A Study on Predicting Split Renal Function Using Renal Blood Flow Weighted Estimated Glomerular Filtration Rate From Arterial Spin Labeling MRI

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Abstract
Background: Traditional methods for evaluating split renal function, including contrast‐enhanced CT and radionuclide imaging, have limitations related to ionizing radiation or potentially nephrotoxic contrast agents. Purpose: To investigate the value of renal blood flow (RBF)‐weighted estimated glomerular filtration rate (eGFR) derived from arterial spin labeling (ASL)‐MRI in predicting split renal function in patients with suspected renal artery stenosis (RAS). Study Type: Retrospective. Population: Fifty‐three consecutive patients (21 females; mean age, 61.28 ± 13.50 years) with suspected RAS and renal insufficiency underwent renal ASL‐MRI. Field Strength/Sequence: 1. 5T ; 3D pseudo‐continuous ASL technique. Assessment: RBF and regions of interest (ROI) areas of the renal cortex and entire kidney were measured on oblique coronal ASL‐MRI perfusion maps. The RBF‐weighted eGFR (RBFw eGFR) for each kidney was derived by normalizing the RBF‐area product to the bilateral total eGFR. The radionuclide GFR (rGFR) obtained from renal dynamic radionuclide imaging was used as the reference standard. Statistical Test: Paired t ‐tests, one‐way repeated‐measures ANOVA, Bonferroni test, Pearson's correlation analysis, and receiver operating characteristic (ROC) curves were used. Statistical significance was set at p = 0.05. Results: The cortical and entire RBFw eGFR showed strong significant correlations with rGFR (r: 0.799 vs. 0.800). The cortical and entire RBFw eGFR had high diagnostic efficiency for differentiating severe, moderate, and mild renal insufficiency (AUC: 0.934 vs. 0.936, 0.927 vs. 0.928, and 0.873 vs. 0.865). Data Conclusions: The RBFw eGFR derived from ASL‐MRI demonstrated a significant correlation with rGFR and high diagnostic performance for differentiating split renal dysfunction grades, suggesting potential for split renal function assessment in patients with RAS. Evidence Level: 3 (Nonconsecutive cohort studies, usually retrospective with an imperfectly applied reference standard). Technical Efficacy: 2 (diagnostic accuracy/clinical efficacy).

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