Basic Principles and New Advances in Kidney Imaging.

Abstract Over the past few years, clinical renal imaging has seen great advances, allowing assessments of kidney structure and morphology, perfusion, function and metabolism, oxygenation, as well as microstructure and interstitium. Medical imaging is becoming increasingly important in the evaluation of kidney physiology and pathophysiology, showing promise in management of patients with renal disease, in particular with regard to diagnosis, classification, and prediction of disease development and progression, monitoring response to therapy, detection of drug toxicity, and patient selection for clinical trials. A variety of imaging modalities, ranging from routine to advanced tools, are currently available to probe the kidney both spatially and temporally, particularly ultrasonography, computed tomography, positron emission tomography, renal scintigraphy, and multiparametric magnetic resonance imaging. Since the range is broad and varied, kidney imaging techniques should be chosen based on the clinical question and specific underlying pathological mechanism, considering contraindications and possible adverse effects. Integration of different modalities providing complementary information will likely bestow the greatest insight into renal pathophysiology. This review aims to highlight major recent advances in key tools currently available or potentially relevant for clinical kidney imaging, with a focus on non-oncological applications. The review also outlines the context of use, limitations, and advantages of different techniques, and finally emphasizes gaps for future development and clinical adoption.