Volume 61, Issue 4 pp. 1969-1978
Research Article

Initial Experience of Metabolic Imaging With Hyperpolarized [1-13C]pyruvate MRI in Kidney Transplant Patients

Xiaoxi Liu PhD

Xiaoxi Liu PhD

Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA

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Ying-Chieh Lai MD

Ying-Chieh Lai MD

Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA

Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan

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Di Cui PhD

Di Cui PhD

Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA

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Shiang-Cheng Kung MD

Shiang-Cheng Kung MD

Department of Medicine, University of California San Francisco Medical Center, San Francisco, California, USA

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Meyeon Park MD, MAS

Meyeon Park MD, MAS

Department of Medicine, University of California San Francisco Medical Center, San Francisco, California, USA

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Zoltan Laszik MD, PhD

Zoltan Laszik MD, PhD

Department of Pathology, University of California San Francisco Medical Center, San Francisco, California, USA

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Peder E. Z. Larson PhD

Corresponding Author

Peder E. Z. Larson PhD

Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA

Address reprint requests to: Z.J.W., 505 Parnassus Avenue, Room S-353, San Francisco, CA 94143, USA. E-mail: [email protected], or P.E.Z.L., 1700 4th St, Byers Hall Room 102C, San Francisco, CA 94143, USA. E-mail: [email protected]

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Zhen J. Wang MD

Corresponding Author

Zhen J. Wang MD

Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA

Address reprint requests to: Z.J.W., 505 Parnassus Avenue, Room S-353, San Francisco, CA 94143, USA. E-mail: [email protected], or P.E.Z.L., 1700 4th St, Byers Hall Room 102C, San Francisco, CA 94143, USA. E-mail: [email protected]

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First published: 06 September 2024
Citations: 2

Abstract

Background

Kidney transplant is the treatment of choice for patients with end-stage renal disease. Early detection of allograft injury is important to delay or prevent irreversible damage.

Purpose

To investigate the feasibility of hyperpolarized (HP) [1-13C]pyruvate MRI for assessing kidney allograft metabolism.

Study Type

Prospective.

Subjects

Six participants (mean age, 45.2 ± 12.4 years, two females) scheduled for kidney allograft biopsy and five patients (mean age, 59.6 ± 10.4 years, two females) with renal cell carcinoma (RCC).

Field Strength/Sequence

Three Tesla, T2-weighted fast spin echo, multi-echo gradient echo, single shot diffusion-weighted echo-planar imaging, and time-resolved HP 13C metabolite-selective imaging.

Assessment

Five of the six kidney allograft participants underwent biopsy after MRI. Estimated glomerular filtration rate (eGFR) and urine protein-to-creatine ratio (uPCR) were collected within 4 weeks of MRI. Kidney metabolism was quantified from HP [1-13C]pyruvate MRI using the lactate-to-pyruvate ratio in allograft kidneys and non-tumor bearing kidneys from RCC patients.

Statistical Tests

Descriptive statistics (mean ± SD).

Results

Biopsy was performed a mean of 9 days (range 5–19 days) after HP [1-13C]pyruvate MRI. Three biopsies were normal, one showed low-grade fibrosis and one showed moderate microvascular inflammation. All had stable functioning allografts with eGFR >60 mL/min/1.73 m2 and normal uPCR. One participant who did not undergo biopsy had reduced eGFR of 49 mL/min/1.73 m2 and elevated uPCR. The mean lactate-to-pyruvate ratio was 0.373 in participants with normal findings (N = 3) and 0.552 in participants with abnormal findings (N = 2). The lactate-to-pyruvate ratio was highest (0.847) in the participant with reduced eGFR and elevated uPRC. Native non-tumor bearing kidneys had a mean lactate-to-pyruvate ratio of 0.309.

Data Conclusion

Stable allografts with normal findings at biopsy showed lactate-to-pyruvate ratios similar to native non-tumor bearing kidneys, whereas allografts with abnormal findings showed higher lactate-to-pyruvate ratios.

Evidence Level

2

Technical Efficacy

Stage 2

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