requirements and signal options

J Magn Reson Imaging

Nuclear medicine applications in molecular imaging

J Magn Reson Imaging

Microbubble ultrasound contrast agents: an update

Eur Radiol

Iodinated contrast media-induced nephropathy: pathophysiology, clinical aspects and prevention

Fundam Clin Pharmacol

Risk of iodinated contrast material—induced nephropathy with intravenous administration

Radiology

Risk of nephropathy after intravenous administration of contrast material: a critical literature analysis

Radiology

Renal function following infusion of radiologic contrast materialA prospective controlled study

Arch Intern Med

Failure to demonstrate contrast nephrotoxicity

Med J Aust

Frequency of serum creatinine changes in the absence of iodinated contrast material: implications for studies of contrast nephrotoxicity

AJR Am J Roentgenol

Intravenous contrast medium-induced nephrotoxicity: is the medical risk really as great as we have come to believe?

Radiology

Metaanalysis of the relative nephrotoxicity of high- and low-osmolality iodinated contrast media

Radiology

Nephrotoxic effects in high-risk patients undergoing angiography

N Engl J Med

Contrast-induced nephropathy in patients with chronic kidney disease undergoing computed tomography: a double-blind comparison of iodixanol and iopamidol

Invest Radiol

Cardiac angiography in renally impaired patients (CARE) study: a randomized double-blind trial of contrast-induced nephropathy in patients with chronic kidney disease

Circulation

The Active Trial: comparison of the effects on renal function of iomeprol-400 and iodixanol-320 in patients with chronic kidney disease undergoing abdominal computed tomography

Invest Radiol

Contrast-induced nephropathy

Eur Radiol

Contrast-medium-induced nephropathy: is there a new consensus?A review of published guidelines

Eur Radiol

Role of thermodynamic and kinetic parameters in gadolinium chelate stability

J Magn Reson Imaging

Nephrogenic systemic fibrosis following the administration of extracellular gadolinium based contrast agents: is the stability of the contrast agent molecule an important factor in the pathogenesis of this condition?

Br J Radiol

The safety of gadolinium in patients with stage 3 and 4 renal failure

Nephrol Dial Transplant