New Initiative Seeks to Boost Imaging of Fibrosis in Liver, Kidney

Effort Relies on Collaboration Between Imaging Specialists, Pathologists

Researchers and clinicians will have improved tools to evaluate renal and hepatic fibrosis if a new initiative to bring together imaging specialists and pathologists by the National Institute of Diabetes and Digestive and Kidney Diseases, or NIDDK, bears fruit.

Spearheaded by Elizabeth Wilder, Ph.D., an NIDDK program director in the Division of Kidney, Urologic, and Hematologic Diseases, the effort is designed to help researchers examine ways to improve current methods of imaging the liver and kidney—such as magnetic resonance imaging—and develop novel technologies.

“We don’t really have a clear idea of which imaging options are the best,” said Wilder. To improve the links between the imaging community and the liver and kidney disease specialists, NIDDK hosted a meeting in April 2005 that brought together the two groups for a day of presentations on the pathology of fibrosis and existing and new imaging technologies.

Range of Options
“Some of the methods that are not now being used in the liver and kidney will be useful,” she said, adding that NIDDK hopes to have a range of options to explore, including “some that are good bets and some that are riskier.”

Wilder said she expects NIDDK to begin funding projects in the imaging of renal and hepatic fibrosis in 2007. The challenge now, she said, is bringing together the imaging and pathology communities to help develop the kind of research alliances that can push the effort forward.

“We’re hoping these collaborations will happen in the next year,” she said, adding that NIDDK plans to push those links along by hosting workshop sessions at larger meetings. “The nuts and bolts of this project come down to community building. These kinds of meetings have proven to be very successful.”

The imaging project is one of the priorities of NIDDK’s translational research initiative (see story page 6), which seeks to bring the findings and technologies of basic research to bear in the clinical realm.

Improving on Biopsy
Tackling the problem of renal and hepatic fibrosis is a particularly high priority because of the importance of fibrosis––the accumulation of scar tissue in an organ––as a marker of severe kidney and liver disease. Assessing fibrosis now is most commonly done via biopsy, an invasive method that can miss evidence of fibrosis.

Instead, researchers would like higher-resolution images of the inside of the organs, technology that could both give a more accurate assessment of the extent of fibrosis and be a tool that could enable earlier detection of problems. But existing imaging modalities, though they can be used in cases of advanced disease, are not sufficiently developed to give useful information about early-stage disease.

Ideally, Wilder said, improved imaging could give clinical researchers an important way of assessing treatments without frequent biopsy or relying on other indicators of organ failure. “This is very important for clinical trials,” she said. “A reliable, non-invasive method of detecting fibrosis early and following its progression would make clinical trials much easier.”

NIH Publication No. 06–4531
October 2005