多参数功能MRI早期检测肾功能损害：临床应用与未来方向

Early identification of renal impairment is critical for improving patient outcomes. Most current biochemical markers of renal function are not sensitive enough to detect early changes in kidney function. Functional magnetic resonance imaging (fMRI) is a new technique that is not only non-invasive (it does not use ionizing radiation) but also provides very high-resolution images of soft tissue. fMRI can measure a variety of parameters related to renal function, including renal perfusion, oxygenation, water-molecule diffusion, and microstructural changes, enabling a comprehensive multiparametric assessment of renal function that may lead to earlier detection of renal impairment. This review provides a systematic analysis of the multiparametric fMRI techniques available for assessing early renal impairment, including the principles of diffusion-weighted imaging (DWI) and its derivatives; blood-oxygen-level-dependent (BOLD) imaging ; arterial spin labeling (ASL); and relaxometry (T1/T2 mapping). It elaborates on their application progress in the early identification of acute kidney injury (AKI), chronic kidney disease (CKD), diabetic kidney disease (DKD), and renal allograft injury. The review objectively analyzes the current limitations and controversies of these technologies and discusses future directions that integrate artificial intelligence (AI) and multimodal fusion. This review aims to equip radiologists and clinicians with the knowledge to make more informed, precise, and timely decisions in the management of early renal impairment.