Probing renal oxygenation with T2*-sensitized MRI (BOLD-MRI)

Reduced renal oxygen availability plays a crucial role in the development and progression of kidney disease. A “surrogate” marker that can noninvasively, robustly, and reproducibly probe tissue oxygenation in patients with kidney failure to inform direct patient management and give prognostic information on evolution of renal impairment is urgently needed. Magnetic resonance imaging (MRI) using T(2)* sensitization induced by the paramagnetic nature of deoxyhemoglobin - most commonly known as blood oxygenation level-dependent magnetic resonance imaging (BOLD-MRI) - shows great potential as an imaging marker for renal tissue oxygenation. Strong preclinical and clinical evidence, technical ease of use, and recent incorporation into prospective clinical trials show that T(2)*-sensitized MRI is currently stepping into the clinical arena. This chapter presents the (patho)physiological and technical foundations of T(2)*-sensitized MRI with a focus on current clinical evidence and potential applications to patient care.