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Bougia CΚ, Astrakas L, Pappa O, Maliakas V, Sofikitis N, Argyropoulou MI, Tsili AC. Diffusion tensor imaging and fiber tractography of the normal epididymis. Abdom Radiol (NY) 2024:10.1007/s00261-024-04372-y. [PMID: 38836882 DOI: 10.1007/s00261-024-04372-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Revised: 04/30/2024] [Accepted: 05/03/2024] [Indexed: 06/06/2024]
Abstract
PURPOSE To evaluate the feasibility of diffusion tensor imaging (DTI) and fiber tractography (FT) of the normal epididymis and to determine normative apparent diffusion coefficient (ADC) and fractional anisotropy (FA) values. METHODS Twenty-eight healthy volunteers underwent MRI of the scrotum, including DTI on a 3.0 T system. For each anatomic part of the epididymis (head, body and tail) free-hand regions of interest were drawn and the mean ADC and FA were measured by two radiologists in consensus. Parametric statistical tests were used to determine intersubject differences in ADC and FA between the anatomic parts of each normal epididymis and between bilateral epididymides. Fiber tracts of the epididymis were reconstructed using the MR Diffusion tool. RESULTS The mean ADC and FA of the normal epididymis was 1.31 × 10-3 mm2/s and 0.20, respectively. No differences in ADC (p = 0.736) and FA (p = 0.628) between the anatomic parts of each normal epididymis were found. Differences (p = 0.020) were observed in FA of the body between the right and the left epididymis. FT showed the fiber tracts of the normal epididymis. Main study's limitations include the following: small number of participants with narrow age range, absence of histologic confirmation and lack of quantitative assessment of the FT reconstructions. CONCLUSION DTI and FT of the normal epididymis is feasible and allow the noninvasive assessment of the structural and geometric organization of the organ.
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Affiliation(s)
- Christina Κ Bougia
- Department of Clinical Radiology, School of Health Sciences, Faculty of Medicine, University of Ioannina, 45110, Ioannina, Greece
| | - Loukas Astrakas
- Department of Medical Physics, School of Health Sciences, Faculty of Medicine, University of Ioannina, 45110, Ioannina, Greece
| | - Ourania Pappa
- Department of Clinical Radiology, School of Health Sciences, Faculty of Medicine, University of Ioannina, 45110, Ioannina, Greece
| | - Vasileios Maliakas
- Department of Clinical Radiology, School of Health Sciences, Faculty of Medicine, University of Ioannina, 45110, Ioannina, Greece
- Department of Clinical Radiology, University Hospital of Ioannina, St. Niarchos, 45500, Ioannina, Greece
| | - Nikolaos Sofikitis
- Department of Urology, School of Health Sciences, Faculty of Medicine, University of Ioannina, 45110, Ioannina, Greece
| | - Maria I Argyropoulou
- Department of Clinical Radiology, School of Health Sciences, Faculty of Medicine, University of Ioannina, 45110, Ioannina, Greece
| | - Athina C Tsili
- Department of Clinical Radiology, School of Health Sciences, Faculty of Medicine, University of Ioannina, 45110, Ioannina, Greece.
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Zhao K, Seeliger E, Niendorf T, Liu Z. Noninvasive Assessment of Diabetic Kidney Disease With MRI: Hype or Hope? J Magn Reson Imaging 2024; 59:1494-1513. [PMID: 37675919 DOI: 10.1002/jmri.29000] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 08/22/2023] [Accepted: 08/23/2023] [Indexed: 09/08/2023] Open
Abstract
Owing to the increasing prevalence of diabetic mellitus, diabetic kidney disease (DKD) is presently the leading cause of chronic kidney disease and end-stage renal disease worldwide. Early identification and disease interception is of paramount clinical importance for DKD management. However, current diagnostic, disease monitoring and prognostic tools are not satisfactory, due to their low sensitivity, low specificity, or invasiveness. Magnetic resonance imaging (MRI) is noninvasive and offers a host of contrast mechanisms that are sensitive to pathophysiological changes and risk factors associated with DKD. MRI tissue characterization involves structural and functional information including renal morphology (kidney volume (TKV) and parenchyma thickness using T1- or T2-weighted MRI), renal microstructure (diffusion weighted imaging, DWI), renal tissue oxygenation (blood oxygenation level dependent MRI, BOLD), renal hemodynamics (arterial spin labeling and phase contrast MRI), fibrosis (DWI) and abdominal or perirenal fat fraction (Dixon MRI). Recent (pre)clinical studies demonstrated the feasibility and potential value of DKD evaluation with MRI. Recognizing this opportunity, this review outlines key concepts and current trends in renal MRI technology for furthering our understanding of the mechanisms underlying DKD and for supplementing clinical decision-making in DKD. Progress in preclinical MRI of DKD is surveyed, and challenges for clinical translation of renal MRI are discussed. Future directions of DKD assessment and renal tissue characterization with (multi)parametric MRI are explored. Opportunities for discovery and clinical break-through are discussed including biological validation of the MRI findings, large-scale population studies, standardization of DKD protocols, the synergistic connection with data science to advance comprehensive texture analysis, and the development of smart and automatic data analysis and data visualization tools to further the concepts of virtual biopsy and personalized DKD precision medicine. We hope that this review will convey this vision and inspire the reader to become pioneers in noninvasive assessment and management of DKD with MRI. LEVEL OF EVIDENCE: 1 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Kaixuan Zhao
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image Analysis and Application, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Erdmann Seeliger
- Institute of Translational Physiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Thoralf Niendorf
- Berlin Ultrahigh Field Facility (B.U.F.F.), Max Delbrueck Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany
| | - Zaiyi Liu
- Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image Analysis and Application, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
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Zhou SP, Wang Q, Chen P, Zhai X, Zhao J, Bai X, Li L, Guo HP, Ning XY, Zhang XJ, Ye HY, Dong ZY, Chen XM, Wang HY. Assessment of the Added Value of Intravoxel Incoherent Motion Diffusion-Weighted MR Imaging in Identifying Non-Diabetic Renal Disease in Patients With Type 2 Diabetes Mellitus. J Magn Reson Imaging 2024; 59:1593-1602. [PMID: 37610209 DOI: 10.1002/jmri.28973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 08/10/2023] [Accepted: 08/10/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND Identification of non-diabetic renal disease (NDRD) in patients with type 2 diabetes mellitus (T2DM) may help tailor treatment. Intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) is a promising tool to evaluate renal function but its potential role in the clinical differentiation between diabetic nephropathy (DN) and NDRD remains unclear. PURPOSE To investigate the added role of IVIM-DWI in the differential diagnosis between DN and NDRD in patients with T2DM. STUDY TYPE Prospective. POPULATION Sixty-three patients with T2DM (ages: 22-69 years, 17 females) confirmed by renal biopsy divided into two subgroups (28 DN and 35 NDRD). FIELD STRENGTH/SEQUENCE 3 T/ T2 weighted imaging (T2WI), and intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI). ASSESSMENT The parameters derived from IVIM-DWI (true diffusion coefficient [D], pseudo-diffusion coefficient [D*], and pseudo-diffusion fraction [f]) were calculated for the cortex and medulla, respectively. The clinical indexes related to renal function (eg cystatin C, etc.) and diabetes (eg diabetic retinopathy [DR], fasting blood glucose, etc.) were measured and calculated within 1 week before MRI scanning. The clinical model based on clinical indexes and the IVIM-based model based on IVIM parameters and clinical indexes were established and evaluated, respectively. STATISTICAL TESTS Student's t-test; Mann-Whitney U test; Fisher's exact test; Chi-squared test; Intraclass correlation coefficient; Receiver operating characteristic analysis; Hosmer-Lemeshow test; DeLong's test. P < 0.05 was considered statistically significant. RESULTS The cortex D*, DR, and cystatin C values were identified as independent predictors of NDRD in multivariable analysis. The IVIM-based model, comprising DR, cystatin C, and cortex D*, significantly outperformed the clinical model containing only DR, and cystatin C (AUC = 0.934, 0.845, respectively). DATA CONCLUSION The IVIM parameters, especially the renal cortex D* value, might serve as novel indicators in the differential diagnosis between DN and NDRD in patients with T2DM. EVIDENCE LEVEL 2 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Shao-Peng Zhou
- Medical School of Chinese PLA, Beijing, China
- Department of Radiology, First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Qian Wang
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People's Liberation Army, National Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing, China
| | - Pu Chen
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People's Liberation Army, National Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing, China
| | - Xue Zhai
- Medical School of Chinese PLA, Beijing, China
- Department of Radiology, First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Jian Zhao
- Department of Radiology, First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Xu Bai
- Medical School of Chinese PLA, Beijing, China
- Department of Radiology, First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Lin Li
- Hospital Management Institute, Department of Innovative Medical Research, Chinese PLA General Hospital, Beijing, China
| | - Hui-Ping Guo
- Medical School of Chinese PLA, Beijing, China
- Department of Radiology, First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Xue-Yi Ning
- Medical School of Chinese PLA, Beijing, China
- Department of Radiology, First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Xiao-Jing Zhang
- Department of Radiology, First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Hui-Yi Ye
- Department of Radiology, First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Zhe-Yi Dong
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People's Liberation Army, National Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing, China
| | - Xiang-Mei Chen
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People's Liberation Army, National Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing, China
| | - Hai-Yi Wang
- Department of Radiology, First Medical Center of Chinese PLA General Hospital, Beijing, China
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Duan S, Geng L, Lu F, Chen C, Jiang L, Chen S, Zhang C, Huang Z, Zeng M, Sun B, Zhang B, Mao H, Xing C, Zhang Y, Yuan Y. Utilization of the corticomedullary difference in magnetic resonance imaging-derived apparent diffusion coefficient for noninvasive assessment of chronic kidney disease in type 2 diabetes. Diabetes Metab Syndr 2024; 18:102963. [PMID: 38373384 DOI: 10.1016/j.dsx.2024.102963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 01/25/2024] [Accepted: 02/04/2024] [Indexed: 02/21/2024]
Abstract
BACKGROUNDS Accumulating data demonstrated that the cortico-medullary difference in apparent diffusion coefficient (ΔADC) of diffusion-weighted magnetic resonance imaging (DWI) was a better correlation with kidney fibrosis, tubular atrophy progression, and a predictor of kidney function evolution in chronic kidney disease (CKD). OBJECTIVES We aimed to assess the value of ΔADC in evaluating disease severity, differential diagnosis, and the prognostic risk stratification for patients with type 2 diabetes (T2D) and CKD. METHODS Total 119 patients with T2D and CKD who underwent renal MRI were prospectively enrolled. Of them, 89 patients had performed kidney biopsy for pathological examination, including 38 patients with biopsy-proven diabetic kidney disease (DKD) and 51 patients with biopsy-proven non-diabetic kidney disease (NDKD) and Mix (DKD + NDKD). Clinicopathological characteristics were compared according to different ΔADC levels. Moreover, univariate and multivariate-linear regression analyses were performed to explore whether ΔADC was independently associated with estimated glomerular filtration rate (eGFR) and urinary albumin creatinine ratio (UACR). The diagnostic performance of ΔADC for discriminating DKD from NDKD + Mix was evaluated by receiver operating characteristic (ROC) analysis. In addition, an individual's 2- or 5-year risk probability of progressing to end-stage kidney disease (ESKD) was calculated by the kidney failure risk equation (KFRE). The effect of ΔADC on prognostic risk stratification was assessed. Additionally, net reclassification improvement (NRI) was used to evaluate the model performance. RESULTS All enrolled patients had a median ΔADC level of 86 (IQR 28, 155) × 10-6 mm2/s. ΔADC significantly decreased across the increasing staging of CKD (P < 0.001). Moreover, those with pathological-confirmed DKD has a significantly lower level of ΔADC than those with NDKD and Mix (P < 0.001). It showed that ΔADC was independently associated with eGFR (β = 1.058, 95% CI = [1.002,1.118], P = 0.042) and UACR (β = -3.862, 95% CI = [-7.360, -0.365], P = 0.031) at multivariate linear regression analyses. Besides, ΔADC achieved an AUC of 0.707 (71% sensitivity and 75% specificity) and AUC of 0.823 (94% sensitivity and 67% specificity) for discriminating DKD from NDKD + Mix and higher ESKD risk categories (≥50% at 5 years; ≥10% at 2 years) from lower risk categories (<50% at 5 years; <10% at 2 years). Accordingly, the optimal cutoff value of ΔADC for higher ESKD risk categories was 66 × 10-6 mm2/s, and the group with the low-cutoff level of ΔADC group was associated with 1.232 -fold (95% CI 1.086, 1.398) likelihood of higher ESKD risk categories as compared to the high-cutoff level of ΔADC group in the fully-adjusted model. Reclassification analyses confirmed that the final adjusted model improved NRI. CONCLUSIONS ΔADC was strongly associated with eGFR and UACR in patients with T2D and CKD. More importantly, baseline ΔADC was predictive of higher ESKD risk, independently of significant clinical confounding. Specifically, ΔADC <78 × 10-6 mm2/s and <66 × 10-6 mm2/s would help to identify T2D patients with the diagnosis of DKD and higher ESKD risk categories, respectively.
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Affiliation(s)
- Suyan Duan
- Department of Nephrology, The First Affiliated Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, China
| | - Luhan Geng
- Department of Nephrology, The First Affiliated Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, China
| | - Fang Lu
- Department of Nephrology, The First Affiliated Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, China
| | - Chen Chen
- Department of Nephrology, The First Affiliated Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, China
| | - Ling Jiang
- Department of Nephrology, The First Affiliated Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, China
| | - Si Chen
- Department of Nephrology, The First Affiliated Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, China
| | - Chengning Zhang
- Department of Nephrology, The First Affiliated Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, China
| | - Zhimin Huang
- Department of Nephrology, The First Affiliated Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, China
| | - Ming Zeng
- Department of Nephrology, The First Affiliated Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, China
| | - Bin Sun
- Department of Nephrology, The First Affiliated Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, China
| | - Bo Zhang
- Department of Nephrology, The First Affiliated Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, China
| | - Huijuan Mao
- Department of Nephrology, The First Affiliated Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, China
| | - Changying Xing
- Department of Nephrology, The First Affiliated Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, China.
| | - Yudong Zhang
- Department of Radiology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu Province, China.
| | - Yanggang Yuan
- Department of Nephrology, The First Affiliated Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, China.
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Stabinska J, Wittsack HJ, Lerman LO, Ljimani A, Sigmund EE. Probing Renal Microstructure and Function with Advanced Diffusion MRI: Concepts, Applications, Challenges, and Future Directions. J Magn Reson Imaging 2023:10.1002/jmri.29127. [PMID: 37991093 PMCID: PMC11117411 DOI: 10.1002/jmri.29127] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 10/26/2023] [Accepted: 10/27/2023] [Indexed: 11/23/2023] Open
Abstract
Diffusion measurements in the kidney are affected not only by renal microstructure but also by physiological processes (i.e., glomerular filtration, water reabsorption, and urine formation). Because of the superposition of passive tissue diffusion, blood perfusion, and tubular pre-urine flow, the limitations of the monoexponential apparent diffusion coefficient (ADC) model in assessing pathophysiological changes in renal tissue are becoming apparent and motivate the development of more advanced diffusion-weighted imaging (DWI) variants. These approaches take advantage of the fact that the length scale probed in DWI measurements can be adjusted by experimental parameters, including diffusion-weighting, diffusion gradient directions and diffusion time. This forms the basis by which advanced DWI models can be used to capture not only passive diffusion effects, but also microcirculation, compartmentalization, tissue anisotropy. In this review, we provide a comprehensive overview of the recent advancements in the field of renal DWI. Following a short introduction on renal structure and physiology, we present the key methodological approaches for the acquisition and analysis of renal DWI data, including intravoxel incoherent motion (IVIM), diffusion tensor imaging (DTI), non-Gaussian diffusion, and hybrid IVIM-DTI. We then briefly summarize the applications of these methods in chronic kidney disease and renal allograft dysfunction. Finally, we discuss the challenges and potential avenues for further development of renal DWI. LEVEL OF EVIDENCE: 5 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Julia Stabinska
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Maryland, USA
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Hans-Jörg Wittsack
- Department of Diagnostic and Interventional Radiology, Medical Faculty, Heinrich Heine University Düsseldorf, Dusseldorf, Germany
| | - Lilach O. Lerman
- Division of Nephrology and Hypertension and Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Alexandra Ljimani
- Department of Diagnostic and Interventional Radiology, Medical Faculty, Heinrich Heine University Düsseldorf, Dusseldorf, Germany
| | - Eric E. Sigmund
- Bernard and Irene Schwartz Center for Biomedical Imaging Center for Advanced Imaging Innovation and Research (CAI2R), New York University Langone Health, New York City, New York, USA
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Alterations of Renal Function in Patients with Diabetic Kidney Disease: A BOLD and DTI Study. COMPUTATIONAL INTELLIGENCE AND NEUROSCIENCE 2022; 2022:6844102. [PMID: 36210998 PMCID: PMC9546653 DOI: 10.1155/2022/6844102] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 08/17/2022] [Accepted: 08/23/2022] [Indexed: 11/17/2022]
Abstract
Objectives Our study aims to determine the patterns of renal oxygenation changes and microstructural changes by BOLD and DTI with deteriorating kidney function in patients with diabetic kidney disease (DKD). Methods Seventy-two patients with type 2 diabetes mellitus (DM) and twenty healthy controls (HCs) underwent laboratory examinations, and renal BOLD and DTI images were obtained on a 3T-MRI machine. R2∗, fractional anisotropy (FA), and average diffusion coefficient (ADC) values were evaluated. DM patients were divided into three subgroups (Group-DI/DII/DIII, based on urinary albumin-creatinine ratio (UACR)) and a nondiabetic kidney disease group (Group-NDKD). D-value and MCR of R2∗ and FA were proposed to evaluate the differentiation between medulla and cortex of the individual kidney among HCs and three subgroups for reducing individual differences. Comparisons were made between NDKD and kidney function-matched DKD patients. Correlations between MRI parameters and renal clinical indices were analyzed. Results Compared with Group-HC/DI, medullary R2∗ and FA values were significantly different in Group-DII/III. The D-value of R2∗ and FA in Group-III were significantly smaller than that in Group-HC. However, only MCR of R2∗ in Group-III was significantly smaller than that in HCs. Medullary R2∗ and FA were negatively associated with serum creatinine (SCr) and cystatin C (Cys C) and positively associated with eGFR. Conclusions With renal function declining, BOLD and DTI could capture alterations including the first rising and then falling medullary R2∗, continuously declining medullary FA, and apparent cortex-medullary differentiation in DKD patients. The MRI parameters showed renal changes accompanied by varying degrees of albuminuria, sharing common involvement in DKD and NDKD patients, but it was hard to distinguish between them. BOLD seemed more sensitive than DTI in identifying renal cortex-medullary differentiation.
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Diffusion-Weighted MRI in the Genitourinary System. J Clin Med 2022; 11:jcm11071921. [PMID: 35407528 PMCID: PMC9000195 DOI: 10.3390/jcm11071921] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 03/25/2022] [Accepted: 03/28/2022] [Indexed: 12/12/2022] Open
Abstract
Diffusion weighted imaging (DWI) constitutes a major functional parameter performed in Magnetic Resonance Imaging (MRI). The DW sequence is performed by acquiring a set of native images described by their b-values, each b-value representing the strength of the diffusion MR gradients specific to that sequence. By fitting the data with models describing the motion of water in tissue, an apparent diffusion coefficient (ADC) map is built and allows the assessment of water mobility inside the tissue. The high cellularity of tumors restricts the water diffusion and decreases the value of ADC within tumors, which makes them appear hypointense on ADC maps. The role of this sequence now largely exceeds its first clinical apparitions in neuroimaging, whereby the method helped diagnose the early phases of cerebral ischemic stroke. The applications extend to whole-body imaging for both neoplastic and non-neoplastic diseases. This review emphasizes the integration of DWI in the genitourinary system imaging by outlining the sequence's usage in female pelvis, prostate, bladder, penis, testis and kidney MRI. In gynecologic imaging, DWI is an essential sequence for the characterization of cervix tumors and endometrial carcinomas, as well as to differentiate between leiomyosarcoma and benign leiomyoma of the uterus. In ovarian epithelial neoplasms, DWI provides key information for the characterization of solid components in heterogeneous complex ovarian masses. In prostate imaging, DWI became an essential part of multi-parametric Magnetic Resonance Imaging (mpMRI) to detect prostate cancer. The Prostate Imaging-Reporting and Data System (PI-RADS) scoring the probability of significant prostate tumors has significantly contributed to this success. Its contribution has established mpMRI as a mandatory examination for the planning of prostate biopsies and radical prostatectomy. Following a similar approach, DWI was included in multiparametric protocols for the bladder and the testis. In renal imaging, DWI is not able to robustly differentiate between malignant and benign renal tumors but may be helpful to characterize tumor subtypes, including clear-cell and non-clear-cell renal carcinomas or low-fat angiomyolipomas. One of the most promising developments of renal DWI is the estimation of renal fibrosis in chronic kidney disease (CKD) patients. In conclusion, DWI constitutes a major advancement in genitourinary imaging with a central role in decision algorithms in the female pelvis and prostate cancer, now allowing promising applications in renal imaging or in the bladder and testicular mpMRI.
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Seah JM, Botterill E, MacIsaac RJ, Milne M, Ekinci EI, Lim RP. Functional MRI in assessment of diabetic kidney disease in people with type 1 diabetes. J Diabetes Complications 2022; 36:108076. [PMID: 34802902 DOI: 10.1016/j.jdiacomp.2021.108076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 10/05/2021] [Accepted: 10/07/2021] [Indexed: 12/16/2022]
Abstract
AIMS To compare levels of renal hypoxia measured by Blood Oxygen Level Dependent (BOLD) magnetic resonance imaging (MRI) with measured transverse relaxation rate (R2*) and renal structural changes including apparent diffusion coefficient (ADC) and fractional anisotropy (FA) in patients with type 1 diabetes and healthy controls. METHODS Cohort study comparing MRI metrics in type 1 diabetes (n = 32, GFR 105 (77, 120) ml/min.1.73m2) and controls (n = 10). Renal function and selected inflammatory renal biomarkers were also measured. RESULTS For BOLD, we found reduced cortical [14.7 (13.7,15.8) (1/s) vs 15.7 (15.1,16.6) (1/s), p < 0.001] and medullary [24.8 (21.8,28.2) (1/s) vs. 29.3 (24.3,32.4) (1/s), p < 0.001] R2*, indicating more oxygenated parenchyma, in type 1 diabetes vs. controls, respectively. We observed reduced cortical FA, indicating decreased structural integrity in type 1 diabetes -0.04 (-0.07, -0.01), (p = 0.02). We found reduced cortical ADC, reflecting reduced water diffusion, in non-hyperfiltering [2.40 (2.29,2.53) (103mm2/s)] versus hyperfiltering [2.61 (2.53,2.74) (103mm2/s)] type 1 diabetes patients. MRI parameters correlated with renal function and inflammatory renal biomarkers. CONCLUSIONS MRI derived indices of renal function and structure differed between (i) type 1 diabetes and healthy controls, and (ii) between non-hyperfiltering and hyperfiltering type 1 diabetes patients, providing insight into the role of hypoxia and renal structural, and functional changes in DKD.
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Affiliation(s)
- Jas-Mine Seah
- Department of Endocrinology and Diabetes, Austin Health, Heidelberg, VIC, Australia; Department of Medicine, The University of Melbourne, Parkville, VIC, Australia
| | - Elissa Botterill
- Department of Radiology and Surgery, Austin Health, Heidelberg, VIC, Australia
| | - Richard J MacIsaac
- Department of Medicine, The University of Melbourne, Parkville, VIC, Australia; Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia
| | - Michele Milne
- Department of Medicine, The University of Melbourne, Parkville, VIC, Australia
| | - Elif I Ekinci
- Department of Endocrinology and Diabetes, Austin Health, Heidelberg, VIC, Australia; Department of Medicine, The University of Melbourne, Parkville, VIC, Australia.
| | - Ruth P Lim
- Department of Medicine, The University of Melbourne, Parkville, VIC, Australia; Department of Radiology and Surgery, Austin Health, Heidelberg, VIC, Australia
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Wahba EN, Elsharkawy A, Awad MH, Abdel Rahman A, Sarhan A. Role of magnetic resonance diffusion weighted imaging in diagnosis of diabetic nephropathy in children living with type 1 diabetes mellitus. J Pediatr Endocrinol Metab 2021; 34:1585-1591. [PMID: 34496164 DOI: 10.1515/jpem-2021-0379] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 08/23/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Diabetic nephropathy is a serious and a common complication of diabetes that can lead to end stage renal disease among children living with type 1 diabetes, thus an early and accurate method of diagnosis that allows timely intervention is of high importance. This study aimed to evaluate the role of magnetic resonance diffusion weighted imaging in diagnosis of diabetic nephropathy in children with type 1 diabetes. METHODS This prospective, observational, case control study included 30 children with type 1 diabetes and 30 matched healthy controls attending the outpatient clinics in Mansoura University Children's Hospital. All were subjected to magnetic resonance DWI of the renal parenchyma and their glomerular filtration rate (GFR) was estimated, along with micro albumin in 24 h urine collection and HbA1c in patients with diabetes. RESULTS Children with diabetes who were positive for microalbuminuria had significantly lower apparent diffusion coefficient value compared to Children with diabetes who were negative for microalbuminuria (p = 0.034) as well as controls (p = 0.001). Among children with type 1 diabetes, apparent diffusion coefficient had significant positive correlation with estimated glomerular filtration rate (r = 0.491, p = 0.006) and negative correlation with microalbuminuria (r = -0.437, p = 0.016). CONCLUSION Magnetic resonance DWI of the renal parenchyma is correlated with estimated glomerular filtration rate (eGFR) in children with type 1 diabetes and can detect GFR deterioration even in presence of normal albumin excretion.
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Affiliation(s)
| | - Ashraf Elsharkawy
- Department of Pediatrics, Mansoura University Children's Hospital, Mansoura, Egypt
| | - Mohammad Hosny Awad
- Department of Pediatrics, Mansoura University Children's Hospital, Mansoura, Egypt
| | - Ashraf Abdel Rahman
- Diagnostic Radiology Department, Mansoura Faculty of Medicine, Mansoura University Children Hospital, Mansoura, Egypt
| | - Amr Sarhan
- Department of Pediatrics, Mansoura University Children's Hospital, Mansoura, Egypt
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Borrelli P, Zacchia M, Cavaliere C, Basso L, Salvatore M, Capasso G, Aiello M. Diffusion tensor imaging for the study of early renal dysfunction in patients affected by bardet-biedl syndrome. Sci Rep 2021; 11:20855. [PMID: 34675323 PMCID: PMC8531379 DOI: 10.1038/s41598-021-00394-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 10/11/2021] [Indexed: 11/28/2022] Open
Abstract
Kidney structural abnormalities are common features of Bardet-Biedl syndrome (BBS) patients that lead to a progressive decline in renal function. Magnetic resonance diffusion tensor imaging (DTI) provides useful information on renal microstructures but it has not been applied to these patients. This study investigated using DTI to detect renal abnormalities in BBS patients with no overt renal dysfunction. Ten BBS subjects with estimated glomerular filtration rates over 60 ml/min/1.73m2 and 14 individuals matched for age, gender, body mass index and renal function were subjected to high-field DTI. Fractional anisotropy (FA), and mean, radial and axial diffusivity were evaluated from renal cortex and medulla. Moreover, the corticomedullary differentiation of each DTI parameter was compared between groups. Only cortical FA statistically differed between BBS patients and controls (p = 0.033), but all the medullary DTI parameters discriminated between the two groups with lower FA (p < 0.001) and axial diffusivity (p = 0.021) and higher mean diffusivity (p = 0.043) and radial diffusivity (p < 0.001) in BBS patients compared with controls. Corticomedullary differentiation values were significantly reduced in BBS patients. Thus, DTI is a valuable tool for investigating microstructural alterations in renal disorders when kidney functionality is preserved.
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Affiliation(s)
| | - Miriam Zacchia
- Department of Medical and Translational Sciences, University of Campania L. Vanvitelli, Naples, Italy
| | | | - Luca Basso
- IRCCS SDN, Via Emanuele Gianturco 113, 80131, Naples, Italy
| | | | - Giovambattista Capasso
- Department of Medical and Translational Sciences, University of Campania L. Vanvitelli, Naples, Italy.,Biogem, Research Institute for Molecular Biology and Genetics, Ariano Irpino, Italy
| | - Marco Aiello
- IRCCS SDN, Via Emanuele Gianturco 113, 80131, Naples, Italy
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11
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The role of diffusion tensor imaging of the liver in children with autoimmune hepatitis. Pol J Radiol 2021; 86:e461-e467. [PMID: 34567291 PMCID: PMC8449556 DOI: 10.5114/pjr.2021.108171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 04/15/2021] [Indexed: 12/04/2022] Open
Abstract
Purpose To evaluate the role of diffusion tensor imaging (DTI) of the liver in children with autoimmune hepatitis (AIH). Material and methods A prospective study was done on 42 children with AIH (30 girls and 12 boys, with a mean age of 13 years) and 20 age- and sex-matched healthy control children. They underwent DTI of the liver and laboratory tests. Liver biopsy was done for the patients. The mean diffusivity (MD) and fractional anisotropy (FA) of the liver were calculated and correlated with the pathological results. Results The mean MD and FA of the liver in children with AIH were 1.42 ± 0.06 × 10-3 mm2/s and 0.37 ± 0.11; and in the control children they were 1.55 ± 0.07 × 10-3 mm2/s and 0.25 ± 0.03, respectively. The MD and FA were significantly different in the children with AIH compared to the control children (p = 0.001). The cutoff MD and FA used to differentiate patients from controls were 1.50 × 10-3 mm2/s, 0.31 with AUC of 0.919 and 0.813, sensitivity of 97.6% and 66.7%, a specificity of 80% and 70%, an accuracy of 94.2% and 67.3%, PPV of 95.3 and 90.3, and NPV of 88.9 and 33.3, respectively. There was significantly lower MD and higher FA of the liver in children with AIH type I (n = 31) than type II (n = 11) (p = 0.001), and patients with (n = 9) and without (n = 33) overlap syndrome (p = 0.005). Conclusions We concluded that DTI parameters can help to diagnose AIH, detect its phenotyping, and give clues as to the presence of associated overlap syndrome.
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12
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Kuipers H, Hoogwater FJH, Holtman GA, van der Hoorn A, de Boer MT, de Haas RJ. Clinical value of diffusion-weighted MRI for differentiation between benign and malignant gallbladder disease: a systematic review and meta-analysis. Acta Radiol 2021; 62:987-996. [PMID: 32830511 DOI: 10.1177/0284185120950115] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Radiological differentiation between benign and malignant gallbladder disease is important but remains challenging. Furthermore, the clinical value of diffusion-weighted imaging (DWI) remains unclear. PURPOSE To determine the value of DWI in discriminating benign from malignant gallbladder disease by conducting a systematic review and meta-analysis. MATERIAL AND METHODS The literature was systematically searched. Studies analyzing diagnostic value of DWI in gallbladder disease with histopathology or follow-up as reference standard were included. Study selection and data extraction were done by two reviewers independently. Methodological quality was assessed using the QUADAS-2 tool. Sensitivity and specificity were calculated and displayed in a forest plot. A sensitivity analysis was performed in case of outliers. Pooled sensitivity and specificity of DWI were plotted on a hierarchical summary receiver operating characteristic curve. If available, the added value of DWI to conventional magnetic resonance imaging (MRI) sequences was analyzed. RESULTS Out of 2456 articles, eight studies fulfilled the inclusion criteria; 592 patients with 221 malignant lesions were included. Pooled sensitivity and specificity rates were 0.87 and 0.84, respectively. In two studies, diagnostic accuracy rates improved after adding DWI to conventional MRI (64% and 75% for conventional MRI vs. 89% and 94% after combining conventional MRI with DWI). In another study, the area under the curve increased from 0.92 to 0.95. CONCLUSION DWI appears to be an accurate imaging technique in discriminating benign from malignant gallbladder disease. To achieve optimal patient care, it should be part of multiparametric MRI and should be combined with other imaging modalities.
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Affiliation(s)
- Hendrien Kuipers
- Department of Surgery, Section Hepato-Pancreato-Biliary Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Frederik JH Hoogwater
- Department of Surgery, Section Hepato-Pancreato-Biliary Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Gea A Holtman
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Anouk van der Hoorn
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Marieke T de Boer
- Department of Surgery, Section Hepato-Pancreato-Biliary Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Robbert J de Haas
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Lim WTH, Ooi EH, Foo JJ, Ng KH, Wong JHD, Leong SS. Shear Wave Elastography: A Review on the Confounding Factors and Their Potential Mitigation in Detecting Chronic Kidney Disease. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:2033-2047. [PMID: 33958257 DOI: 10.1016/j.ultrasmedbio.2021.03.030] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 03/24/2021] [Accepted: 03/26/2021] [Indexed: 06/12/2023]
Abstract
Early detection of chronic kidney disease is important to prevent progression of irreversible kidney damage, reducing the need for renal transplantation. Shear wave elastography is ideal as a quantitative imaging modality to detect chronic kidney disease because of its non-invasive nature, low cost and portability, making it highly accessible. However, the complexity of the kidney architecture and its tissue properties give rise to various confounding factors that affect the reliability of shear wave elastography in detecting chronic kidney disease, thus limiting its application to clinical trials. The objective of this review is to highlight the confounding factors presented by the complex properties of the kidney, in addition to outlining potential mitigation strategies, along with the prospect of increasing the versatility and reliability of shear wave elastography in detecting chronic kidney disease.
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Affiliation(s)
- William T H Lim
- School of Engineering, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway, Malaysia
| | - Ean H Ooi
- School of Engineering, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway, Malaysia; Advanced Engineering Platform, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway, Malaysia.
| | - Ji J Foo
- School of Engineering, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway, Malaysia
| | - Kwan H Ng
- Department of Biomedical Imaging, University of Malaya, Kuala Lumpur, Malaysia; University of Malaya Research Imaging Centre, University of Malaya, Kuala Lumpur, Malaysia
| | - Jeannie H D Wong
- Department of Biomedical Imaging, University of Malaya, Kuala Lumpur, Malaysia; University of Malaya Research Imaging Centre, University of Malaya, Kuala Lumpur, Malaysia
| | - Sook S Leong
- Department of Biomedical Imaging, University of Malaya, Kuala Lumpur, Malaysia; Department of Biomedical Imaging, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
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Lin L, Zhou X, Dekkers IA, Lamb HJ. Cardiorenal Syndrome: Emerging Role of Medical Imaging for Clinical Diagnosis and Management. J Pers Med 2021; 11:734. [PMID: 34442378 PMCID: PMC8400880 DOI: 10.3390/jpm11080734] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 07/24/2021] [Accepted: 07/24/2021] [Indexed: 12/16/2022] Open
Abstract
Cardiorenal syndrome (CRS) concerns the interconnection between heart and kidneys in which the dysfunction of one organ leads to abnormalities of the other. The main clinical challenges associated with cardiorenal syndrome are the lack of tools for early diagnosis, prognosis, and evaluation of therapeutic effects. Ultrasound, computed tomography, nuclear medicine, and magnetic resonance imaging are increasingly used for clinical management of cardiovascular and renal diseases. In the last decade, rapid development of imaging techniques provides a number of promising biomarkers for functional evaluation and tissue characterization. This review summarizes the applicability as well as the future technological potential of each imaging modality in the assessment of CRS. Furthermore, opportunities for a comprehensive imaging approach for the evaluation of CRS are defined.
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Affiliation(s)
- Ling Lin
- Cardiovascular Imaging Group (CVIG), Department of Radiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (L.L.); (I.A.D.); (H.J.L.)
| | - Xuhui Zhou
- Department of Radiology, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen 510833, China
| | - Ilona A. Dekkers
- Cardiovascular Imaging Group (CVIG), Department of Radiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (L.L.); (I.A.D.); (H.J.L.)
| | - Hildo J. Lamb
- Cardiovascular Imaging Group (CVIG), Department of Radiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (L.L.); (I.A.D.); (H.J.L.)
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15
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Diffusion tensor imaging of renal cortex in lupus nephritis. Jpn J Radiol 2021; 39:1069-1076. [PMID: 34125367 DOI: 10.1007/s11604-021-01154-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 06/08/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE To evaluate the diagnostic value of diffusion tensor imaging (DTI) of renal cortex in assessment of lupus nephritis (LN) and prediction of its pathological subtypes. METHODS Prospective study was performed upon 39 female patients with pathologically proven LN and 16 sex- and age-matched healthy controls. Patients and controls underwent DTI of kidney. Mean diffusivity (MD) and fractional anisotropy (FA) of renal cortex were calculated by two radiologists. LN patients were pathologically classified into either non-proliferative (n = 15) or proliferative (n = 24). RESULTS Mean MD of renal cortex in LN was significantly lower (p = 0.001) than that of controls with cut-off (2.16 and 2.2 X10-3mm2/s), area under curve (AUC) of (0.92, 0.94) and accuracy of (91%, 89%) for both observers. Mean FA of renal cortex in LN was significantly higher (p = 0.001) than that of controls with cut-off (0.20, 0.21), AUC of (0.86, 0.82) and accuracy of (86%, 84%) for both observers. Renal cortex MD and FA in non-proliferative LN were significantly different (p = 0.001) from that of proliferative LN for both observers. There was excellent inter-observer agreement of MD and FA (ICC = 0.96 and 0.81). CONCLUSION MD and FA of renal cortex may help to assess renal affection in LN patients and predict its pathological subtypes.
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Perspectives on the Role of Magnetic Resonance Imaging (MRI) for Noninvasive Evaluation of Diabetic Kidney Disease. J Clin Med 2021; 10:jcm10112461. [PMID: 34199385 PMCID: PMC8199575 DOI: 10.3390/jcm10112461] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 05/27/2021] [Accepted: 05/28/2021] [Indexed: 01/09/2023] Open
Abstract
Renal magnetic resonance imaging (MRI) techniques are currently in vogue, as they provide in vivo information on renal volume, function, metabolism, perfusion, oxygenation, and microstructural alterations, without the need for exogenous contrast media. New imaging biomarkers can be identified using these tools, which represent a major advance in the understanding and study of the different pathologies affecting the kidney. Diabetic kidney disease (DKD) is one of the most important diseases worldwide due to its high prevalence and impact on public health. However, its multifactorial etiology poses a challenge for both basic and clinical research. Therefore, the use of novel renal MRI techniques is an attractive step forward in the comprehension of DKD, both in its pathogenesis and in its detection and surveillance in the clinical practice. This review article outlines the most promising MRI techniques in the study of DKD, with the purpose of stimulating their clinical translation as possible tools for the diagnosis, follow-up, and monitoring of the clinical impacts of new DKD treatments.
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Razek AAKA, Hafez MM, Mahmoud W, Ismail AR, Ali KM, Barakat TE. Diffusion tensor imaging of the spleen in prediction and grading of esophageal varices in cirrhotic children with portal hypertension. Jpn J Radiol 2021; 39:907-913. [PMID: 33914254 DOI: 10.1007/s11604-021-01123-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 04/15/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To assess diffusion tensor imaging (DTI) of spleen in prediction and grading of esophageal varices (OV) in cirrhotic children. METHODS This prospective study was conducted upon 30 children with cirrhotic children with OV and 10 age-gender matched controls that underwent DTI of abdomen. Mean diffusivity (MD) and fractional anisotropy (FA) of spleen were calculated and matched with the grading of OV at endoscopy and laboratory biomarkers of portal hypertension. RESULTS Mean ADC of spleen in patient was significantly different (p = 0.001) from that of controls by both reviewers respectively. The cutoff ADC measurement of the spleen used for prediction of OV was ≥ 0.75 and ≥ 0.76 × 10-3mm2/s with AUC was 0.993 and 0.997 for both reviewers respectively. The FA of the spleen in patient was different (p = 0.01) from of controls of both reviewers respectively. Cutoff FA of spleen used for prediction of OV was ≤ 0.35 and ≤ 0.36 for both observers respectively. ADC and FA of spleen was correlated with platelets count (r = - 0.713, 0.392; p = 0.001, 0.012) and prothrombin time (r = 0.518, - 0.380; p = 0.001, 0.016). CONCLUSION DTI metrics of spleen can predict and grade OV and correlated with laboratory biomarkers of portal hypertension.
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Affiliation(s)
| | - Mona Mohamed Hafez
- Cardiology Unit, Department of Pediatrics, Mansoura Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Walaa Mahmoud
- Department of Diagnostic Radiology, Mansoura Faculty of Medicine, Mansoura University, Mansoura, 13551, Egypt
| | - Ahmed Ramadan Ismail
- Gastroenterology and Hepatology Unit, Department of Pediatrics, Mansoura Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Khadiga M Ali
- Department of Pathology, Mansoura Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Tarek Elsayed Barakat
- Gastroenterology and Hepatology Unit, Department of Pediatrics, Mansoura Faculty of Medicine, Mansoura University, Mansoura, Egypt
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Correlation of Kidney Size on Computed Tomography with GFR, Creatinine and HbA1C for an Accurate Diagnosis of Patients with Diabetes and/or Chronic Kidney Disease. Diagnostics (Basel) 2021; 11:diagnostics11050789. [PMID: 33925666 PMCID: PMC8145367 DOI: 10.3390/diagnostics11050789] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 04/20/2021] [Accepted: 04/23/2021] [Indexed: 11/16/2022] Open
Abstract
Diabetes is considered one of the major causes of chronic kidney disease (CKD), affecting renal blood vessels and nerves. Diagnosis of CKD by traditional biochemical serum and blood analyses is insufficient and insensitive, thus requiring the development of a more robust technique. This novel study aims to propose a new method for the accurate diagnosis of CKD, quantification of kidney damage, and its prognosis by physicians by measuring the kidney volume on computed tomography (CT). In total, 251 patients were enrolled in this retrospective study. They were divided into four groups: control, patients having diabetes, patients having CKD, and patients having both diabetes and CKD. Results showed that kidney volume correlated negatively with both GFR and HbA1C on CT images, in addition to decreasing faster in males than females. Moreover, HbA1C was shown to correlate positively with creatinine and negatively with GFR. Finally, GFR was more robust than creatinine when correlated with age. The association between kidney volume with GFR and HbA1c can be used to accurately anticipate kidney volume in established CKD on CT scan, especially in resource-poor settings. Furthermore, HbA1C can serve as a powerful biomarker for studying renal function in diabetic CKD patients as it correlates with creatinine and GFR.
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Nassar MK, Khedr D, Abu-Elfadl HG, E Abdulgalil A, Abdalbary M, Moustafa FEH, Sayed Ahmed N, Shemies RS. Diffusion Tensor Imaging in early prediction of renal fibrosis in patients with renal disease: Functional and histopathological correlations. Int J Clin Pract 2021; 75:e13918. [PMID: 33295069 DOI: 10.1111/ijcp.13918] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 12/06/2020] [Indexed: 12/15/2022] Open
Abstract
AIM Renal fibrosis (RF) is a well-known marker of chronic kidney disease (CKD) progression. However, renal biopsy is an available tool for evaluation of RF, non-invasive tools are needed not only to detect but also to monitor the progression of fibrosis. The aim of this study is to evaluate the role of diffusion tensor imaging (DTI) in the assessment of renal dysfunction and RF in patients with renal disease. METHODS Fifty-six patients with renal disorders and 22 healthy controls were recruited. All participants underwent DTI. Renal biopsy was performed for all patients. Mean renal medullary and cortical fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values were compared between patients and healthy controls and correlated to serum creatinine (SCr), estimated glomerular filtration rate (eGFR), 24-h urinary protein (24h-UPRO) and renal histopathological scores. RESULTS Cortical FA values were significantly higher (P = .001), while cortical ADC values were significantly lower in the patients' group (P = .002). Cortical FA values positively correlated to SCr (P = .006) and negatively correlated to eGFR (P = .03), while cortical ADC negatively correlated to percentage of sclerotic glomeruli, atrophic tubules and interstitial fibrosis (P = .001 for all variables). Medullary ADC negatively correlated to tubular atrophy (P = .02). The diagnostic performance of DTI for detecting RF was supported by ROC curve. Multiple linear regression analysis revealed that the mean cortex ADC was significantly decreased by 0.199 mg/dL for patients with >50% glomerulosclerosis in renal biopsy. CONCLUSION DTI appears to represent a valuable tool for the non-invasive assessment of renal dysfunction and renal fibrosis.
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Affiliation(s)
- Mohammed K Nassar
- Mansoura Nephrology and Dialysis Unit, Mansoura University, Mansoura, Egypt
| | - Doaa Khedr
- Department of diagnostic radiology, Mansoura University, Mansoura, Egypt
| | - Hend G Abu-Elfadl
- Department of diagnostic radiology, Mansoura University, Mansoura, Egypt
| | - Ahmed E Abdulgalil
- Mansoura Nephrology and Dialysis Unit, Mansoura University, Mansoura, Egypt
| | - Mohamed Abdalbary
- Mansoura Nephrology and Dialysis Unit, Mansoura University, Mansoura, Egypt
| | | | - Nagy Sayed Ahmed
- Mansoura Nephrology and Dialysis Unit, Mansoura University, Mansoura, Egypt
| | - Rasha S Shemies
- Mansoura Nephrology and Dialysis Unit, Mansoura University, Mansoura, Egypt
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Zhang G, Liu Y, Sun H, Xu L, Sun J, An J, Zhou H, Liu Y, Chen L, Jin Z. Texture analysis based on quantitative magnetic resonance imaging to assess kidney function: a preliminary study. Quant Imaging Med Surg 2021; 11:1256-1270. [PMID: 33816165 DOI: 10.21037/qims-20-842] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background Magnetic resonance imaging (MRI) has demonstrated its potential in the evaluation of renal function. Texture analysis (TA) is a novel technique to quantify tissue heterogeneity. We aim to investigate the feasibility of using TA based on the apparent diffusion coefficient (ADC), as well as T1 and T2 maps to evaluate renal function. Methods Patients with impaired renal function and subjects with a normal renal function who underwent renal diffusion weighted imaging (DWI), as well as T1 and T2 mapping at 3T, were prospectively enrolled. The participants were classified into four groups according to the estimated glomerular filtration rate (eGFR, mL/min/1.73 m2): normal (eGFR ≥90), mildly impaired (60≤ eGFR <90), moderately impaired (30≤ eGFR <60), and severely impaired (eGFR <30) renal function groups. Texture features quantified from the renal cortex or medulla were selected to build classifiers to discriminate different renal function groups by plotting receiver operating characteristic (ROC) curves and calculating the area under the curve (AUC), sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Results In total, 116 candidates were included (94 patients and 22 healthy volunteers, mean age 37.9±14.9 years). There were 46 participants in the normal renal function group, 14 in the mildly impaired renal function group, 27 in the moderately impaired renal function group, and 29 in the severely impaired renal function group. Texture features from the ADC and T1 maps exhibited a good correlation to eGFR. The AUC, sensitivity, specificity, PPV, and NPV to differentiate between the normal and impaired renal function groups were 0.835, 0.792, 0.867, 0.905, and 0.722, respectively; to differentiate between the mildly impaired and moderately impaired groups were 0.937, 0.889, 0.857, 0.923, and 0.800, respectively; and to differentiate between the moderately impaired and severely impaired groups was 0.940, 0.759, 0.889, 0.880, and 0.774, respectively. Conclusions TA based on ADC and T1 maps is feasible for evaluating renal function with relatively good accuracy.
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Affiliation(s)
- Gumuyang Zhang
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Yan Liu
- Department of Nephrology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Hao Sun
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Lili Xu
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | | | - Jing An
- MR Collaboration, Siemens Healthcare Ltd., Beijing, China
| | - Hailong Zhou
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Yanhan Liu
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Limeng Chen
- Department of Nephrology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Zhengyu Jin
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
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Lim RP, Lim JC, Teruel JR, Botterill E, Seah JM, Farquharson S, Ekinci EI, Sigmund EE. Geometric Distortion Correction of Renal Diffusion Tensor Imaging Using the Reversed Gradient Method. J Comput Assist Tomogr 2021; 45:218-223. [PMID: 33661149 PMCID: PMC8194095 DOI: 10.1097/rct.0000000000001124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
ABSTRACT Renal echo planar diffusion tensor imaging (DTI) has clinical potential but suffers from geometric distortion. We evaluated feasibility of reversed gradient distortion correction in 10 diabetic patients and 6 volunteers. Renal area, apparent diffusion coefficient, fractional anisotropy, and tensor eigenvalues were measured on uncorrected and distortion-corrected DTI. Corrected DTI correlated better than uncorrected DTI (r = 0.904 vs 0.840, P = 0.002) with reference anatomic T2-weighted imaging, with no significant difference in DTI metrics.
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Affiliation(s)
- Ruth P. Lim
- Austin Health, Radiology and Surgery, The University of Melbourne, Melbourne, Australia
- Department of Medicine, Radiology and Surgery, The University of Melbourne, Melbourne, Australia
| | - Jeremy C. Lim
- Austin Health, Radiology and Surgery, The University of Melbourne, Melbourne, Australia
| | - Jose R. Teruel
- Department of Radiation Oncology, NYU Langone Health, New York, NY
| | - Elissa Botterill
- Austin Health, Radiology and Surgery, The University of Melbourne, Melbourne, Australia
| | - Jas-mine Seah
- Austin Health, Radiology and Surgery, The University of Melbourne, Melbourne, Australia
| | - Shawna Farquharson
- The Florey Institute of Neuroscience and Mental Health, Melbourne, Australia
| | - Elif I. Ekinci
- Austin Health, Radiology and Surgery, The University of Melbourne, Melbourne, Australia
- Department of Medicine, Radiology and Surgery, The University of Melbourne, Melbourne, Australia
| | - Eric E. Sigmund
- Department of Radiology, NYU Langone Medical Center, New York, NY
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Razek AAKA, Elsebaie NA. Imaging of vascular cognitive impairment. Clin Imaging 2021; 74:45-54. [PMID: 33434866 DOI: 10.1016/j.clinimag.2020.12.038] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 11/21/2020] [Accepted: 12/30/2020] [Indexed: 12/15/2022]
Abstract
Vascular cognitive impairment (VCI) is a major health challenge and represents the second most common cause of dementia. We review the updated imaging classification and imaging findings of different subtypes of VCI. We will focus on the magnetic resonance imaging (MRI) markers of each subtype and highlight the role of advanced MR imaging sequences in the evaluation of these patients. Small vessel dementia appears as white matter hyperintensity, lacunae, microinfarcts, and microbleeds. Large vessel dementia includes strategic infarction and multi-infarction dementias. Hypoperfusion dementia can be seen as watershed infarcts and cortical laminar necrosis. Hemorrhagic dementia results from cerebral amyloid angiopathy and cortical superficial siderosis. Hereditary forms of VCI, caused by gene mutations such as CADASIL, should be suspected when dementia presents in young patients. Mixed dementia is seen in patients with Alzheimer's disease and the coexistence of cerebrovascular disease.
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Affiliation(s)
- Ahmed Abdel Khalek Abdel Razek
- Department of Diagnostic Radiology, Mansoura Faculty of Medicine, Mansoura, Egypt; Department of Radiology, Alexandria Faculty of Medicine, Alexandria, Egypt.
| | - Nermeen A Elsebaie
- Department of Diagnostic Radiology, Mansoura Faculty of Medicine, Mansoura, Egypt; Department of Radiology, Alexandria Faculty of Medicine, Alexandria, Egypt.
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Kanpittaya J, Apipattarakul W, Chotmongkol V, Sawanyawisuth K. ADC cut points for chronic kidney disease in pathologically-proven cholangiocarcinoma. Eur J Radiol Open 2020; 8:100304. [PMID: 33335955 PMCID: PMC7734226 DOI: 10.1016/j.ejro.2020.100304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 11/30/2020] [Accepted: 11/30/2020] [Indexed: 11/18/2022] Open
Abstract
Purpose Apparent diffusion coefficient (ADC) has been shown to indicate renal function in various conditions. As cholangiocarcinoma may have renal involvement due to immune complex-mediated glomerulonephritis, this study aimed to determine whether or not there is any association between ADC values and renal function in these patients. Methods This was a retrospective, analytical study. The inclusion criteria were age over 18 years, pathologically proven cholangiocarcinoma diagnosis and having undergone either 1.5 T or 3.0 T diffusion-weighted MRI. Chronic kidney disease (CKD) was defined as eGFR less than 60 mL/min/1.73m2. Patients’ ADC levels in the CKD and non-CKD groups were compared, and subgroup analysis was performed by MRI field strength and type of cholangiocarcinoma. Results One hundred fifty-eight patients participated in the study. Most were male (66.46 %), and the average age (SD) was 61.59 years (7.91). Average ADC levels in the CDK and non-CDK group differed significantly, regardless of MRI field strength or type of cholangiocarcinoma (2.11 mm/s2 in the ADC group vs 1.91 mm/s2 in the non-ADC group; P < 0.001). An ADC cut-point of 1.75 mm/s2 yielded sensitivities ranging from 66.67–90.00 in almost all study populations. The distal cholangiocarcinoma group had a perfect cut-point at 1.78 mm/s2 with 100 % sensitivity and area under the ROC curve. Conclusions Radiologists can use ADC to detect CKD in cholangiocarcinoma patients regardless of MRI field strength or type of cholangiocarcinoma.
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Affiliation(s)
| | | | - Verajit Chotmongkol
- Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Kittisak Sawanyawisuth
- Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
- Corresponding author.
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Zhi HJ, Li Y, Wang B, Cui XY, Zhang M, Hu ZJ. Renal echography for predicting acute kidney injury in critically ill patients: a prospective observational study. Ren Fail 2020; 42:263-269. [PMID: 32160803 PMCID: PMC7144271 DOI: 10.1080/0886022x.2020.1737544] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Objective To investigate the diagnostic performances of renal resistive index (RRI) and semiquantitative power Doppler ultrasound (PDU) scores in predicting acute kidney injury (AKI) stage 3 in critically ill patients. Methods This prospective observational study included 148 patients (80 with reduced cardiac index [CI], 68 with maintained CI). RRI and semiquantitative PDU scores were measured within 6 h after intensive care unit admission. AKI was defined according to Kidney Disease Improving Global Outcomes criteria. Results A negative correlation between RRI and PDU score (r = −0.517, p < 0.001) and a positive correlation between PDU score and CI (r = 0.193, p = 0.019) were found, whereas RRI was not correlated with CI (r = 0.131, p = 0.121). The predictive value of RRI for AKI stage 3 was similar between CI-reduced (area under the curve [AUC] 0.761, 95% confidence interval 0.650–0.851, p < 0.001) and CI-maintained (AUC 0.786, 95% confidence interval 0.665–0.878, p < 0.001) patients. Conversely, PDU score could effectively predict AKI stage 3 in CI-reduced patients (AUC 0.872, 95% confidence interval 0.778–0.936, p < 0.001) but not in CI-maintained patients (AUC 0.669, 95% confidence interval 0.544–0.778, p = 0.071). The predictive value of PDU score for AKI stage 3 was statistically different between CI-reduced and CI-maintained patients (p = 0.021). Conclusions PDU scores could effectively predict AKI stage 3 in CI-reduced patients but not in CI-maintained patients. RRI is a poor predictor of AKI stage 3 in patients with reduced or maintained CI.
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Affiliation(s)
- Hai Jun Zhi
- Department of Critical Care Medicine, Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yong Li
- Emergency Department, Cangzhou Central Hospital, Cangzhou, China
| | - Bo Wang
- Emergency Department, Cangzhou Central Hospital, Cangzhou, China
| | - Xiao Ya Cui
- Emergency Department, Cangzhou Central Hospital, Cangzhou, China
| | - Meng Zhang
- Emergency Department, Cangzhou Central Hospital, Cangzhou, China
| | - Zhen Jie Hu
- Department of Critical Care Medicine, Fourth Hospital of Hebei Medical University, Shijiazhuang, China
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Abstract
OBJECTIVE To explore whether a radiomics signature based on diffusion tensor imaging (DTI) can detect early kidney damage in diabetic patients. MATERIALS AND METHODS Twenty-eight healthy volunteers (group A) and thirty type 2 diabetic patients (group B) with micro-normoalbuminuria, a urinary albumin-to-creatinine ratio (ACR) < 30 mg/g and an estimated glomerular filtration rate (eGFR) of 60-120 mL/(min 1.73 m2) were recruited. Kidney DTI was performed using 1.5T magnetic resonance imaging (MRI).The radiologist manually drew regions of interest (ROI) on the fractional anisotropy (FA) map of the right kidney ROI including the cortex and medulla. The texture features of the ROIs were extracted using MaZda software. The Fisher coefficient, mutual information (MI), and probability of classification error and average correlation coefficient (POE + ACC) methods were used to select the texture features. The most valuable texture features were further selected by the least absolute shrinkage and selection operator (LASSO) algorithm. A LASSO regression model based on the radiomics signature was established. The diagnostic performance of the model for detecting early diabetic kidney changes was evaluated by the area under the receiver operating characteristic (ROC) curve (AUC). Empower (R), R, and MedCalc15.8 software were used for statistical analysis RESULTS: A total of 279 texture features were extracted from ROI of the kidney, and 30 most valuable texture features were selected from groups A and B using MaZda software. After LASSO-logistic regression, a diagnostic model of diabetic kidney damage based on texture features was established. Model discrimination evaluation: AUC = 0.882 (0.770 ± 0.952). Model calibration evaluation: Hosmer-Lemeshow X2 = 5.3611, P = 0.7184, P > 0.05, the model has good calibration. CONCLUSION The texture features based on DTI could play a promising role in detecting early diabetic kidney damage.
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Mrđanin T, Nikolić O, Molnar U, Mitrović M, Till V. Diffusion-weighted imaging in the assessment of renal function in patients with diabetes mellitus type 2. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2020; 34:273-283. [DOI: 10.1007/s10334-020-00869-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 07/16/2020] [Accepted: 07/17/2020] [Indexed: 12/15/2022]
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Abdel Razek AAK, Abdalla A, Elfar R, Ashmalla GA, Ali K, Barakat T. Assessment of Diffusion Tensor Imaging Parameters of Hepatic Parenchyma for Differentiation of Biliary Atresia from Alagille Syndrome. Korean J Radiol 2020; 21:1367-1373. [PMID: 32729270 PMCID: PMC7689146 DOI: 10.3348/kjr.2019.0824] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 03/22/2020] [Accepted: 04/18/2020] [Indexed: 12/11/2022] Open
Abstract
Objective To assess diffusion tensor imaging (DTI) parameters of the hepatic parenchyma for the differentiation of biliary atresia (BA) from Alagille syndrome (ALGS). Materials and Methods This study included 32 infants with BA and 12 infants with ALGS groups who had undergone DTI. Fractional anisotropy (FA) and mean diffusivity (MD) of the liver were calculated twice by two separate readers and hepatic tissue was biopsied. Statistical analyses were performed to determine the mean values of the two groups. The optimum cut-off values for DTI differentiation of BA and ALGS were calculated by receiver operating characteristic (ROC) analysis. Results The mean hepatic MD of BA (1.56 ± 0.20 and 1.63 ± 0.2 × 10−3 mm2/s) was significantly lower than that of ALGS (1.84 ± 0.04 and 1.79 ± 0.03 × 10−3 mm2/s) for both readers (r = 0.8, p = 0.001). Hepatic MD values of 1.77 and 1.79 × 10−3 mm2/s as a threshold for differentiating BA from ALGS showed accuracies of 82 and 79% and area under the curves (AUCs) of 0.90 and 0.91 for both readers, respectively. The mean hepatic FA of BA (0.34 ± 0.04 and 0.36 ± 0.04) was significantly higher (p = 0.01, 0.02) than that of ALGS (0.30 ± 0.06 and 0.31 ± 0.05) for both readers (r = 0.80, p = 0.001). FA values of 0.30 and 0.28 as a threshold for differentiating BA from ALGS showed accuracies of 75% and 82% and AUCs of 0.69 and 0.68 for both readers, respectively. Conclusion Hepatic DTI parameters are promising quantitative imaging parameters for the detection of hepatic parenchymal changes in BA and ALGS and may be an additional noninvasive imaging tool for the differentiation of BA from ALGS.
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Affiliation(s)
| | - Ahmed Abdalla
- Gastroenterology and Hepatology Unit, Mansoura Children Hospital, Mansoura Faculty of Medicine, Mansoura, Egypt
| | - Reda Elfar
- Gastroenterology and Hepatology Unit, Mansoura Children Hospital, Mansoura Faculty of Medicine, Mansoura, Egypt
| | | | - Khadiga Ali
- Department of Pathology, Mansoura Faculty of Medicine, Mansoura, Egypt
| | - Tarik Barakat
- Gastroenterology and Hepatology Unit, Mansoura Children Hospital, Mansoura Faculty of Medicine, Mansoura, Egypt
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Shayganfar A, Moradi M, Moshiri R, Khosravi A, Ebrahimian S. Is High Preprocedural Renal Resistive Index Sensitive Enough to Predict Iodine Contrast-Induced Nephropathy in Patients Receiving Intra-Arterial Iodinate Contrast? Curr Probl Diagn Radiol 2020; 50:328-331. [PMID: 32088025 DOI: 10.1067/j.cpradiol.2020.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 11/24/2019] [Accepted: 01/06/2020] [Indexed: 11/22/2022]
Abstract
PURPOSE Renal Resistive Index (RRI) is a newly introduced sonographic index in predicting contrast-induced nephropathy (CIN) development. It has been suggested that RRI > 0.69 should be considered as a risk factor for CIN development. The present study aimed to calculate the predictive value of RRI using a cutoff point of 0.69. METHODS A total of 90 patients who were a candidate for coronary vessels angiography were enrolled in this study. Color Doppler ultrasonography was performed and RRI was measured. Patients were followed up for 48 hours after contrast media exposure for the CIN development. The diagnosis of CIN was based on a 25% relative rise or 0.5 mg/dL absolute rise in creatinine level. The predictive values of RRI were measured using 0.69 as a cutoff point. RESULTS Out of 90 patients, CIN developed in 3 patients and 17 patients had preprocedural RRI > 0.69. Of 3 patients with CIN, 1 had RRI > 0.69. Using 0.69 as the cutoff point, the measured sensitivity and specificity of RRI were 33.3% and 83.9%, respectively. CONCLUSIONS RRI > 0.69 is not a sensitive index in predicting the CIN development and cannot be used as an independent factor.
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Affiliation(s)
- Azin Shayganfar
- Department of Radiology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Maryam Moradi
- Department of Radiology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Roshanak Moshiri
- Department of Radiology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Alireza Khosravi
- Hypertension Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shadi Ebrahimian
- Department of Radiology, Isfahan University of Medical Sciences, Isfahan, Iran.
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Li WL, Wang X, Zhang SY, Xu ZG, Zhang YW, Wei X, Li CD, Zeng P, Luan SD. Goodpasture syndrome and hemorrhage after renal biopsy: A case report. World J Clin Cases 2020; 8:404-409. [PMID: 32047792 PMCID: PMC7000945 DOI: 10.12998/wjcc.v8.i2.404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 12/18/2019] [Accepted: 12/22/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Goodpasture syndrome (GS) is a rare disease, the morbidity of which is estimated to be 0.5-0.8 per million per year. Hemorrhage is the most serious complication in renal biopsy. Despite the fact that both GS and hemorrhage after renal biopsy are rare, it has not been reported that they are likely to occur in the same patient.
CASE SUMMARY A 30-year-old man with diffuse pulmonary hemorrhage and rapid progressive renal function caused by anti-glomerular basement membrane disease presented atypical symptoms without hemoptysis, accompanied by life-threatening hypoxemia. Plasmapheresis was performed, and glucocorticoids and cyclophosphamide were administered. The patient started to show signs of improvement. Percutaneous renal biopsy is an appropriate diagnostic measure that is commonly safe, but this patient experienced hemorrhage after operation, thus necessitating embolization of the renal artery to stop the bleeding. The patient’s condition was improved, and the serum anti-glomerular basement membrane antibody level was 106 AU/mL (normal range: < 24 AU/mL) and slowly decreased. His discharge medications were oral daily prednisone (30 mg) and continued maintenance hemodialysis.
CONCLUSION GS is a rare organ-specific autoimmune disease that is invariably ubiquitous in the lung and kidney areas. Renal biopsy is the appropriate procedure for the treatment of GS disease, although it is an invasive measure.
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Affiliation(s)
- Wei-Long Li
- Department of Nephrology, Shenzhen Longhua District Central Hospital, Shenzhen 518110, Guangdong Province, China
| | - Xi Wang
- Department of Nephrology, Shenzhen Longhua District Central Hospital, Shenzhen 518110, Guangdong Province, China
| | - Shu-Yuan Zhang
- Department of Nephrology, Shenzhen Longhua District Central Hospital, Shenzhen 518110, Guangdong Province, China
| | - Zi-Gan Xu
- Department of Nephrology, Shenzhen Longhua District Central Hospital, Shenzhen 518110, Guangdong Province, China
| | - Ying-Wei Zhang
- Department of Nephrology, Shenzhen Longhua District Central Hospital, Shenzhen 518110, Guangdong Province, China
| | - Xing Wei
- Department of Nephrology, Shenzhen Longhua District Central Hospital, Shenzhen 518110, Guangdong Province, China
| | - Chun-Di Li
- Department of Nephrology, Shenzhen Longhua District Central Hospital, Shenzhen 518110, Guangdong Province, China
| | - Ping Zeng
- Department of Nephrology, Shenzhen Longhua District Central Hospital, Shenzhen 518110, Guangdong Province, China
| | - Shao-Dong Luan
- Department of Nephrology, Shenzhen Longhua District Central Hospital, Shenzhen 518110, Guangdong Province, China
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Correlation Between Apparent Diffusion Coefficient Values of the Renal Parenchyma and Estimated Glomerular Filtration Rates on 3-T Diffusion-Weighted Echo-Planar Magnetic Resonance Imaging. J Comput Assist Tomogr 2019; 43:780-785. [PMID: 31268879 DOI: 10.1097/rct.0000000000000890] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To evaluate the relationship between the apparent diffusion coefficient (ADC) values of renal parenchyma and estimated glomerular filtration rates (eGFR). METHODS Data on 216 patients examined by 3-T magnetic resonance imaging for various reasons were retrospectively collected. RESULTS There was a significant linear correlation between the ADC values and eGFRs (r = 0.254, P < 0.001). The ADC values in patients with an eGFR of less than 60 mL/min per 1.73 m were significantly lower than those with an eGFR of 60 mL/min per 1.73 m or greater. The mean ADC value of patients with grouped stage 2 disease was significantly higher than those with grouped stage 3 of chronic kidney disease (P < 0.01). CONCLUSIONS The ADC value of renal parenchyma may be a promising marker for the determination of patients with normal to mild reduction in renal function (eGFR ≥60 mL/min per 1.73 m) versus those with a moderate to severe reduction in renal function (eGFR <60 mL/min per 1.73 m).
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Besheer T, Elalfy H, Abd El-Maksoud M, Abd El-Razek A, Taman S, Zalata K, Elkashef W, Zaghloul H, Elshahawy H, Raafat D, Elemshaty W, Elsayed E, El-Gilany AH, El-Bendary M. Diffusion-weighted magnetic resonance imaging and micro-RNA in the diagnosis of hepatic fibrosis in chronic hepatitis C virus. World J Gastroenterol 2019; 25:1366-1377. [PMID: 30918429 PMCID: PMC6429339 DOI: 10.3748/wjg.v25.i11.1366] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 01/30/2019] [Accepted: 02/16/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Diffusion-weighted magnetic resonance imaging has shown promise in the detection and quantification of hepatic fibrosis. In addition, the liver has numerous endogenous micro-RNAs (miRs) that play important roles in the regulation of biological processes such as cell proliferation and hepatic fibrosis.
AIM To assess diffusion-weighted magnetic resonance imaging and miRs in diagnosing and staging hepatic fibrosis in patients with chronic hepatitis C.
METHODS This prospective study included 208 patients and 82 age- and sex-matched controls who underwent diffusion-weighted magnetic resonance imaging of the abdomen, miR profiling, and liver biopsy. Pathological scoring was classified according to the METAVIR scoring system. The apparent diffusion coefficient (ADC) and miR were calculated and correlated with pathological scoring.
RESULTS The ADC value decreased significantly with the progression of fibrosis, from controls (F0) to patients with early fibrosis (F1 and F2) to those with late fibrosis (F3 and F4) (median 1.92, 1.53, and 1.25 × 10-3 mm2/s, respectively) (P = 0.001). The cut-off ADC value used to differentiate patients from controls was 1.83 × 10-3 mm2/s with an area under the curve (AUC) of 0.992. Combining ADC and miR-200b revealed the highest AUC (0.995) for differentiating patients from controls with an accuracy of 96.9%. The cut-off ADC used to differentiate early fibrosis from late fibrosis was 1.54 × 10-3 mm2/s with an AUC of 0.866. The combination of ADC and miR-200b revealed the best AUC (0.925) for differentiating early fibrosis from late fibrosis with an accuracy of 80.2%. The ADC correlated with miR-200b (r = - 0.61, P = 0.001), miR-21 (r = - 0.62, P = 0.001), and miR-29 (r = 0.52, P = 0.001).
CONCLUSION Combining ADC and miRs offers an alternative surrogate non-invasive diagnostic tool for diagnosing and staging hepatic fibrosis in patients with chronic hepatitis C.
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Affiliation(s)
- Tarek Besheer
- Department of Tropical Medicine and Hepatology, Mansoura Faculty of Medicine - Mansoura University, Mansoura 35111, Egypt
| | - Hatem Elalfy
- Department of Tropical Medicine and Hepatology, Mansoura Faculty of Medicine - Mansoura University, Mansoura 35111, Egypt
| | - Mohamed Abd El-Maksoud
- Department of Tropical Medicine and Hepatology, Mansoura Faculty of Medicine - Mansoura University, Mansoura 35111, Egypt
| | - Ahmed Abd El-Razek
- Department of Diagnostic Radiology, Mansoura Faculty of Medicine - Mansoura University, Mansoura 35111, Egypt
| | - Saher Taman
- Department of Diagnostic Radiology, Mansoura Faculty of Medicine - Mansoura University, Mansoura 35111, Egypt
| | - Khaled Zalata
- Department of Pathology, Mansoura Faculty of Medicine - Mansoura University, Mansoura 35111, Egypt
| | - Wagdy Elkashef
- Department of Pathology, Mansoura Faculty of Medicine - Mansoura University, Mansoura 35111, Egypt
| | - Hossam Zaghloul
- Department of Clinical Pathology, Mansoura Faculty of Medicine - Mansoura University, Mansoura 35111, Egypt
| | - Heba Elshahawy
- Department of Clinical Pathology, Mansoura Faculty of Medicine - Mansoura University, Mansoura 35111, Egypt
| | - Doaa Raafat
- Department of Clinical Pathology, Mansoura Faculty of Medicine - Mansoura University, Mansoura 35111, Egypt
| | - Wafaa Elemshaty
- Department of Clinical Pathology, Mansoura Faculty of Medicine - Mansoura University, Mansoura 35111, Egypt
| | - Eman Elsayed
- Department of Clinical Pathology, Mansoura Faculty of Medicine - Mansoura University, Mansoura 35111, Egypt
| | - Abdel-Hady El-Gilany
- Department of Public Health and Preventive Medicine, Mansoura Faculty of Medicine - Mansoura University, Mansoura 35111, Egypt
| | - Mahmoud El-Bendary
- Department of Tropical Medicine and Hepatology, Mansoura Faculty of Medicine - Mansoura University, Mansoura 35111, Egypt
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Abstract
Although testicular carcinoma represents approximately only 1% of solid neoplasms in men, it is the most common malignancy between young men. The two main histologic categories are testicular germ cell tumors (TGCTs), including seminomas and nonseminomas, accounting for 90-95% of testicular neoplasms and sex cord-stromal tumors. Scrotal MRI, including a multiparametric protocol, has been proposed as a valuable supplemental imaging technique in the investigation of testicular pathology. Recently, the Scrotal and Penile Imaging Working Group appointed by the board of the European Society of Urogenital Radiology has produced recommendations on when to perform scrotal MRI. Regarding intratesticular masses, MRI of the scrotum may be used for their characterization, when US findings are indeterminate and for local staging of TGCTs, when organ-sparing surgery is planned. Differentiation between seminomas and nonseminomas is possible based on MRI features, when clinically needed. Scrotal MRI may also help in differentiating between TGCTs and nongerm cell tumors. Functional information based on diffusion-weighted imaging and dynamic contrast-enhanced MRI data improve testicular mass lesion characterization. Preliminary observations on diffusion tensor imaging, magnetization transfer imaging, and proton MR spectroscopy bring about new data in the understanding of testicular microstructure and pathophysiology.
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Affiliation(s)
- Athina C Tsili
- Department of Clinical Radiology, Medical School, University of Ioannina, University Campus, 45110, Ioannina, Greece.
| | - Nikolaos Sofikitis
- Department of Urology, Medical School, University of Ioannina, University Campus, 45110, Ioannina, Greece
| | - Efrosyni Stiliara
- Department of Clinical Radiology, Medical School, University of Ioannina, University Campus, 45110, Ioannina, Greece
| | - Maria I Argyropoulou
- Department of Clinical Radiology, Medical School, University of Ioannina, University Campus, 45110, Ioannina, Greece
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Assessment of Liver and Spleen in Children With Gaucher Disease Type 1 With Chemical Shift Imaging. J Comput Assist Tomogr 2019; 43:183-186. [DOI: 10.1097/rct.0000000000000817] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Abdel Razek AAK, Zaky M, Bayoumi D, Taman S, Abdelwahab K, Alghandour R. Diffusion tensor imaging parameters in differentiation recurrent breast cancer from post-operative changes in patients with breast-conserving surgery. Eur J Radiol 2018; 111:76-80. [PMID: 30691669 DOI: 10.1016/j.ejrad.2018.12.022] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 12/12/2018] [Accepted: 12/29/2018] [Indexed: 12/12/2022]
Abstract
AIM OF THE WORK To investigate mean diffusivity (MD) and fractional anisotropy (FA) measured by diffusion tensor imaging (DTI) as complementary tools to differentiate recurrent breast cancer from post-operative changes in patients with breast-conserving surgery (BCS). PATIENTS AND METHODS Prospective study was conducted upon 30 patients with BCS that underwent DTI and dynamic contrast MR imaging. DTI was performed using an axial two-dimensional spin-echo echo-planar imaging sequence. The MD and FA of the lesions were calculated by 2 observers. A single pixel seed isotropic region of interest was placed in the solid part of the tumor on the axial color FA map guided by an enhanced part of the tumor. The final diagnosis was done by biopsy for all patients. RESULTS /s) used for differentiation between entities revealed sensitivity (76.9%, 92.3%), specificity (82.4%, 64.7%) and accuracy (80%, 76.7%) of both observers respectively. At ROC curve analysis of FA, the AUC was 0.82 and 0.75 by both observers. The threshold FA (0.82, 0.75) was used for differentiation between entities revealed sensitivity (92.3%, 76.9%), specificity (70.6%, 70.6%) and accuracy of (80.0%, 73.3%) of both observers respectively. There was a strong positive correlation of MD (r = 0.86) and FA (r = 0.73) of both observers. Combined analysis of FA and MD used for differentiation between entities had AUC (0.90, 0.88) revealed sensitivity (92.3%, 92.3%), specificity (82.4%, 70.6%) and accuracy of (86.7%, 80.0%) for both observers respectively. CONCLUSIONS Combined analysis of MD and FA of DTI may play an important role as a non-invasive method for differentiation recurrent breast cancer from post-operative changes in patients with BCS.
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Affiliation(s)
| | - Mona Zaky
- Department of Diagnostic Radiology, Mansoura Faculty of Medicine, Mansoura, 13551, Egypt.
| | - Dalia Bayoumi
- Department of Diagnostic Radiology, Mansoura Faculty of Medicine, Mansoura, 13551, Egypt.
| | - Saher Taman
- Department of Diagnostic Radiology, Mansoura Faculty of Medicine, Mansoura, 13551, Egypt.
| | - Khaled Abdelwahab
- Department of Oncology Surgery, Mansoura faculty of Medicine, Mansoura, 13551, Egypt.
| | - Reham Alghandour
- Department of Medical Oncology, Mansoura Faculty of Medicine, Mansoura, 13551, Egypt.
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Using magnetic resonance diffusion tensor imaging to evaluate renal function changes in diabetic patients with early-stage chronic kidney disease. Clin Radiol 2018; 74:116-122. [PMID: 30360880 DOI: 10.1016/j.crad.2018.09.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 09/25/2018] [Indexed: 12/15/2022]
Abstract
AIM To investigate the clinical value of diffusion tensor imaging (DTI) in assessing renal function changes in diabetic patients with early-stage chronic kidney disease (CKD), and the relationship of DTI parameters with estimated glomerular filtration rate (eGFR) and urinary biomarkers. MATERIALS AND METHODS Thirty-six patients with diabetes mellitus (DM; 30 CKD stage 1 and 6 CKD stage 2) and 26 healthy control subjects were enrolled. DTI was performed using a clinical 3 T MRI system. Apparent diffusion coefficient (ADC) and fractional anisotropy (FA) values were calculated from the renal cortex and medulla. The correlation of the DTI parameters with eGFR and urinary biomarkers was evaluated. RESULTS FA values were significantly reduced in the renal cortex and medulla of DM group compared with the control group (cortical FA, Z=-2.834, p=0.005; medullary FA, t=2.768, p=0.007). In the DM group, FA values in the renal cortex and medulla were positively correlated with eGFR, while FA values in the medulla were negatively correlated with the urinary albumin/creatinine ratio, urinary alpha-1 microglobulin/creatinine ratio, and urinary transferring/creatinine ratio. ADC values in the renal cortex and medulla showed a trend towards an increase in the DM group compared with the control group. CONCLUSIONS Renal DTI is a promising method for assessing early renal function changes in DM patients.
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Caroli A, Schneider M, Friedli I, Ljimani A, De Seigneux S, Boor P, Gullapudi L, Kazmi I, Mendichovszky IA, Notohamiprodjo M, Selby NM, Thoeny HC, Grenier N, Vallée JP. Diffusion-weighted magnetic resonance imaging to assess diffuse renal pathology: a systematic review and statement paper. Nephrol Dial Transplant 2018; 33:ii29-ii40. [PMID: 30137580 PMCID: PMC6106641 DOI: 10.1093/ndt/gfy163] [Citation(s) in RCA: 95] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 05/02/2018] [Indexed: 12/26/2022] Open
Abstract
Diffusion-weighted magnetic resonance imaging (DWI) is a non-invasive method sensitive to local water motion in the tissue. As a tool to probe the microstructure, including the presence and potentially the degree of renal fibrosis, DWI has the potential to become an effective imaging biomarker. The aim of this review is to discuss the current status of renal DWI in diffuse renal diseases. DWI biomarkers can be classified in the following three main categories: (i) the apparent diffusion coefficient-an overall measure of water diffusion and microcirculation in the tissue; (ii) true diffusion, pseudodiffusion and flowing fraction-providing separate information on diffusion and perfusion or tubular flow; and (iii) fractional anisotropy-measuring the microstructural orientation. An overview of human studies applying renal DWI in diffuse pathologies is given, demonstrating not only the feasibility and intra-study reproducibility of DWI but also highlighting the need for standardization of methods, additional validation and qualification. The current and future role of renal DWI in clinical practice is reviewed, emphasizing its potential as a surrogate and monitoring biomarker for interstitial fibrosis in chronic kidney disease, as well as a surrogate biomarker for the inflammation in acute kidney diseases that may impact patient selection for renal biopsy in acute graft rejection. As part of the international COST (European Cooperation in Science and Technology) action PARENCHIMA (Magnetic Resonance Imaging Biomarkers for Chronic Kidney Disease), aimed at eliminating the barriers to the clinical use of functional renal magnetic resonance imaging, this article provides practical recommendations for future design of clinical studies and the use of renal DWI in clinical practice.
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Affiliation(s)
- Anna Caroli
- Medical Imaging Unit, Bioengineering Department, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Bergamo, Italy
| | - Moritz Schneider
- Department of Radiology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany
- Comprehensive Pneumology Center, German Center for Lung Research, Munich, Germany
| | - Iris Friedli
- Division of Radiology, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
| | - Alexandra Ljimani
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Dusseldorf, Germany
| | - Sophie De Seigneux
- Service and Laboratory of Nephrology, Department of Internal Medicine Specialties and Department of Physiology and Metabolism, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
| | - Peter Boor
- Institute of Pathology and Division of Nephrology, RWTH University of Aachen, Aachen, Germany
| | - Latha Gullapudi
- Centre for Kidney Research and Innovation, University of Nottingham, Nottingham, UK
| | - Isma Kazmi
- Centre for Kidney Research and Innovation, University of Nottingham, Nottingham, UK
| | - Iosif A Mendichovszky
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke’s Hospital, Cambridge, UK
| | | | - Nicholas M Selby
- Centre for Kidney Research and Innovation, University of Nottingham, Nottingham, UK
| | - Harriet C Thoeny
- Department of Diagnostic, Pediatric, and Interventional Radiology, Inselspital University Hospital, Bern, Switzerland
| | - Nicolas Grenier
- Service d'Imagerie Diagnostique et Interventionnelle de l'Adulte, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Jean-Paul Vallée
- Division of Radiology, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
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Wang YT, Yan X, Pu H, Yin LL. In vivo evaluation of early renal damage in type 2 diabetic patients on 3.0 T MR diffusion tensor imaging. World J Radiol 2018; 10:83-90. [PMID: 30190800 PMCID: PMC6120998 DOI: 10.4329/wjr.v10.i8.83] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 06/26/2018] [Accepted: 07/10/2018] [Indexed: 02/07/2023] Open
Abstract
AIM To investigate the utility of renal diffusion tensor imaging (DTI) to detect early renal damage in patients with type 2 diabetes.
METHODS Twenty-six diabetic patients (12 with microalbuminuria (MAU), and 14 with normoalbuminuria) and fourteen healthy volunteers were prospectively included in this study. Renal DTI on 3.0 T MR was performed, and estimated glomerular filtration rate (eGFR) was recorded for each subject. Mean cortical and medullary fractional anisotropy (FA) values were calculated by placing multiple representative regions of interest. Mean FA values were statistically compared among groups. Correlations between FA values and eGFR were evaluated.
RESULTS Both cortical and medullary FA were significantly reduced in diabetic patients compared to healthy controls (0.403 ± 0.064 vs 0.463 ± 0.047, P = 0.004, and 0.556 ± 0.084 vs 0.645 ± 0.076, P = 0.002, respectively). Cortical FA was significantly lower in diabetic patients with NAU than healthy controls (0.412 ± 0.068 vs 0.463 ± 0.047, P = 0.02). Medullary FA in diabetic patients with NAU and healthy controls were similar (0.582 ± 0.096 vs 0.645 ± 0.076, P = 0.06). Both cortical FA and medullary FA correlated with eGFR (r = 0.382, P = 0.015 and r = 0.552, P = 0.000, respectively).
CONCLUSION FA of renal parenchyma on DTI might serve as a more sensitive biomarker of early diabetic nephropathy than MAU.
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Affiliation(s)
- Yu-Ting Wang
- Department of Radiology, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu 611731, Sichuan Province, China
| | - Xiong Yan
- Department of Radiology, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu 611731, Sichuan Province, China
| | - Hong Pu
- Department of Radiology, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu 611731, Sichuan Province, China
| | - Long-Lin Yin
- Department of Radiology, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu 611731, Sichuan Province, China
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Diffusion tensor imaging of the optic disc in idiopathic intracranial hypertension. Neuroradiology 2018; 60:1159-1166. [DOI: 10.1007/s00234-018-2078-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 08/07/2018] [Indexed: 12/11/2022]
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El-Mewafy ZMH, Razek AAKA, El-Eshmawy MM, El-Eneen NRA, EL-Biaomy AAB. Magnetic resonance spectroscopy of the frontal region in patients with metabolic syndrome: correlation with anthropometric measurement. Pol J Radiol 2018; 83:e215-e219. [PMID: 30627238 PMCID: PMC6323604 DOI: 10.5114/pjr.2018.76024] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Accepted: 07/25/2017] [Indexed: 12/20/2022] Open
Abstract
PURPOSE To demonstrate 1H-MR spectroscopy of the frontal region in patients with metabolic syndrome and to correlate the metabolic ratios with anthropometric measurement. MATERIAL AND METHODS A prospective study was conducted upon 20 patients with metabolic syndrome (10 male, 10 female; mean age 52 years) and 20 age- and sex-matched volunteers. Patients were mild-moderate (n = 14) and marked and morbid obesity (n = 6). Patients and volunteers underwent 1H-MR spectroscopy of the frontal region. The Ch/Cr and NAA/Cr ratio were calculated and correlated with anthropometric measurement. RESULTS The Cho/Cr and NAA/Cr of patients with Mets (1.03 ± 0.08 and 1.62 ± 0.08) were significantly different (p = 0.001) to those of volunteers (0.78 ± 0 and 1.71 ± 0.61, respectively). The Cho/Cr and NAA/Cr cutoffs used to differentiate patients from volunteers were 0.89 and 1.77 with areas under the curve of 0.992 and 0.867 and accuracy of 97% and 93%, respectively. There was a significant difference in Cho/Cr and NAA/Cr between patients with marked-morbid obesity and moderate-mild obesity (p = 0.001 respectively). CONCLUSIONS We concluded that NAA/Cr and Cho/Cr ratios of the frontal region can differentiate patients with metabolic syndrome from volunteers and are well correlated with the anthropometric measurement.
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Ghobrial FEI, Eldin MS, Razek AAKA, Atwan NI, Shamaa SSA. Computed Tomography Assessment of Hepatic Metastases of Breast Cancer with Revised Response Evaluation Criteria in Solid Tumors (RECIST) Criteria (Version 1.1): Inter-Observer Agreement. Pol J Radiol 2017; 82:593-597. [PMID: 29657622 PMCID: PMC5894063 DOI: 10.12659/pjr.902930] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 01/24/2017] [Indexed: 12/29/2022] Open
Abstract
Background To assess inter-observer agreement of revised RECIST criteria (version 1.1) for computed tomography assessment of hepatic metastases of breast cancer. Material/Methods A prospective study was conducted in 28 female patients with breast cancer and with at least one measurable metastatic lesion in the liver that was treated with 3 cycles of anthracycline-based chemotherapy. All patients underwent computed tomography of the abdomen with 64-row multi- detector CT at baseline and after 3 cycles of chemotherapy for response assessment. Image analysis was performed by 2 observers, based on the RECIST criteria (version 1.1). Results Computed tomography revealed partial response of hepatic metastases in 7 patients (25%) by one observer and in 10 patients (35.7%) by the other observer, with good inter-observer agreement (k=0.75, percent agreement of 89.29%). Stable disease was detected in 19 patients (67.8%) by one observer and in 16 patients (57.1%) by the other observer, with good agreement (k=0.774, percent agreement of 89.29%). Progressive disease was detected in 2 patients (7.2%) by both observers, with perfect agreement (k=1, percent agreement of 100%). The overall inter-observer agreement in the CT-based response assessment of hepatic metastasis between the two observers was good (k=0.793, percent agreement of 89.29%). Conclusions We concluded that computed tomography is a reliable and reproducible imaging modality for response assessment of hepatic metastases of breast cancer according to the RECIST criteria (version 1.1).
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Affiliation(s)
- Fady Emil Ibrahim Ghobrial
- Department of Internal Medicine (Medical Oncology), Faculty of Medicine, Oncology Center Mansoura University, Mansoura, Egypt
| | - Manal Salah Eldin
- Department of Internal Medicine (Medical Oncology), Faculty of Medicine, Oncology Center Mansoura University, Mansoura, Egypt
| | | | - Nadia Ibrahim Atwan
- Department of Pathology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Sameh Sayed Ahmed Shamaa
- Department of Internal Medicine (Medical Oncology), Faculty of Medicine, Oncology Center Mansoura University, Mansoura, Egypt
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Diagnostic performance of diffusion-weighted MR imaging in differentiation of diabetic osteoarthropathy and osteomyelitis in diabetic foot. Eur J Radiol 2017; 89:221-225. [PMID: 28267543 DOI: 10.1016/j.ejrad.2017.02.015] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 01/09/2017] [Accepted: 02/12/2017] [Indexed: 12/15/2022]
Abstract
PURPOSE To study the diagnostic performance of diffusion weighted MR imaging in differentiation of diabetic osteoarthropathy and osteomyelitis in diabetic foot. PATIENTS AND METHODS This prospective study was carried out on 41 patients with diabetic foot, 22 males and 19 females with mean age of 51 years. They underwent diffusion-weighted MR imaging of the foot. The apparent diffusion coefficient (ADC) values of the bony lesions were calculated by two reviewers and correlated with the surgical findings or biopsy. The kappa statistic (k) was used to estimate the proportion of inter-observer agreement of two reviewers. RESULTS The mean ADC of acute diabetic osteoarthropathy was 1.27±0.19×10-3mm2/s for reviewer 1 and 1.26±0.21×10-3mm2/s for reviewer 2. The mean ADC value in diabetic osteomyelitis was 0.86±0.11×10-3mm2/s for reviewer 1 and 0.85±0.12×10-3mm2/s for reviewer 2. There was excellent inter-observer agreement of ADC value of bony lesions in diabetic foot by both reviewers (K=0.93). There was statistically significant difference in the ADC values of both groups (P=0.001). The cut-off point of ADC value of both reviewers used in differentiating acute diabetic osteoarthropathy and osteomyelitis were 0.98×10-3mm2/s and 1.04×10-3mm2/s with an accuracy of 94% and 93% and area under the curve of 0.94 and 0.93 respectively. CONCLUSION We conclude that the ADC value is a non-invasive imaging parameter that can help in differentiation of diabetic osteoarthropathy from osteomyelitis with excellent inter-observer agreement.
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