Korean J Radiol.  2018 Apr;19(2):201-208. 10.3348/kjr.2018.19.2.201.

Functional Evaluation of Transplanted Kidneys with Reduced Field-of-View Diffusion-Weighted Imaging at 3T

• Xie Y
• Li Y
• Wen J
• Li X
• Zhang Z
• Li J
• Zhao Y
• Wang P
• Zhang J
• Tian Y
• Zhang LJ
• Lu GM

• KMID: 2404916
• DOI: http://doi.org/10.3348/kjr.2018.19.2.201

Abstract

OBJECTIVE
To determine the feasibility of reduced field-of-view diffusion-weighted imaging (rFOV DWI) with multi-b values to detect functional variability in transplanted kidneys.
MATERIALS AND METHODS
Using a 3T MRI scanner, multi-b rFOV DWI of transplanted kidney or native kidney was performed in 40 renal transplantation recipients and 18 healthy volunteers. The patients were stratified, according to an estimated glomerular filtration rate (eGFR): Group 1, eGFR ≥ 60 mL/min/1.73 m2; Group 2, eGFR ≥ 30 mL/min/1.73 m2 and < 60 mL/min/1.73 m2; Group 3, eGFR < 30 mL/min/1.73 m2. Total apparent diffusion coefficient (ADCT), perfusion-free ADC (ADCD) and perfusion fraction (FP) of kidneys were calculated and compared among the four groups. Correlations between the imaging results and eGFR were assessed.
RESULTS
All volunteers had eGFR ≥ 60 mL/min/1.73 m2, while 16, 16, and 8 patients were included in Groups 1, 2, and 3, respectively. In the renal cortex, ADCT was higher in Group 1 ([1.65 ± 0.13] × 10−3 mm2/s) than Group 3 ([1.44 ± 0.11] × 10−3 mm2/s) (p < 0.05), and the inter-group differences of FP values were significant (all p < 0.05) (0.330 ± 0.024, 0.309 ± 0.019, 0.278 ± 0.033, and 0.250 ± 0.028 for control group, Groups 1, 2, and 3, respectively). Renal cortical ADCT, ADCD, FP, and renal medullary ADCT and FP correlated positively with eGFR (r = 0.596, 0.403, 0.711, 0.341, and 0.323, respectively; all p < 0.05). When using 0.278 as the cutoff value, renal cortical FP had a sensitivity of 97.1% and a specificity of 66.7% for predicting decreased renal function.
CONCLUSION
Multi-b rFOV DWI presents transplanted kidneys with high resolution, which is a promising functional tool for non-invasively monitoring function of transplanted kidneys.

Keyword

Diffusion-weighted imaging; Kidney allografts; Transplantation; Reduced field-of-view; MRI; 3T

MeSH Terms

Diffusion
Glomerular Filtration Rate
Healthy Volunteers
Humans
Kidney Transplantation
Kidney*
Magnetic Resonance Imaging
Perfusion
Sensitivity and Specificity
Transplantation
Volunteers

Figure

• 

  Fig. 1 ROI placement in transplanted kidney.ROI (1) as large as possible (about 500 pixels) is placed in renal cortex and several elliptical ROIs (2–4) with about 25 pixels each are placed in renal medulla. ROI = region of interest

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  Fig. 2 DWI images and ADC maps of transplanted kidneys in different groups.DWI images (A–D) with b value of 10 s/mm2 with high resolution (1 × 1 mm2 for axial images) and ADC (E–H) maps of kidneys in 4 groups. Images from healthy volunteer (A, E) with eGFR = 102.1 mL/min/1.73 m2 and patient (B, F) in Group 1 with eGFR = 97.1 mL/min/1.73 m2 show marked corticomedullary differences. Images (C, G) from patient (eGFR = 54.59 mL/min/1.73 m2) in Group 2 show corticomedullary difference to lesser extent. Images (D, H) from patient (eGFR = 17.00 mL/min/1.73 m2) in Group 3 show no marked corticomedullary difference. ADC = apparent diffusion coefficient, DWI = diffusion-weighted imaging, eGFR = estimated glomerular filtration rate

• 

  Fig. 3 Diffusion parameters in different groups.A. Cortical ADCT differs significantly among eGFR levels (p < 0.001). ADCT in Group 1 is significantly higher than Group 3 (p < 0.05). B. Cortical FP differs significantly among eGFR levels (p < 0.001), cortical FP values between each two groups show significant differences (p < 0.05). Medullary FP is significantly higher in Group 1 compared to Group 3 (p < 0.05). ADCD = perfusion-free apparent diffusion coefficient, ADCT = total apparent diffusion coefficient, FP = perfusion fraction

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  Fig. 4 Correlation analysis results between cortical FP and eGFR.FP values in cortex correlate positively with eGFR (r = 0.711, p < 0.001).

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  Fig. 5 Receiver operating characteristic curves of diffusion parameters.Using diffusion parameters as predictors for normal and mildly decreased renal function (eGFR ≥ 60 ml/min/1.73 m2), cortical FP shows best performance with area under curve of 0.890.

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