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. 2022 Feb 28:9:793777.
doi: 10.3389/fcvm.2022.793777. eCollection 2022.

Prediction of Split Renal Function Improvement After Renal Artery Stenting by Blood Oxygen Level-Dependent Magnetic Resonance Imaging

Zhiyong Lin  1   2 , Bihui Zhang  1 , Letao Lin  1   3   4 , Rui Wang  2 , Guochen Niu  1 , Ziguang Yan  1 , Yinghua Zou  1 , Xiaoqiang Tong  1 , Jianxing Qiu  2 , Min Yang  1
Affiliations

Prediction of Split Renal Function Improvement After Renal Artery Stenting by Blood Oxygen Level-Dependent Magnetic Resonance Imaging

Zhiyong Lin et al. Front Cardiovasc Med. .

Abstract

Background: The discrepancy between the high technical success rate and the relatively low clinical response rate of renal artery stenting (RAS) raises the importance to identify atherosclerotic renal artery stenosis (ARAS) patients who are most likely to benefit from RAS. This study aimed to investigate the feasibility and accuracy of blood oxygen level-dependent magnetic resonance imaging (BOLD-MRI) in predicting split renal function (SRF) improvement after RAS in patients with ARAS.

Methods: Thirty patients with severe ARAS who were treated with RAS were enrolled. Baseline cortical and medullary R2* values of each kidney were measured by BOLD-MRI, and each patient's SRF was evaluated by nuclear renal dynamic imaging at baseline and 1-month follow-up.

Results: In total, 35 severe stenotic renal arteries of the 30 patients were analyzed. At 1-month follow-up, 34 kidneys (97.1%) of severe ARAS had acquired SRF. SRF improved in 12 kidneys of 10 patients. The cortical R2* and medullary R2* values in the SRF improvement kidneys were higher than those in the non-improvement kidneys (P ≤ 0.001). The area under the curve of medullary R2* was 0.879 (95% confidence interval [CI] 0.736-1.000). A medullary R2* value ≥29.1 s-1 was noted to provide good sensitivity (0.833, 95% CI 0.552-0.970) and specificity (0.864, 95% CI 0.667-0.953) in predicting SRF improvement. Medullary R2* value was the only independent predictor of SRF improvement in multivariable analysis (P = 0.034, OR 3.017, 95%CI 1.089-8.358).

Conclusion: This study showed that a BOLD-MRI medullary R2* value ≥29.1 s-1 was an excellent predictor of SRF improvement in patients with severe ARAS who underwent renal artery stenting.

Keywords: atherosclerotic renal artery stenosis; blood oxygen level-dependent magnetic resonance imaging; prediction; renal artery stenting; renovascular stenting.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Methods for ROI selection on BOLD-MRI images. (A) The original T2*-weighted image; (B) The pseudo-color T2*-weighted image. The long and narrow area depicted by the dashed line was the ROI of renal cortex, excluding the renal medulla, collecting system, incidental cysts, and hilar vessels. The three circular areas on the upper, middle and lower medulla of the kidney were the ROIs of the medulla.
FIGURE 2
FIGURE 2
Flow chart of patients and lesions. n stands for number of patients and N stands for number of renal artery lesions. aScreen failure was due to <70% stenosis confirmed by angiography in three patients with unilateral renal artery stenosis and unsuccessful guidewire crossing in four patients with bilateral renal artery lesions. bThe missing patient had 1-month follow-up, but didn’t complete the nuclear renal dynamic imaging.
FIGURE 3
FIGURE 3
The correlation between cortical R2* (A) and medullary R2* (B) and change of SRF of the stented kidney. SRF, split renal function; GFR, glomerular filtration rate.
FIGURE 4
FIGURE 4
The ROC curve of cortical R2* (A) and medullary R2* (B) in predicting SRF improvement. ROC, receiver operating characteristic; SRF, split renal function.
See this image and copyright information in PMC

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