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Semi-automated application for kidney motion correction and filtration analysis in MR renography

Introduction: Altered renal function commonly affects patients with cirrhosis, a consequence of chronic liver disease. From lowdose contrast material-enhanced magnetic resonance (MR) renography, we can estimate the Glomerular Filtration Rate (GFR), an important parameter to assess renal function. Two-dimensional MR images are acquired every 2 seconds for approximately 5 minutes during free breathing, which results in a dynamic series of 140 images representing kidney filtration over time. This specific acquisition presents dynamic contrast changes but is also challenged by organ motion due to breathing. Rather than use conventional image registration techniques, we opted for an alternative method based on object detection. We developed a novel analysis framework available under a stand-alone toolkit to efficiently register dynamic kidney series, manually select regions of interest, visualize the concentration curves for these ROIs, and fit them into a model to obtain GFR values. This open-source cross-platform application is written in C++, using the Insight Segmentation and Registration Toolkit (ITK) library, and QT4 as a graphical user interface.