Functional evaluation of transplanted kidneys with diffusion-weighted and BOLD MR imaging: initial experience

PURPOSE: To prospectively evaluate feasibility and reproducibility of diffusion-weighted (DW) and blood oxygenation level-dependent (BOLD) magnetic resonance (MR) imaging in patients with renal allografts, as compared with these features in healthy volunteers with native kidneys. MATERIALS AND METHODS: The local ethics committee approved the study protocol; patients provided written informed consent. Fifteen patients with a renal allograft and in stable condition (nine men, six women; age range, 20-67 years) and 15 age- and sex-matched healthy volunteers underwent DW and BOLD MR imaging. Seven patients with renal allografts were examined twice to assess reproducibility of results. DW MR imaging yielded a total apparent diffusion coefficient including diffusion and microperfusion (ADC(tot)), as well as an ADC reflecting predominantly pure diffusion (ADC(D)) and the perfusion fraction. R2* of BOLD MR imaging enabled the estimation of renal oxygenation. Statistical analysis was performed, and analysis of variance was used for repeated measurements. Coefficients of variation between and within subjects were calculated to assess reproducibility. RESULTS: In patients, ADC(tot), ADC(D), and perfusion fraction were similar in the cortex and medulla. In volunteers, values in the medulla were similar to those in the cortex and medulla of patients; however, values in the cortex were higher than those in the medulla (P < .05). Medullary R2* was higher than cortical R2* in patients (12.9 sec(-1) +/- 2.1 [standard deviation] vs 11.0 sec(-1) +/- 0.6, P < .007) and volunteers (15.3 sec(-1) +/- 1.1 vs 11.5 sec(-1) +/- 0.5, P < .0001). However, medullary R2* was lower in patients than in volunteers (P < .004). Increased medullary R2* was paralleled by decreased diffusion in patients with allografts. A low coefficient of variation in the cortex and medulla within subjects was obtained for ADC(tot), ADC(D), and R2* (<5.2%), while coefficient of variation within subjects was higher for perfusion fraction (medulla, 15.1%; cortex, 8.6%). Diffusion and perfusion indexes correlated significantly with serum creatinine concentrations. CONCLUSION: DW and BOLD MR imaging are feasible and reproducible in patients with renal allografts.

The role of subpolar deep water formation and Nordic Seas overflows in simulated multidecadal variability of the Atlantic meridional overturning circulation

We investigate the respective role of variations in subpolar deep water formation and Nordic Seas overflows for the decadal to multidecadal variability of the Atlantic meridional overturning circulation (AMOC). This is partly done by analysing long (order of 1000 years) control simulations with five coupled climate models. For all models, the maximum influence of variations in subpolar deep water formation is found at about 45° N, while the maximum influence of variations in Nordic Seas overflows is rather found at 55 to 60° N. Regarding the two overflow branches, the influence of variations in the Denmark Strait overflow is, for all models, substantially larger than that of variations in the overflow across the Iceland–Scotland Ridge. The latter might, however, be underestimated, as the models in general do not realistically simulate the flow path of the Iceland–Scotland overflow water south of the Iceland–Scotland Ridge. The influence of variations in subpolar deep water formation is, on multimodel average, larger than that of variations in the Denmark Strait overflow. This is true both at 45° N, where the maximum standard deviation of decadal to multidecadal AMOC variability is located for all but one model, and at the more classical latitude of 30° N. At 30° N, variations in subpolar deep water formation and Denmark Strait overflow explain, on multimodel average, about half and one-third respectively of the decadal to multidecadal AMOC variance. Apart from analysing multimodel control simulations, we have performed sensitivity experiments with one of the models, in which we suppress the variability of either subpolar deep water formation or Nordic Seas overflows. The sensitivity experiments indicate that variations in subpolar deep water formation and Nordic Seas overflows are not completely independent. We further conclude from these experiments that the decadal to multidecadal AMOC variability north of about 50° N is mainly related to variations in Nordic Seas overflows. At 45° N and south of this latitude, variations in both subpolar deep water formation and Nordic Seas overflows contribute to the AMOC variability, with neither of the processes being very dominant compared to the other.