Functional MRI evaluation of blood oxygen dependent (BOLD) in renal allograft dysfunction: a prospective study

Background: Blood oxygen level dependent-magnetic resonance imaging (BOLD-MRI) is a non-invasive functional imaging technique that can be used to assess renal allograft dysfunction.Purpose: To evaluate the diagnostic performance of BOLD-MRI using a 3-T scanner in discriminating causes of renal allograft dysfunction in the post-transplant period.Material and methods: This prospective study was conducted on 112 live donor-renal allograft recipients: 53 with normal graft function, as controls; 18 with biopsy-proven acute rejection (AR); and 41 with biopsy-proven acute tubular necrosis (ATN). Multiple fast-field echo sequences were performed to obtain T2*-weighted images. Cortical R2* (CR2*) level, medullary R2* (MR2*) level, and medullary over cortical R2* ratio (MCR) were measured in all participants.Results: The mean MR2* level was significantly lower in the AR group (20.8 +/- 2.8/s) compared to the normal group (24 +/- 2.4/s, P <0.001) and ATN group (27.4 +/- 1.7/s, P <0.001). The MCR was higher in ATN group (1.47 +/- 0.18) compared to the AR group (1.18 +/- 0.17) and normal functioning group (1.34 +/- 0.2). Both MR2* (area under the curve [AUC] = 0.837, P <0.001) and MCR (AUC = 0.727, P = 0.003) can accurately discriminate ATN from AR, however CR2* (AUC = 0.590, P = 0.237) showed no significant difference between both groups.Conclusion: In early post-transplant renal dysfunction, BOLD-MRI is a valuable non-invasive diagnostic technique that can differentiate between AR and ATN by measuring changes in intra-renal tissue oxygenation.