The significance of BOLD MRI in differentiation between renal transplant rejection and acute tubular necrosis

Nephrol Dial Transplant. 2008 Aug;23(8):2666-72. doi: 10.1093/ndt/gfn064. Epub 2008 Feb 28.


Background: Blood oxygen level-dependent MRI (BOLD MRI) can be used to assess intra-renal oxygen bioavailability by measuring the R2(*) level, which reflects tissue deoxyhaemoglobin levels. This study was designed to identify the significance of BOLD MRI in differentiation of acute rejection (AR) and acute tubular necrosis (ATN) in patients within 6 months after kidney transplantation.

Methods: Eighty-two patients with normal graft function and 28 patients with biopsy-proven AR (n = 21) or ATN (n = 7) were enrolled. Patients with normal functioning allograft underwent BOLD MRI within 2 to 3 weeks post-transplantation, while patients with AR and ATN underwent BOLD MRI within 6 days before or after kidney transplant biopsy. Cortical R2(*) (CR2(*)) and medullary R2(*) (MR2(*)) levels were measured.

Results: The mean CR2(*) level was significantly higher in the ATN group (15.25 +/- 1.03/s) compared to the normal group (13.35 +/- 2.31/s, P = 0.028) and AR group (12.02 +/- 1.72/s, P = 0.001). There was a significant difference also between the AR group and normal group on CR2(*) levels (P = 0.013). The mean MR2(*) level was significantly lower in the AR group (14.02 +/- 2.68/s) compared to the normal group (16.66 +/- 2.82/s, P < 0.001) and ATN group (19.47 +/- 1.62/s, P < 0.001). There was also a significant difference between the ATN group and normal group on MR2(*) levels (P = 0.011). There were no correlations between characteristics such as patient age, post-operation time, post-biopsy time, Scr level, HB level, urine output volume, MAP level, CNI trough concentration and R2(*) levels, except between MAP level and CR2(*) level (P = 0.029).

Conclusions: BOLD MRI could be a valuable method to discriminate between AR and ATN by measuring tissue oxygen bioavailability in early kidney allograft dysfunction.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Diagnosis, Differential
  • Female
  • Graft Rejection / blood
  • Graft Rejection / diagnosis*
  • Graft Rejection / physiopathology
  • Hemoglobins / metabolism
  • Humans
  • Kidney / blood supply
  • Kidney / physiopathology
  • Kidney Transplantation / adverse effects*
  • Kidney Transplantation / pathology*
  • Kidney Transplantation / physiology
  • Kidney Tubular Necrosis, Acute / blood
  • Kidney Tubular Necrosis, Acute / diagnosis*
  • Kidney Tubular Necrosis, Acute / physiopathology
  • Magnetic Resonance Imaging / methods*
  • Magnetic Resonance Imaging / statistics & numerical data
  • Male
  • Middle Aged
  • Oxygen / blood*
  • Oxygen / metabolism


  • Hemoglobins
  • deoxyhemoglobin
  • Oxygen