Angiotensin-converting enzyme inhibitor-enhanced MR renography: repeated measures of GFR and RPF in hypertensive patients

Abstract

This study aims to assess the feasibility of a protocol to diagnose renovascular disease using dual MR renography acquisitions: before and after administration of angiotensin-converting enzyme inhibitor (ACEi). Results of our simulation study aimed at testing the reproducibility of glomerular filtration rate (GFR) and renal plasma flow demonstrate that for a fixed overall dose of 12 ml gadolinium-based contrast material (500 mmol/l), the second dose should be approximately twice as large as the first dose. A three-compartment model for analyzing the second-injection data was shown to appropriately handle the tracer residue from the first injection. The optimized protocol was applied to 18 hypertensive patients without renovascular disease, showing minimal systematic difference in GFR measurements before and after ACEi of 0.8 ± 4.4 ml/min or 2.7 ± 14.9%. For 10 kidneys with significant renal artery stenosis, GFR decreased significantly after ACEi ( P < 0.001, T value = 3.79), and the difference in GFR measurements before and after ACEi averaged 8.3 ± 6.9 ml/min or 26.2 ± 43.9%. Dual-injection MRI with optimized dose distribution appears promising for ACEi renography by offering measures of GFR changes with clinically acceptable precision and accuracy.