Measurement of glomerular filtration rate using dynamic magnetic resonance imaging in patients with chronic kidney disease.

Background: Determination of glomerular filtration rate (GFR) using plasma disappearance curves requires the injection of a filtration marker and repeated timed blood collections. Gadolinium-containing contrast media are excreted exclusively by glomerular filtration and could provide a novel approach to quantifying GFR using magnetic resonance (MR) imaging. The aim of this study was to demonstrate the feasibility of measuring GFR by the clearance of gadolinium-containing contrast medium in patients with chronic kidney disease (CKD). Methods: Informed consent was obtained from stable CKD patients in stages 1, 2 or 3 (n=16; 5 women, 11 men; median age 54 years). GFR was measured after a bolus injection of gadobutrol (4 mL, approximately 0.05 mmol/kg) and calculated from the washout of the signal intensity obtained over the liver. The obtained MR-GFR was compared with simultaneously measured plasma clearance of inulin and gadobutrol. Results: Technical failure occurred in 2 patients. The mean obtained MR-GFR was 71 +/- 25 (SD) mL/min per 1.73 m(2) and agreed well with the mean inulin-GFR (70 +/- 24 mL/min per 1.73 m(2)). Pearson's correlation coefficient was r=0.91. The mean of the paired differences was 1 +/- 10 mL/min per 1.73 m(2) and not significantly different from zero. GFR obtained from gadobutrol plasma clearance also agreed well with inulin-GFR and MR-GFR (r=0.92 and r=0.75, respectively). Conclusions: We describe a novel method of determining GFR from MR imaging using a low dose of gadobutrol in patients with reduced GFR that enables the absolute quantification of GFR after routine contrast-enhanced MR imaging.