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Assessment of chronic allograft injury in renal transplantation using diffusional kurtosis imaging
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Assessment of chronic allograft injury in renal transplantation using diffusional kurtosis imaging
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Journal Article
Assessment of chronic allograft injury in renal transplantation using diffusional kurtosis imaging
2021
Overview
Background
Chronic allograft injury (CAI) is a significant reason for which many grafts were lost. The study was conducted to assess the usefulness of diffusional kurtosis imaging (DKI) technology in the non-invasive assessment of CAI.
Methods
Between February 2019 and October 2019, 110 renal allograft recipients were included to analyze relevant DKI parameters. According to estimated glomerular filtration rate (eGFR) (mL/min/ 1.73 m
2
) level, they were divided to 3 groups: group 1, eGFR ≥ 60 (n = 10); group 2, eGFR 30–60 (n = 69); group 3, eGFR < 30 (n = 31). We performed DKI on a clinical 3T magnetic resonance imaging system. We measured the area of interest to determine the mean kurtosis (MK), mean diffusivity (MD), and apparent diffusion coefficient (ADC) of the renal cortex and medulla. We performed a Pearson correlation analysis to determine the relationship between eGFR and the DKI parameters. We used the receiver operating characteristic curve to estimate the predicted values of DKI parameters in the CAI evaluation. We randomly selected five patients from group 2 for biopsy to confirm CAI.
Results
With the increase of creatinine, ADC, and MD of the cortex and medulla decrease, MK of the cortex and medulla gradually increase. Among the three different eGFR groups, significant differences were found in cortical and medullary MK (
P
= 0.039,
P
< 0.001,
P
< 0.001, respectively). Cortical and medullary ADC and MD are negatively correlated with eGFR (r = − 0.49, − 0.44, − 0.57, − 0.57, respectively;
P
< 0.001), while cortical and medullary MK are positively correlated with eGFR (r = 0.42, 0.38;
P
< 0.001). When 0.491 was set as the cutoff value, MK's CAI assessment showed 87% sensitivity and 100% specificity. All five patients randomly selected for biopsy from the second group confirmed glomerulosclerosis and tubular atrophy/interstitial fibrosis.
Conclusion
The DKI technique is related to eGFR as allograft injury progresses and is expected to become a potential non-invasive method for evaluating CAI.
Publisher
BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
Subject
/ Age
/ Allografts - diagnostic imaging
/ Allografts - physiopathology
/ Atrophy
/ Biopsy
/ Consent
/ Diffusion Magnetic Resonance Imaging - methods
/ DKI
/ Epidermal growth factor receptors
/ Female
/ Fibrosis
/ Glomerular Filtration Rate - physiology
/ Glomerulosclerosis, Focal Segmental - pathology
/ Glomerulosclerosis, Focal Segmental - physiopathology
/ Humans
/ Imaging
/ Injuries
/ Kidney Cortex - diagnostic imaging
/ Kidney Cortex - physiopathology
/ Kidney Medulla - diagnostic imaging
/ Kidney Medulla - physiopathology
/ Kidney Tubules - physiopathology
/ Kidneys
/ Kurtosis
/ Male
/ Medicine
/ Patients
