To efficiently measure kidney interstitial fibrosis with MRI, there are some challenges that still need to be overcome. Obviously, these first experiments have to be confirmed, in particular in a larger cohort of non-homogenous patients. The multiparametric study, with T1 and ADC, showed the potential of combining several biomarkers to assess more precisely kidney fibrosis. A non-invasive score must be validated against biopsy in a large population of kidney pathologies with the coupling of the several biomarkers. The addition of non-MRI biomarkers will also help to identify precisely the interstitial fibrosis from others pathologies.
ADC is very sensitive as we showed, however, this specificity should be improved. All pathologies inducing a decrease of interstitial space would lead to a decrease of ADC. Consequently, we need to identify and isolate other pathologies, not necessarily linked to interstitial fibrosis, that could also induce a decrease of ADC.
For that point, dividing patients into subgroups will help. Separation according to the level of inflammation, vascular injury, and oedema needs to be performed. Since ADC is sensitive to every effects on the extracel-lular space, a clear understand of this factors is of major importance. Also, we need to understand which part the perfusion effect plays in the measured ADC. Experiments showed that removing the small b-values would decrease the R2. It would be interesting to include perfusion evaluation in our population, such as Arterial Spin Labeled (ASL) to evaluate the perfusion and integrate this information in an MLR of ASL and ADC at high b-values. I recommend that all renal DWI should be compensated for motion and a more adapted fit and b-values should be used. With a better understanding of the perfusion effect combined with an efficient correction of motion, we should be able to decrease the number of b-values efficiency.
In conclusion, this thesis demonstrated the feasibility of measuring renal interstitial fibrosis more reliably by addressing and minimizing sources of variability and pitfalls.
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4 Appendix: curriculum vitae
156
Iris FRIEDLI
Friedli.Iris@gmail.com Born in Basel (CH), 23/09/1985 Nationality: Swiss, French Mobile: (+41) 766854874 Office: (+41) 223725212
Department of Radiology Geneva University Hospitals rue Gabrielle Perret-Gentil 4, 1205 Geneva, Switzerland
MRI Physicist
PhD student in MRI physics, (November 2012 - )
Title: Renal Fibrosis Assessment by Diffusion-Weighted Magnetic Resonance Imaging Thesis supervisors: Pr. J.-P. Vall´ee (Division of Radiology, Geneva University Hospitals) and Pr. J.-P. Wolf (Biophotonics Group, University of Geneva)
• Research work mainly focused onpre-clinical and clinical validation of novel quantitative MRI methodsfor chronic kidney disease assessment
Participation in the European FP7 NanoDiaRA Project on Rheumatoid Arthritis and Osteoarthritis
• Iron Oxide Nanoparticles (SPION) as contrast agents and quantitative MRI in small animal models MRI Skills:
• Protocol optimisation and MRI acquisitions for research protocols (Siemens, Philips)
• Quantitative MRI (Diffusion-Weighted Imaging (DWI), T1-, T2- and T2* Mapping)
• Image processing, image analysis and statistical analysis Other Skills:
• Languages: French (mother tongue), English (fluent)
• Computer skills: OsiriX, Matlab, R, ImageJ, SPSS, LaTeX
• Ability to work in interdiciplinary environment (radiologist, nephrologist, physicist)
QUALIFICATION and RESEARCH EXPERIENCE MSc degree in Physics, University of Strasbourg, France
• Radiation Physics, Detector, Instrumentation and Imagery (2011-2012)
• Subatomic Physics and Astroparticles (2010-2011) Continued education:
RESAL: LTK Module 1 Swiss Authorization in vivo studies, Lausanne, Switzerland
Course in Laboratory Animal Science accredited by the Federation of European Laboratory Animal Science Associations (FELASA accreditation Nr. 38/12)
1
Study projects:
Master Internship in Particle Physics (2012, 5 months)
Supervisor: Dr C. Jollet and Dr A. Meregaglia, Hubert Curien Institute, University of Strasbourg, France Study of muon-induced background in the Double Chooz experiement
Programming: C++, ROOT
Master Internship in Particle Physics (2011, 4 months)
Supervisor: Pr. A. Nomerotski, Physics Department, University of Oxford, UK
Characterization of PImMS Monolithic Active Pixel Sensor for Imaging Mass Spectrometry Programming: LabVIEW
Theoretical Internship in Particle Physics (2010, 4 months)
Supervisor: Dr. B. Fuks, Hubert Curien Institute, University of Strasbourg, France Symmetry breaking in the Standard Model
Exchange Project with University Politechnika of Wroclaw, Poland (2007, 1 month) Experimental work with Laser and Workshop on quantum dots
AWARDS and DISTINCTION
ISMRM Magna Cum Laude Merit Award for the work entitled:
Multiple Linear Regression for Predicting Fibrosis in the Kidney using T1 Mapping and RESOLVE Diffusion-Weighted MRI, presented at the ISMRM 24th Annual Meeting, Singapore 2016
STIPEND Award for Annual ISMRM 2017 Meeting, Honolulu, HI, USA 2017 TEACHING EXPERIENCE
Teaching Assistant (2012-2016)
Co supervision of bachelor students (medicine and medical imaging technologist) University of Geneva and Haute Ecole de Sant´e, Geneva, Switzerland
ADDITIONAL INFORMATION Sales assistant (2004-2010)
Various retail outlets (Camaieu, Minelli, Darjeeling, Brice, Armand Thiery)
Other interests including: travelling, world food at home and abroad, running (Lausanne half marathon 2016 in 2:13)
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PUBLICATIONS Peer reviewed journal papers:
• Crowe LA, Montecucco F, Carbone F,Friedli I, Hachulla AL, Braunersreuther V, Mach F, Vall´ee JP.
4D cardiac imaging at clinical 3.0 T provides accurate assessment of murine myocardial function and viability. Magn Reson Imaging. doi: 10.1016/j.mri.2017.07.024
• Berchtold L,Friedli I, Vall´ee JP, Moll S, Martin PY, de Seigneux S Diagnosis and assessment of renal fibrosis: the state of the art. Swiss Med Wkly. 2017;147:w14442. doi: 10.4414/smw.2017.14442
• Friedli I, Crowe LA, de Perrot T, Berchtold L, Martin PY, de Seigneux S, Vall´ee JP; Comparison of Readout-Segmented and Conventional Single-Shot for Echo-Planar Diffusion-Weighted Imaging in the Assessment of Kidney Interstitial Fibrosis. J Magn Reson Imaging 2017. doi: 10.1002/jmri.25687
• Orci LA, Oldani G, Lacotte S, Slits F, Friedli I, Wirth W, Toso C, Vall´ee JP, Crowe LA. Dynamic Volume Assessment of Hepatocellular Carcinoma in Rat Livers Using a Clinical 3T MRI and Novel Segmentation. J Invest Surg. 2017 Jan 20:1-10. doi: 10.1080/08941939.2016.1276987
• Friedli I, Crowe LA, Berchtold L, Moll S, Hadaya K, de Perrot T, Vesin C, Martin PY, de Seigneux S, Vall´ee JP. New Magnetic Resonance Imaging Index for Renal Fibrosis Assessment: A Comparison between Diffusion-Weighted Imaging and T1 Mapping with Histological Validation. Sci Rep. 2016 Jul 21;6:30088. doi: 10.1038/srep30088
• Friedli I, Crowe LA, Viallon M, Porter DA, Martin PY, de Seigneux S, Vall´ee JP. Improvement of Renal Diffusion-Weighted Magnetic Resonance Imaging with Readout-Segmented Echo-Planar Imaging at 3T. Magn Reson Imaging. 2015 Jul;33(6):701-8. doi: 10.1016/j.mri.2015.02.023. Epub 2015 Feb 27 International conference proceedings:
International Society for Magnetic Resonance Medicine (ISMRM), 2017, Honolulu, HI, USA Posters
• Friedli I, Crowe LA, Delattre, B MA, de Perrot T, Martin PY, de Seigneux S, Vall´ee JP; The Cortico-Medullary ADC Difference reduces inter-system variability in Renal Diffusion-Weighted Imaging
• Crowe LA, Montecucco F, Carbone F, Friedli I, Hachulla AL, Braunersreuther V, Mach F,Vall´ee JP; 4D cine strategy for assessment of mouse cardiac function and infarct size in a single acquisition optimized for a clinical 3T MR system
International Society for Magnetic Resonance Medicine (ISMRM), 2016, Singapore PowerPitch
• Friedli I, Crowe LA, Berchtold L, Moll S, Hadaya K, de Perrot T, Martin PY, de Seigneux S, Vall´ee
• Friedli I, Crowe LA, Berchtold L, Moll S, Hadaya K, de Perrot T, Martin PY, de Seigneux S, Vall´ee