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Chen PK, Cheng ZY, Wang YL, Xu BJ, Yu ZC, Li ZX, Gong SA, Zhang FT, Qian L, Cui W, Feng YZ, Cai XR. Renal interstitial fibrotic assessment using non-Gaussian diffusion kurtosis imaging in a rat model of hyperuricemia. BMC Med Imaging 2024; 24:78. [PMID: 38570748 PMCID: PMC10988851 DOI: 10.1186/s12880-024-01259-8] [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: 10/12/2023] [Accepted: 03/26/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND To investigate the feasibility of Diffusion Kurtosis Imaging (DKI) in assessing renal interstitial fibrosis induced by hyperuricemia. METHODS A hyperuricemia rat model was established, and the rats were randomly split into the hyperuricemia (HUA), allopurinol (AP), and AP + empagliflozin (AP + EM) groups (n = 19 per group). Also, the normal rats were selected as controls (CON, n = 19). DKI was performed before treatment (baseline) and on days 1, 3, 5, 7, and 9 days after treatment. The DKI indicators, including mean kurtosis (MK), fractional anisotropy (FA), and mean diffusivity (MD) of the cortex (CO), outer stripe of the outer medulla (OS), and inner stripe of the outer medulla (IS) were acquired. Additionally, hematoxylin and eosin (H&E) staining, Masson trichrome staining, and nuclear factor kappa B (NF-κB) immunostaining were used to reveal renal histopathological changes at baseline, 1, 5, and 9 days after treatment. RESULTS The HUA, AP, and AP + EM group MKOS and MKIS values gradually increased during this study. The HUA group exhibited the highest MK value in outer medulla. Except for the CON group, all the groups showed a decreasing trend in the FA and MD values of outer medulla. The HUA group exhibited the lowest FA and MD values. The MKOS and MKIS values were positively correlated with Masson's trichrome staining results (r = 0.687, P < 0.001 and r = 0.604, P = 0.001, respectively). The MDOS and FAIS were negatively correlated with Masson's trichrome staining (r = -626, P < 0.0014 and r = -0.468, P = 0.01, respectively). CONCLUSION DKI may be a non-invasive method for monitoring renal interstitial fibrosis induced by hyperuricemia.
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Affiliation(s)
- Ping-Kang Chen
- Medical Imaging Center, The First Affiliated Hospital of Jinan University, No.613 West Huangpu Avenue, Tianhe District, Guangzhou, Guangdong, 510630, China
| | - Zhong-Yuan Cheng
- Medical Imaging Center, The First Affiliated Hospital of Jinan University, No.613 West Huangpu Avenue, Tianhe District, Guangzhou, Guangdong, 510630, China
| | - Ya-Lin Wang
- Medical Imaging Center, The First Affiliated Hospital of Jinan University, No.613 West Huangpu Avenue, Tianhe District, Guangzhou, Guangdong, 510630, China
| | - Bao-Jun Xu
- Medical Imaging Center, The First Affiliated Hospital of Jinan University, No.613 West Huangpu Avenue, Tianhe District, Guangzhou, Guangdong, 510630, China
| | - Zong-Chao Yu
- Nephrology department, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China
| | - Zhao-Xia Li
- Department of Rheumatology, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China
| | - Shang-Ao Gong
- Medical Imaging Center, The First Affiliated Hospital of Jinan University, No.613 West Huangpu Avenue, Tianhe District, Guangzhou, Guangdong, 510630, China
| | - Feng-Tao Zhang
- Intervention department, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Long Qian
- Department of Biomedical Engineering, College of Engineering, Peking University, Beijing, China
| | - Wei Cui
- MRI Research, GE Healthcare, Beijing, China
| | - You-Zhen Feng
- Medical Imaging Center, The First Affiliated Hospital of Jinan University, No.613 West Huangpu Avenue, Tianhe District, Guangzhou, Guangdong, 510630, China.
| | - Xiang-Ran Cai
- Medical Imaging Center, The First Affiliated Hospital of Jinan University, No.613 West Huangpu Avenue, Tianhe District, Guangzhou, Guangdong, 510630, China.
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Zhong G, Chen L, Lin Z, Xiang Z. Evaluation of renal function in chronic kidney disease using histogram analysis based on multiple diffusion models. Br J Radiol 2024; 97:803-811. [PMID: 38291900 PMCID: PMC11027312 DOI: 10.1093/bjr/tqae024] [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: 11/16/2023] [Revised: 12/22/2023] [Accepted: 01/24/2024] [Indexed: 02/01/2024] Open
Abstract
OBJECTIVES To compare the diagnostic value of histogram features of multiple diffusion metrics in predicting early renal impairment in chronic kidney disease (CKD). METHODS A total of 77 patients with CKD (mild group, estimated glomerular filtration rate (eGFR) ≥60 mL/min/1.73 m2) and 30 healthy controls (HCs) were enrolled. Diffusion-weighted imaging was performed by using single-shot echo planar sequence with 13 b values (0, 20, 50, 80, 100, 150, 200, 500, 800, 1000, 1500, 2000, and 2500 s/mm2). Diffusion models including mono-exponential (Mono), intravoxel incoherent motion (IVIM), stretched-exponential (SEM), and kurtosis (DKI) were calculated, and their histogram features were analysed. All diffusion models for predicting early renal impairment in CKD were established using logistic regression analysis, and diagnostic efficiency was compared among the models. RESULTS All diffusion models had high differential diagnosis efficiency between the mild group and HCs. The areas under the curve (AUCs) of Mono, IVIM, SEM, DKI, and the combined diffusion model for predicting early renal impairment in CKD were 0.829, 0.809, 0.760, 0.825, and 0.861, respectively. There were no significant differences in AUCs except SEM and combined model, SEM, and DKI model. There were significant correlations between eGFR/serum creatinine and some of histogram features. CONCLUSIONS Histogram analysis based on multiple diffusion metrics was practicable for the non-invasive assessment of early renal impairment in CKD. ADVANCES IN KNOWLEDGE Advanced diffusion models provided microstructural information. Histogram analysis further reflected histological characteristics and heterogeneity. Histogram analysis based on multiple diffusion models could provide an accurate and non-invasive method to evaluate the early renal damage of CKD.
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Affiliation(s)
- Guimian Zhong
- The First Affiliated Hospital of Jinan University, Guangzhou 510632, China
- Department of Radiology, Guangzhou Panyu Central Hospital, Guangzhou 511400, China
| | - Luyan Chen
- Department of Radiology, Guangzhou Panyu Central Hospital, Guangzhou 511400, China
| | | | - Zhiming Xiang
- Department of Radiology, Guangzhou Panyu Central Hospital, Guangzhou 511400, China
- Jinan University, Guangzhou 510632, China
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Zhu J, Chen A, Gao J, Zou M, Du J, Wu PY, Zhang J, Mao Y, Song Y, Chen M. Diffusion-weighted, intravoxel incoherent motion, and diffusion kurtosis tensor MR imaging in chronic kidney diseases: Correlations with histology. Magn Reson Imaging 2024; 106:1-7. [PMID: 37414367 DOI: 10.1016/j.mri.2023.07.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 06/30/2023] [Accepted: 07/02/2023] [Indexed: 07/08/2023]
Abstract
OBJECTIVES To probe the correlations of parameters derived from standard DWI and its extending models including intravoxel incoherent motion (IVIM), diffusion tensor imaging (DTI), and diffusion kurtosis imaging (DKI) with the pathological and functional alterations in CKD. MATERIAL AND METHODS Seventy-nine CKD patients with renal biopsy and 10 volunteers were performed with DWI, IVIM, diffusion kurtosis tensor imaging (DKTI) scanning. Correlations between imaging results and the pathological damage [glomerulosclerosis index (GSI) and tubulointerstitial fibrosis index (TBI)], as well as eGFR, 24 h urinary protein and Scr) were evaluated.CKD patients were divided into 2 groups: group 1: both GSI and TBI scores <2 points (61 cases); group 2: both GSI and TBI scores ≥2 points (18 cases). RESULTS There were significant difference in cortical and medullary MD, and cortical D among 3 groups and between group 1 and 2. Cortical and medullary MD, cortical D, and medullary FA were negatively correlated with GSI score (r = -0.322 to -0.386, P < 0.05). Cortical and medullary MD and D, medullary FA were also negatively correlated with TBI score (r = -0.257 to -0.395, P < 0.05). These parameters were all correlated with eGFR and Scr. Cortical MD and D showed the highest AUC of 0.790 and 0.745 in discriminating mild and moderate-severe glomerulosclerosis and tubular interstitial fibrosis, respectively. CONCLUSIONS The corrected diffusion-related indices, including cortical and medullary D and MD, as well as medullary FA were superior to ADC, perfusion-related and kurtosis indices for evaluating the severity of renal pathology and function in CKD patients.
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Affiliation(s)
- Jie Zhu
- Department of Radiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, 100730, PR China
| | - Aiqun Chen
- Department of Nephrology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, 100730, PR China
| | - Jiayin Gao
- Department of Radiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, 100730, PR China
| | - Mingzhu Zou
- Department of Radiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, 100730, PR China
| | - Jun Du
- Department of Pathology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, 100730, PR China
| | - Pu-Yeh Wu
- GE Healthcare, Beijing 100176, China
| | - Jintao Zhang
- Department of Radiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, 100730, PR China
| | - Yonghui Mao
- Department of Nephrology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, 100730, PR China
| | - Yan Song
- Department of Radiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, 100730, PR China.
| | - Min Chen
- Department of Radiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, 100730, PR China.
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Bane O, Seeliger E, Cox E, Stabinska J, Bechler E, Lewis S, Hickson LJ, Francis S, Sigmund E, Niendorf T. Renal MRI: From Nephron to NMR Signal. J Magn Reson Imaging 2023; 58:1660-1679. [PMID: 37243378 PMCID: PMC11025392 DOI: 10.1002/jmri.28828] [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: 02/03/2023] [Revised: 05/11/2023] [Accepted: 05/12/2023] [Indexed: 05/28/2023] Open
Abstract
Renal diseases pose a significant socio-economic burden on healthcare systems. The development of better diagnostics and prognostics is well-recognized as a key strategy to resolve these challenges. Central to these developments are MRI biomarkers, due to their potential for monitoring of early pathophysiological changes, renal disease progression or treatment effects. The surge in renal MRI involves major cross-domain initiatives, large clinical studies, and educational programs. In parallel with these translational efforts, the need for greater (patho)physiological specificity remains, to enable engagement with clinical nephrologists and increase the associated health impact. The ISMRM 2022 Member Initiated Symposium (MIS) on renal MRI spotlighted this issue with the goal of inspiring more solutions from the ISMRM community. This work is a summary of the MIS presentations devoted to: 1) educating imaging scientists and clinicians on renal (patho)physiology and demands from clinical nephrologists, 2) elucidating the connection of MRI parameters with renal physiology, 3) presenting the current state of leading MR surrogates in assessing renal structure and functions as well as their next generation of innovation, and 4) describing the potential of these imaging markers for providing clinically meaningful renal characterization to guide or supplement clinical decision making. We hope to continue momentum of recent years and introduce new entrants to the development process, connecting (patho)physiology with (bio)physics, and conceiving new clinical applications. We envision this process to benefit from cross-disciplinary collaboration and analogous efforts in other body organs, but also to maximally leverage the unique opportunities of renal physiology. LEVEL OF EVIDENCE: 1 TECHNICAL EFFICACY STAGE: 2.
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Affiliation(s)
- Octavia Bane
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
- Icahn School of Medicine at Mount Sinai, BioMedical Engineering and Imaging Institute, New York City, New York, USA
| | - Erdmann Seeliger
- Institute of Translational Physiology, Charité-University Medicine Berlin, Berlin, Germany
| | - Eleanor Cox
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, UK
| | - 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
| | - Eric Bechler
- Department of Diagnostic and Interventional Radiology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Sara Lewis
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - LaTonya J Hickson
- Division of Nephrology and Hypertension, Mayo Clinic, Jacksonville, Florida, USA
| | - Sue Francis
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, UK
| | - Eric 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
| | - Thoralf Niendorf
- Berlin Ultrahigh Field Facility (B.U.F.F.), Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany
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Cattran DC, Floege J, Coppo R. Evaluating Progression Risk in Patients With Immunoglobulin A Nephropathy. Kidney Int Rep 2023; 8:2515-2528. [PMID: 38106572 PMCID: PMC10719597 DOI: 10.1016/j.ekir.2023.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 09/05/2023] [Accepted: 09/08/2023] [Indexed: 12/19/2023] Open
Abstract
The highly variable rate of decline in kidney function in patients with immunoglobulin A nephropathy (IgAN) provides a major clinical challenge. Predicting which patients will progress to kidney failure, and how quickly, is difficult. Multiple novel therapies are likely to be approved in the short-term, but clinicians lack the tools to identify patients most likely to benefit from specific treatments at the right time. Noninvasive and validated markers for selecting at-risk patients and longitudinal monitoring are urgently needed. This review summarizes what is known about demographic, clinical, and histopathologic prognostic markers in the clinician's toolkit, including the International IgAN Prediction Tool. We also briefly review what is known on these topics in children and adolescents with IgAN. Although helpful, currently used markers leave clinicians heavily reliant on histologic features from the diagnostic kidney biopsy and standard clinical data to guide treatment choice, and very few noninvasive markers reflect treatment efficacy over time. Novel prognostic and predictive markers are under clinical investigation, with considerable progress being made in markers of complement activation. Other areas of research are the interplay between gut microbiota and galactose-deficient IgA1 expression; microRNAs; imaging; artificial intelligence; and markers of fibrosis. Given the rate of therapeutic advancement, the remaining gaps in biomarker research need to be addressed. We finish by describing our route to clinical utility of predictive and prognostic markers in IgAN. This route will provide us with the chance to improve IgAN prognosis by using robust, clinically practical markers to inform patient care.
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Affiliation(s)
| | - Jürgen Floege
- Division of Nephrology and Clinical Immunology, RWTH Aachen University, Aachen, Germany
| | - Rosanna Coppo
- Fondazione Ricerca Molinette, Regina Margherita Hospital, Turin, Italy
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Liang P, Yuan G, Li S, Peng Y, Xu C, Benkert T, Hu D, Han M, Li Z. Noninvasive Assessment of the Renal Function, Oxford Classification and Prognostic Risk Stratification of IgAN by Using Intravoxel Incoherent Motion Diffusion-Weighted Imaging and Blood Oxygenation Level-Dependent MRI. J Magn Reson Imaging 2023; 58:879-891. [PMID: 36527202 DOI: 10.1002/jmri.28565] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/29/2022] [Accepted: 12/01/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Immunoglobulin A nephropathy (IgAN) is the most common primary glomerulonephritis worldwide. Oxford classification including mesangial hypercellularity (M), endothelial hypercellularity (E), segmental sclerosis (S), interstitial fibrosis/tubular atrophy (T), and crescent (C) were recommended to predict the prognosis of IgAN. PURPOSE To explore whether multiparametric magnetic resonance imaging (MRI) can be applied to assess the renal function, Oxford classification, and risk of progression to end-stage kidney disease within 5 years of IgAN. STUDY TYPE Prospective. POPULATION A total of 46 patients with pathologically confirmed IgAN and 20 healthy volunteers. FIELD STRENGTH/SEQUENCE A 3-T, blood oxygenation level-dependent (BOLD)-MRI, intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI). ASSESSMENT Two radiologists measured the cortex and medulla T2*, apparent diffusion coefficient (ADC), true diffusion (Dt), pseudo-diffusion (Dp), perfusion fraction (fp). All participants were divided into three groups: group 1, healthy volunteers; group 2, patients with estimated glomerular filtration rate (eGFR) ≥60 mL/min/1.73 m2 ; group 3, patients with eGFR <60 mL/min/1.73 m2 . Or two groups: group A, 5-year risk scores ≤10% and group B, 5-year risk scores >10%. STATISTICAL TESTS Intraclass correlation coefficient, one-way analysis of variance, least-significant difference, Student's t-test, Pearson product-moment correlation, Spearman's rank correlation, and receiver operating characteristics (ROC) with the area under the curve (AUC). A P value <0.05 was considered statistically significant. RESULTS Except for cortical Dp, all other MRI parameters showed significant differences between group 1 and group 2. None of the MRI parameters showed a significant correlation with M, E, or C scores. Cortical T2*, Dt, fp, and medullary Dt and fp showed low-to-moderate significant correlations with S scores. Except for cortical and medullary Dp, all other MRI parameters were significantly correlated with T scores. Cortical Dt showed the largest AUC for differentiating group A from group B (AUC = 0.927) and T0 from T1/T2 (AUC = 0.963). DATA CONCLUSION Imaging by IVIM-DWI and BOLD-MRI could facilitate noninvasive assessment of the renal function, Oxford classification, and prognostic risk of IgAN patients. EVIDENCE LEVEL 2. TECHNICAL EFFICACY Stage 3.
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Affiliation(s)
- Ping Liang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Guanjie Yuan
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Shichao Li
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yang Peng
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Chuou Xu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Thomas Benkert
- MR Application Predevelopment, Siemens Healthcare Gmbh, Erlangen, Germany
| | - Daoyu Hu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Min Han
- Department of Nephrology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Zhen Li
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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Cheng ZY, Chen PK, Feng YZ, Chen XQ, Qian L, Cai XR. Preliminary Feasibility Study on Diffusion Kurtosis Imaging to Monitor the Early Functional Alterations of Kidneys in Streptozocin-Induced Diabetic Rats. Acad Radiol 2023; 30:1544-1551. [PMID: 36244869 DOI: 10.1016/j.acra.2022.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 09/16/2022] [Accepted: 09/17/2022] [Indexed: 11/30/2022]
Abstract
RATIONALE AND OBJECTIVES The aim of this study was to investigate the potential of diffusion kurtosis imaging (DKI) to assess the early renal functional undulation of diabetic mellitus (DM). MATERIALS AND METHODS Fifty-seven Sprague-Dawley (SD) rats were randomly divided into two groups and eventually 48 rats were included in this study: the normal control (CON) group and diabetic mellitus (DM) group. Weeks 0, 4, 8, and 12 after the diabetes model was successfully established, all the rats were scanned on the 3.0T MRI. The DKI derived parameters of renal parenchyma, including fractional anisotropy (FAco, FAme), mean diffusivity (MDco, MDme), and mean kurtosis (MKco, MKme) were measured. Their alteration over time was analyzed and then correlated with urine volume (UV), blood urea nitrogen (BUN), and serum creatinine (Scr) using Pearson correlation analysis. Finally, hematoxylin and eosin (H&E) staining was performed on the kidneys of the two groups. RESULT There was a decreasing trend in FA, MK, and MD values over time in diabetic rats. Also, the gradually worsening histological damage of kidneys was noted over time in diabetic rats. The cortical FA and MK values and medullary FA, MK and MD values of diabetic rats were significantly lower than those of controls at most time points after DM induction. In addition, negative correlations were revealed between the BUN and FAco (r = -0.43, p = 0.03) or FAme value (r = -0.49, p = 0.01). The cortical MK value was moderately correlated with UV (r = -0.46, p = 0.03) and BUN (r = -0.55, p = 0.01). CONCLUSION The preliminary findings suggest that DKI might be an effective and sensitive tool to assess the early changes of renal function impairment in diabetic rats. The FA values of the cortex and medulla and the MK value of the cortex are sensitive markers in detecting renal injury in diabetic rats.
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Affiliation(s)
- Zhong-Yuan Cheng
- Medical Imaging Center, Jinan University First Affiliated Hospital, No.613 West Huangpu Avenue, Tianhe District, Guangzhou, Guangdong 510630, China
| | - Ping-Kang Chen
- Medical Imaging Center, Jinan University First Affiliated Hospital, No.613 West Huangpu Avenue, Tianhe District, Guangzhou, Guangdong 510630, China
| | - You-Zhen Feng
- Medical Imaging Center, Jinan University First Affiliated Hospital, No.613 West Huangpu Avenue, Tianhe District, Guangzhou, Guangdong 510630, China
| | - Xiao-Qiao Chen
- Radiology Department, Shenzhen Mental Health Center, Shenzhen Kangning Hospital, Shenzhen, Guangdong, China
| | - Long Qian
- Department of Biomedical Engineering, Peking University, Beijing, 100871, China
| | - Xiang-Ran Cai
- Medical Imaging Center, Jinan University First Affiliated Hospital, No.613 West Huangpu Avenue, Tianhe District, Guangzhou, Guangdong 510630, China.
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Evaluating the renal mild tubulointerstitial damage and renal function in IgAN patients: a comparative study based on diffusion kurtosis imaging and diffusion tensor imaging. ABDOMINAL RADIOLOGY (NEW YORK) 2023; 48:1350-1362. [PMID: 36749369 DOI: 10.1007/s00261-023-03822-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 01/14/2023] [Accepted: 01/16/2023] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To compare the performance of 3.0 T magnetic resonance diffusion kurtosis imaging (DKI) and diffusion tensor imaging (DTI) in evaluation of the degree of tubulointerstitial damage and renal function in Immunoglobulin A Nephropathy (IgAN) patients. METHODS Both DKI and DTI were performed in 40 IgAN patients and 17 healthy volunteers. IgAN patients were divided into two groups according to tubulointerstitial lesion score: Mild injury group, n = 24; Moderate-severe injury group, n = 16. DKI characteristic parameters [mean kurtosis (MK), axial kurtosis (Ka), radial kurtosis (Kr)] and DTI parameters [fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (Da), radial diffusivity (Dr)] of renal cortex and medulla were measured and compared among different groups. Correlations between DKI, DTI parameters and clinicopathological characteristics were assessed. Diagnostic performance of DKI and DTI to evaluate tubulointerstitial damage of IgAN was compared. RESULTS Cortical MK, Kr, Da and parenchymal Ka significantly differed among three groups (P < 0.05). Cortical MK, Kr, Ka were negatively correlated with estimated glomerular filtration rate (eGFR) (MK: r = - 0.613; Kr: r = - 0.539; Ka: r = - 0.664) and positively correlated with tubulointerstitial lesion score (MK: r = 0.655; Kr: r = 0.577; Ka: r = 0.661) (all P < 0.001). Lower correlation coefficient was found among cortical FA, MD, Dr and eGFR, tubulointerstitial lesion score (all|r|< 0.350). The AUCs of DKI and DTI parameters for differentiating Mild injury group from control group were (cortical MK 0.822, cortical Ka 0.816; cortical FA 0.515, cortical MD 0.714) and for differentiating Mild injury group from Moderate-severe injury group were (cortical MK 0.813, cortical Ka 0.831; medulla FA 0.784, medulla MD 0.586). CONCLUSION Compared with DTI, DKI was more sensitive and accurate to probe the renal function and the tubulointerstitial damage of IgAN, especially the mild tubulointerstitial damage.
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Monoexponential, biexponential, stretched-exponential and kurtosis models of diffusion-weighted imaging in kidney assessment: comparison between patients with primary aldosteronism and healthy controls. ABDOMINAL RADIOLOGY (NEW YORK) 2023; 48:1340-1349. [PMID: 36745206 DOI: 10.1007/s00261-023-03833-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 01/23/2023] [Accepted: 01/24/2023] [Indexed: 02/07/2023]
Abstract
PURPOSE This study used various diffusion-weighted imaging (DWI) models (including monoexponential, biexponential, stretched-exponential and kurtosis models) in renal magnetic resonance imaging (MRI) to compare whether there were differences in each diffusion parameter between patients with primary aldosteronism (PA) and healthy volunteers. MATERIALS AND METHODS Twenty-two (female:male, 14:8; age, 48 ± 10 years) patients with PA and 22 age- and sex-matched healthy controls (HCs) underwent MRI examinations of the kidneys. The independent-sample t test or the Mann‒Whitney U test was used to detect differences in the diffusion metrics of the kidneys between the two groups. Univariable and multivariable linear regression were applied to analyze the correlations between diffusion parameters and the clinical indicators. RESULTS The mean diffusivity (MD, p < 0.001) and radial diffusivity (Dr, p < 0.001) values in the medulla were lower in the PA group than in the HC group. The medullary fractional anisotropy (FA, p < 0.001) was higher than that of HCs. The FA (p < 0.001) and axial diffusivity (Da, p < 0.001) values in the cortex were lower in the PA group. The cortical α (anomalous exponent term, p = 0.016) was higher in the PA patients than in the HCs. Linear regression analysis showed that log(plasma aldosterone concentration) and the estimated glomerular filtration rate (eGFR) were correlated with medullary FA. CONCLUSION The stretched-exponential model (cortical α) and the kurtosis model (FA, MD and Dr in the medulla and FA and Da in the cortex) showed significant differences between PA patients and healthy volunteers and may have potential for noninvasive renal assessment in PA patients.
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Yuan G, Qu W, Li S, Liang P, He K, Li A, Li J, Hu D, Xu C, Li Z. Noninvasive assessment of renal function and fibrosis in CKD patients using histogram analysis based on diffusion kurtosis imaging. Jpn J Radiol 2023; 41:180-193. [PMID: 36255600 PMCID: PMC9889447 DOI: 10.1007/s11604-022-01346-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 09/28/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE To investigate the potential of histogram analysis based on diffusion kurtosis imaging (DKI) in evaluating renal function and fibrosis associated with chronic kidney disease (CKD). MATERIALS AND METHODS Thirty-six CKD patients were enrolled, and DKI was performed in all patients before the renal biopsy. The histogram parameters of diffusivity (D) and kurtosis (K) were obtained using FireVoxel. The histogram parameters between the stable [estimated glomerular filtration rate (eGFR) ≥ 60 ml/min/1.73 m2] and impaired (eGFR < 60 ml/min/1.73 m2) eGFR group were compared. Besides, patients were classified into mild, moderate, and severe fibrosis group using a semi-quantitative standard. The correlations of histogram parameters with eGFR and fibrosis scores were investigated and the diagnostic performances of histogram parameters in assessing renal dysfunction and fibrosis were analyzed. The added value of combination of most significant parameter with 24 h urinary protein (24 h-UPRO) in evaluating fibrosis was also explored. RESULTS Seven D histogram parameters in cortex (mean, median, 10th, 25th, 75th, 90th percentiles and entropy), two D histogram parameters in medulla (75th, 90th percentiles), seven K histogram parameters in cortex (mean, min, median, 10th, 25th, 75th, 90th percentiles) and three K histogram parameters in medulla (mean, median, 25th percentile) were significantly different between the two groups. The Dmean of cortex was the most relevant parameter to eGFR (r = 0.648, P < 0.001) and had the largest area under the curve (AUC) for differentiating the stable from impaired eGFR group [AUC = 0.889; 95% confidence interval (CI) 0.728-0.970]. The K90th of cortex presented the strongest correlation with fibrosis scores (r = 0.575, P < 0.001) and achieved the largest AUC for distinguishing the mild from moderate to severe fibrosis group (AUC = 0.849, 95% CI 0.706-0.993). Combining the K90th in cortex with 24 h-UPRO gained statistically higher AUC value (AUC = 0.880, 95% CI 0.763-0.996). CONCLUSION Histogram analysis based on DKI is practicable for the noninvasive assessment of renal function and fibrosis in CKD patients.
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Affiliation(s)
- Guanjie Yuan
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Qiaokou District Wuhan 430030, Hubei, China
| | - Weinuo Qu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Qiaokou District Wuhan 430030, Hubei, China
| | - Shichao Li
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Qiaokou District Wuhan 430030, Hubei, China
| | - Ping Liang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Qiaokou District Wuhan 430030, Hubei, China
| | - Kangwen He
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Qiaokou District Wuhan 430030, Hubei, China
| | - Anqin Li
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Qiaokou District Wuhan 430030, Hubei, China
| | - Jiali Li
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Qiaokou District Wuhan 430030, Hubei, China
| | - Daoyu Hu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Qiaokou District Wuhan 430030, Hubei, China
| | - Chuou Xu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Qiaokou District Wuhan 430030, Hubei, China.
| | - Zhen Li
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Qiaokou District Wuhan 430030, Hubei, China
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Dai H, Zhao C, Xiong Y, He Q, Su W, Li J, Yang Y, Lin R, Xiang S, Shao J. Evaluation of contrast-induced acute kidney injury using IVIM and DKI MRI in a rat model of diabetic nephropathy. Insights Imaging 2022; 13:110. [PMID: 35767196 PMCID: PMC9243200 DOI: 10.1186/s13244-022-01249-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 06/07/2022] [Indexed: 11/17/2022] Open
Abstract
Objective To assess the potential of intravoxel incoherent motion (IVIM) and diffusion kurtosis imaging (DKI) in monitoring renal changes in a diabetic nephropathy (DN) rat model with acute kidney injury (CI-AKI) induced by iso-osmotic contrast media (IOCM) and low-osmotic contrast media (LOCM). Methods A diabetic nephropathy rat model was established, and the animals were randomly split into the LOCM group and IOCM group (n = 13 per group), with iopamidol and iodixanol injection, respectively (4 g iodine/kg). MRI including IVIM and DKI was performed 24 h before contrast medium injections (baseline) and 1, 24, 48, and 72 h after injections. Changes in pure molecular diffusion (D), pseudo-diffusion coefficient (D*), perfusion fraction (f), mean diffusion (MD), mean kurtosis (MK), serum creatinine (SCr) and urea nitrogen (BUN), histopathology alterations, and α-smooth muscle actin (α-SMA) expression were assessed. Inter-observer agreement was evaluated using the intraclass correlation coefficient (ICC). Results Compared against baseline levels, significant decreases in D, D*, and f were observed in all anatomical kidney compartments after contrast injection (p < 0.05). MD in the cortex (CO) and outer medullary (OM) gradually decreased, and MK in OM gradually increased 24–72 h after injection. D, D*, f, and MD were negatively correlated with the histopathologic findings and α-smooth muscle actin (α-SMA) expression in all anatomical kidney compartments. Inter-observer reproducibility was generally good (ICCs ranging from 0.776 to 0.979). Conclusions IVIM and DKI provided noninvasive imaging parameters, which might offer effective detection of CI-AKI in DN.
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Affiliation(s)
- Hongyan Dai
- Department of Radiology, The Affiliated Hospital of Yunnan University, NO.176 Qingnian Road, Kunming, 650021, Yunnan, China
| | - Chun Zhao
- Department of Radiology, The Affiliated Hospital of Yunnan University, NO.176 Qingnian Road, Kunming, 650021, Yunnan, China
| | - Yuxin Xiong
- Department of Endocrinology and Metabolism, The Affiliated Hospital of Yunnan University, Kunming, Yunnan, China
| | - Qian He
- Department of Radiology, The Affiliated Hospital of Yunnan University, NO.176 Qingnian Road, Kunming, 650021, Yunnan, China
| | - Wei Su
- Department of Radiology, The Affiliated Hospital of Yunnan University, NO.176 Qingnian Road, Kunming, 650021, Yunnan, China
| | - Jianbo Li
- Department of Radiology, The Affiliated Hospital of Yunnan University, NO.176 Qingnian Road, Kunming, 650021, Yunnan, China
| | - Ying Yang
- Department of Endocrinology and Metabolism, The Affiliated Hospital of Yunnan University, Kunming, Yunnan, China
| | - Ruyun Lin
- Department of Hospital Quality Control, The Affiliated Hospital of Yunnan University, Kunming, Yunnan, China
| | - Shutian Xiang
- Department of Radiology, The Affiliated Hospital of Yunnan University, NO.176 Qingnian Road, Kunming, 650021, Yunnan, China.
| | - Juwei Shao
- Department of Radiology, The Affiliated Hospital of Yunnan University, NO.176 Qingnian Road, Kunming, 650021, Yunnan, China.
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Li A, Yuan G, Hu Y, Shen Y, Hu X, Hu D, Li Z. Renal functional and interstitial fibrotic assessment with non-Gaussian diffusion kurtosis imaging. Insights Imaging 2022; 13:70. [PMID: 35394225 PMCID: PMC8993956 DOI: 10.1186/s13244-022-01215-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 03/21/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES To evaluate the application value of diffusion kurtosis imaging (DKI) for monitoring renal function and interstitial fibrosis. METHODS Forty-two patients suspected of having primary nephropathy, hypertension or diabetes with impaired renal function were examined with DKI. DKI metrics of renal cortex and medulla on both sides of each patient were measured, including mean kurtosis (MK), axial kurtosis (Ka), radial kurtosis (Kr), mean diffusivity (MD) and fractional anisotropy (FA). The differences in DKI metrics between stable and impaired estimated glomerular filtration rate (eGFR) patients as well as between mild and severe interstitial fibrosis patients were compared. Correlations of DKI metrics with clinical indicators and pathology were analyzed. Diagnostic performance of DKI to assess the degree of renal dysfunction was analyzed. RESULTS Cortical MK, parenchymal Ka, MD and medullary FA were different in stable vs impaired eGFR patients and mild vs severe interstitial fibrosis patients (all p < .05). Negative correlation was found between Ka and eGFR (cortex: r = - 0.579; medulla: r = - 0.603), between MD and interstitial fibrosis (cortex: r = - 0.899; medulla: r = - 0.770), and positive correlation was found between MD and eGFR (cortex: r = 0.411; medulla: r = 0.344), between Ka and interstitial fibrosis (cortex: r = 0.871; medulla: r = 0.844) (all p < .05). DKI combined with mean arterial blood pressure (MAP) and urea showed good diagnostic power for assessing the degree of renal dysfunction (sensitivity: 90.5%; specificity: 89.5%). CONCLUSIONS Noninvasive DKI has certain application value for monitoring renal function and interstitial fibrosis.
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Affiliation(s)
- Anqin Li
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, Hubei, China
| | - Guanjie Yuan
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, Hubei, China
| | - Yao Hu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, Hubei, China
| | - Yaqi Shen
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, Hubei, China
| | - Xuemei Hu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, Hubei, China
| | - Daoyu Hu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, Hubei, China
| | - Zhen Li
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, Hubei, China.
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Iopromide and Iodixanol in the Development of Postoperative Contrast Nephropathy in Patients with Renal Insufficiency: A Meta-Analysis. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:1469370. [PMID: 35422982 PMCID: PMC9005303 DOI: 10.1155/2022/1469370] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 02/23/2022] [Accepted: 03/11/2022] [Indexed: 01/31/2023]
Abstract
In order to compare the effects of iopromide and isoxazole on postoperative contrast-induced nephropathy in patients with renal insufficiency, the paper searches for randomized controlled trials and retrospective cohort studies comparing the effects of iopromide and iodixanol on renal function in patients with renal insufficiency after surgery. The data are extracted from eligible studies. We tried to assess the incidence of contrast-agent nephropathy, preoperative and postoperative serum creatinine indicators, and mortality. This paper includes 8 studies with a total of 1243 patients. The incidence of contrast-induced nephropathy in the iopromide group is higher than that in the iodixanol group, and there is no significant difference between the two groups in postoperative mortality and preoperative serum creatinine expression. Sensitivity analysis and funnel chart show that our research is robust and has low publication bias. Our research shows that in patients with renal insufficiency, the incidence of contrast-medium nephropathy in the iopromide group is higher than that in the iodixanol group. Iodixanol is safer and has less effect on patients' serum creatinine levels.
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Diffusion kurtosis imaging for assessing endometrial fibrosis: a preliminary clinical study. Abdom Radiol (NY) 2022; 47:1448-1456. [PMID: 35113173 DOI: 10.1007/s00261-022-03413-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 01/05/2022] [Accepted: 01/06/2022] [Indexed: 11/01/2022]
Abstract
PURPOSE To investigate the feasibility of using diffusion kurtosis imaging (DKI) for the assessment of endometrial fibrosis. METHODS 40 patients with hysteroscopy confirmed endometrial fibrosis and 30 healthy women underwent MR examination including the DKI sequence (b = 0, 500, 1000, 1500, and 2000 s/mm2). Endometrial thickness (ET), apparent diffusion coefficient (ADC), corrected ADC (D), and kurtosis of diffusion (K) were measured and compared, and the diagnostic performance of those parameters was evaluated using ROC curves analysis. RESULTS Patients with endometrial fibrosis had a thinner endometrium than the healthy controls (P < 0.001). They also had significantly lower ADC and D values and significantly higher K values of the endometrium than the healthy controls (all P < 0.001). ADC, D, K, and ET all performed excellently in diagnosing endometrial fibrosis, with areas under the curve (AUCs) of 0.940, 0.879, 0.860, and 0.853, respectively. ADC showed the highest AUC, demonstrating better diagnostic accuracy than K (z = 2.307, P < 0.05). However, there were no differences in AUC between D, K, and ET, or ADC, D, and ET (all P > 0.05). The reproducibility of ADC, D, and K values in patients with endometrial fibrosis and healthy controls was excellent (ICC 0.951-0.991). CONCLUSION DKI of the endometrium has promising potential for the noninvasive assessment of endometrial fibrosis.
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Liang P, Li S, Yuan G, He K, Li A, Hu D, Li Z, Xu C. Noninvasive assessment of clinical and pathological characteristics of patients with IgA nephropathy by diffusion kurtosis imaging. Insights Imaging 2022; 13:18. [PMID: 35092495 PMCID: PMC8800983 DOI: 10.1186/s13244-022-01158-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 01/07/2022] [Indexed: 11/10/2022] Open
Abstract
Objectives To explore the diagnostic performance of diffusion kurtosis imaging (DKI) in evaluating the clinical and pathological characteristics of patients with immunoglobulin A nephropathy (IgAN) compared with conventional DWI. Materials and methods A total of 28 IgAN patients and 14 healthy volunteers prospectively underwent MRI examinations including coronal T2WI, axial T1WI, T2WI, and DWI sequences from September 2020 to August 2021. We measured mean kurtosis (MK), mean diffusivity (MD), and apparent diffusion coefficient (ADC) by using MR Body Diffusion Toolbox v1.4.0 (Siemens Healthcare). Patients were divided into three groups according to their estimated glomerular filtration rate (eGFR) (Group1, healthy volunteers without kidney disease or other diseases that affect renal function; Group2, IgAN patients with eGFR > 60 mL/min/1.73 m2; Group3, IgAN patients with eGFR < 60 mL/min/1.73 m2). One-way analysis of variance, Pearson or Spearman correlation, and receiver operating characteristic curves were applied in our statistical analysis. Results MKCortex and ADCCortex showed significant differences between the Group1 and Group2. MKCortex, MDCortex, ADCCortex, MKMedulla, and ADCMedulla showed significant differences between Group2 and Group3. MKCortex had the highest correlation with CKD stages (r = 0.749, p < 0.001), and tubulointerstitial lesion score (r = 0.656, p < 0.001). MDCortex had the highest correlation with glomerular lesion score (r = − 0.475, p = 0.011). MKCortex had the highest AUC (AUC = 0.923) for differentiating Group1 from Group2, and MDCortex had the highest AUC (AUC = 0.924) for differentiating Group2 from Group3, followed by MKMedulla (AUC = 0.923). Conclusions DKI is a feasible and reliable technique that can assess the clinical and pathological characteristics of IgAN patients and can provide more valuable information than conventional DWI, especially MKCortex.
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Wang B, Wang Y, Li L, Guo J, Wu PY, Zhang H, Zhang H. Diffusion kurtosis imaging and arterial spin labeling for the noninvasive evaluation of persistent post-contrast acute kidney injury. Magn Reson Imaging 2021; 87:47-55. [PMID: 34968702 DOI: 10.1016/j.mri.2021.12.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 11/01/2021] [Accepted: 12/22/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVE We investigated whether diffusion kurtosis imaging (DKI) and arterial spin labeling (ASL) facilitated the assessment of serial alterations in persistent post-contrast acute kidney injury (PC-AKI). MATERIALS AND METHODS We randomly divided 24 rats into four PC-AKI groups (days 1, 3, 7, and 13, n = 6/group), with an additional six control animals. We conducted functional magnetic resonance imaging (MRI), diffusion kurtosis imaging (DKI), and arterial spin-labeling (ASL) analyses. Mean kurtosis (MK), axial kurtosis (Ka), mean diffusivity (MD), fractional anisotropy (FA), radial kurtosis (Kr), and renal blood flow (RBF) maps were normalized to baseline (prior to contrast injection) to calculate adjusted △RBF, △MK, △Ka, △MD, △FA, and △Kr values. We also investigated urinary neutrophil gelatinase associated lipocalin (NGAL), serum cystatin C (CysC), aquaporin-2 (AQP2), hypoxia-inducible factor-1 (HIF-1α), and histological indices. RESULTS In the inner stripe of the outer medulla, when compared with controls, decreased △FA and △MD levels were observed on days 1, 3, and 7, and a distinct elevation in △MK and △Kr on days 1-13, and a persistent decrease in △RBF on days 1-13, and a prominent increase in △Ka on days 7 and 13 in PC-AKI animals (all p < 0.05). △Ka and △MK were positively correlated with AQP-2 (r = 0.8086, p < 0.0001 and r = 0.7314, p < 0.0001, respectively), and △RBF was highly correlated with HIF-1α (r = -0.7592, p < 0.0001). Moreover, both CysC and NGAL were significantly elevated in PC-AKI animals when compared with controls from days 1-13 (all p < 0.05). Renal histological data indicated severe tubular and glomerular injury at days 1-13 in all PC-AKI groups. CONCLUSION ASL and DKI may be noninvasively and longitudinally used to detect PC-AKI and predict further outcomes.
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Affiliation(s)
- Bin Wang
- Department of Medical Imaging, Shanxi Medical University, Taiyuan 030000, Shanxi, China
| | - Yongfang Wang
- Department of Medical Imaging, First Hospital of Shanxi Medical University, Taiyuan 030000, Shanxi, China
| | - Lina Li
- Department of Medical Imaging, Shanxi Medical University, Taiyuan 030000, Shanxi, China
| | - Jinxia Guo
- GE Healthcare, MR Research China, Beijing 100000, China
| | - Pu-Yeh Wu
- GE Healthcare, MR Research China, Beijing 100000, China
| | - Hui Zhang
- Department of Medical Imaging, First Hospital of Shanxi Medical University, Taiyuan 030000, Shanxi, China.
| | - Hong Zhang
- The College of Biomedical Engineering and Instrument Science of Zhejiang University, Hangzhou 310000, Zhejiang, China.
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Liu Y, Zhang GMY, Peng X, Li X, Sun H, Chen L. Diffusion kurtosis imaging as an imaging biomarker for predicting prognosis in chronic kidney disease patients. Nephrol Dial Transplant 2021; 37:1451-1460. [PMID: 34302484 DOI: 10.1093/ndt/gfab229] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Renal fibrosis is the strongest prognosis predictor of end-stage renal disease (ESRD) in chronic kidney disease (CKD). Diffusion kurtosis imaging (DKI) is a promising method of magnetic resonance imaging (MRI) successfully used to assess renal fibrosis in IgA nephropathy. This study first evaluated the long-term prognostic value of DKI in CKD patients. METHODS Forty-two patients with CKD were prospectively enrolled, and underwent DKI on a clinical 3 T MR scanner. We excluded patients with comorbidities that could affect the volume or the components of the kidney. DKI parameters, including mean kurtosis (K), mean diffusivity (D) and apparent diffusion coefficient (ADC) of kidney cortex were obtained by region-of-interest measurement. We followed up these patients for a median of 43 months and investigated the correlations between each DKI parameter and overall renal prognosis. RESULTS Both K and ADC values were correlated well with the eGFR on recruitment and the eGFR of the last visit in follow-up (p<0.001). K and ADC values were also well associated with the eGFR slopes in CKD patients, both with the first-last time point slope (p = 0.011 and p<0.001, respectively) and with the regression slope (p = 0.010 and p<0.001, respectively). Cox proportional hazard regression indicated that lower eGFR and ADC values independently predicted eGFR loss of more than 30% and ESRD. The receiver operating characteristic analysis showed that K and ADC values were predictable for renal prognosis, and ADC displayed better capabilities for both ESRD (AUC 0.936, sensitivity 92.31%, specificity 82.76%) and the composite endpoint (eGFR loss>30% or ESRD) (AUC 0.881, sensitivity 66.67%, specificity 96.3%). CONCLUSIONS Renal ADC values obtained from DKI showed significant predictive value for the prognosis of CKD patients, which could be a promising noninvasive technique in follow-up.
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Affiliation(s)
- Yan Liu
- Department of Nephrology, State Key Laboratory of Complex Severe and Rare Diseases
| | - Gu-Mu-Yang Zhang
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Xiaoyan Peng
- Department of Nephrology, State Key Laboratory of Complex Severe and Rare Diseases
| | - Xuemei Li
- Department of Nephrology, State Key Laboratory of Complex Severe and Rare Diseases
| | - Hao Sun
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Limeng Chen
- Department of Nephrology, State Key Laboratory of Complex Severe and Rare Diseases
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Mao W, Ding Y, Ding X, Fu C, Zeng M, Zhou J. Diffusion kurtosis imaging for the assessment of renal fibrosis of chronic kidney disease: A preliminary study. Magn Reson Imaging 2021; 80:113-120. [PMID: 33971241 DOI: 10.1016/j.mri.2021.05.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 04/30/2021] [Accepted: 05/05/2021] [Indexed: 01/18/2023]
Abstract
PURPOSE To investigate the potential of diffusion kurtosis imaging (DKI) for the assessment of renal fibrosis in chronic kidney disease (CKD), using histopathology as the reference standard. METHODS Eighty-nine CKD patients and twenty healthy volunteers were recruited in this study. DKI was performed in all participants and all CKD patients received renal biopsy. The values of mean diffusivity (MD) and mean kurtosis (MK) in the renal cortex and medulla were compared between CKD patients and healthy volunteers. The Spearman correlation coefficient was calculated to assess the relationship between MD, MK values and the estimated glomerular filtration rate (eGFR), serum creatinine (SCr), 24 h urinary protein (24 h-UPRO), histopathological fibrosis score. RESULTS The medullary MD values were significantly lower than cortex, while the cortical MK values were significantly lower than medulla for all participants. Renal parenchymal MD values were significantly lower in the CKD patients than healthy controls, whereas MK values were significantly higher in the CKD patients than healthy controls. In the CKD patients, the significantly negative correlation was observed between the renal parenchymal MD values and the 24 h-UPRO, SCr, histopathological fibrosis score, as well as between the renal parenchymal MK values and the eGFR, while the significantly positive correlation was found between the renal parenchymal MD values and the eGFR, as well as between the renal parenchymal MK values and the 24 h-UPRO, SCr, histopathological fibrosis score. CONCLUSION DKI shows great potential in the noninvasive assessment of renal fibrosis in CKD.
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Affiliation(s)
- Wei Mao
- Department of Radiology, Zhongshan Hospital, Fudan University; Shanghai Institute of Medical Imaging, 180 Fenglin Road, Shanghai 200032, People's Republic of China
| | - Yuqin Ding
- Department of Radiology, Zhongshan Hospital, Fudan University; Shanghai Institute of Medical Imaging, 180 Fenglin Road, Shanghai 200032, People's Republic of China
| | - Xiaoqiang Ding
- Department of Nephrology, Zhongshan Hospital, Fudan University; 180 Fenglin Road, Shanghai 200032, People's Republic of China
| | - Caixia Fu
- Siemens Shenzhen Magnetic Resonance Ltd, Shenzhen, People's Republic of China
| | - Mengsu Zeng
- Department of Radiology, Zhongshan Hospital, Fudan University; Shanghai Institute of Medical Imaging, 180 Fenglin Road, Shanghai 200032, People's Republic of China.
| | - Jianjun Zhou
- Department of Radiology, Zhongshan Hospital, Fudan University; Shanghai Institute of Medical Imaging, 180 Fenglin Road, Shanghai 200032, People's Republic of China; Department of Radiology, Xiamen Branch, Zhongshan Hospital, Fudan University, Xiamen, China.
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Zheng X, Li M, Wang P, Li X, Zhang Q, Zeng S, Jiang T, Hu X. Assessment of chronic allograft injury in renal transplantation using diffusional kurtosis imaging. BMC Med Imaging 2021; 21:63. [PMID: 33827457 PMCID: PMC8028790 DOI: 10.1186/s12880-021-00595-3] [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: 09/27/2020] [Accepted: 03/28/2021] [Indexed: 11/12/2022] Open
Abstract
Background Chronic allograft injury (CAI) is a significant reason for which many grafts were lost. The study was conducted to assess the usefulness of diffusional kurtosis imaging (DKI) technology in the non-invasive assessment of CAI. Methods Between February 2019 and October 2019, 110 renal allograft recipients were included to analyze relevant DKI parameters. According to estimated glomerular filtration rate (eGFR) (mL/min/ 1.73 m2) level, they were divided to 3 groups: group 1, eGFR ≥ 60 (n = 10); group 2, eGFR 30–60 (n = 69); group 3, eGFR < 30 (n = 31). We performed DKI on a clinical 3T magnetic resonance imaging system. We measured the area of interest to determine the mean kurtosis (MK), mean diffusivity (MD), and apparent diffusion coefficient (ADC) of the renal cortex and medulla. We performed a Pearson correlation analysis to determine the relationship between eGFR and the DKI parameters. We used the receiver operating characteristic curve to estimate the predicted values of DKI parameters in the CAI evaluation. We randomly selected five patients from group 2 for biopsy to confirm CAI. Results With the increase of creatinine, ADC, and MD of the cortex and medulla decrease, MK of the cortex and medulla gradually increase. Among the three different eGFR groups, significant differences were found in cortical and medullary MK (P = 0.039, P < 0.001, P < 0.001, respectively). Cortical and medullary ADC and MD are negatively correlated with eGFR (r = − 0.49, − 0.44, − 0.57, − 0.57, respectively; P < 0.001), while cortical and medullary MK are positively correlated with eGFR (r = 0.42, 0.38; P < 0.001). When 0.491 was set as the cutoff value, MK's CAI assessment showed 87% sensitivity and 100% specificity. All five patients randomly selected for biopsy from the second group confirmed glomerulosclerosis and tubular atrophy/interstitial fibrosis. Conclusion The DKI technique is related to eGFR as allograft injury progresses and is expected to become a potential non-invasive method for evaluating CAI. Supplementary Information The online version contains supplementary material available at 10.1186/s12880-021-00595-3.
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Affiliation(s)
- Xin Zheng
- Department of Urology, Beijing Youan Hospital, Capital Medical University, No. 8, Xi Tou Tiao, Youanmen Wai, Fengtai District, Beijing, 100069, People's Republic of China
| | - Min Li
- Department of Radiology, Beijing Chao-Yang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 200020, People's Republic of China
| | - Pan Wang
- Department of Radiology, Beijing Chao-Yang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 200020, People's Republic of China
| | - Xiangnan Li
- Department of Radiology, Beijing Chao-Yang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 200020, People's Republic of China
| | - Qiang Zhang
- Institute of Urology, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 200020, People's Republic of China.,Department of Urology, Beijing Chao-Yang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 200020, People's Republic of China
| | - Song Zeng
- Institute of Urology, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 200020, People's Republic of China.,Department of Urology, Beijing Chao-Yang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 200020, People's Republic of China
| | - Tao Jiang
- Department of Radiology, Beijing Chao-Yang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 200020, People's Republic of China.
| | - Xiaopeng Hu
- Institute of Urology, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 200020, People's Republic of China. .,Department of Urology, Beijing Chao-Yang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 200020, People's Republic of China.
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A novel identification system combining diffusion kurtosis imaging with conventional magnetic resonance imaging to assess intestinal strictures in patients with Crohn's disease. Abdom Radiol (NY) 2021; 46:936-947. [PMID: 32964274 DOI: 10.1007/s00261-020-02765-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 09/04/2020] [Accepted: 09/10/2020] [Indexed: 01/16/2023]
Abstract
PURPOSE To determine the utility of diffusion kurtosis imaging (DKI) for assessing bowel fibrosis and to establish a new magnetic resonance imaging (MRI)-based classification based on DKI and conventional MRI parameters for characterizing intestinal strictures in Crohn's disease (CD) using the histological evaluation of resected intestine samples as the reference standard. METHODS Thirty-one patients with CD undergoing preoperative conventional MRI and diffusion-weighted imaging (DWI) (b values = 0-2000 s/mm2) were consecutively enrolled. We classified the mural T2-weighted signal intensity and arterial-phase enhancement patterns on conventional MRI. We also measured DWI-derived apparent diffusion coefficients (ADCs) and DKI-derived apparent diffusion for non-Gaussian distribution (Dapp) and apparent diffusional kurtosis (Kapp). A new MRI-based classification was established to characterize intestinal strictures in CD. Its performance was validated in nine additional patients with CD. RESULTS Histological inflammation grades were significantly correlated to T2-weighted signal intensity (r = 0.477; P < 0.001) and ADC (r = - 0.226; P = 0.044). Histological fibrosis grades were moderately correlated to Kapp (r = 0.604, P < 0.001); they were also correlated to Dapp (r = - 0.491; P < 0.001) and ADC (r = - 0.270; P = 0.015). T2-weighted signal intensity could differentiate between no-to-mild and moderate-to-severe bowel inflammation (sensitivity, 0.970; specificity, 0.479). Kapp could differentiate between no-to-mild and moderate-to-severe bowel fibrosis (sensitivity, 0.959; specificity, 0.781). The agreement between the new MRI-based classification and the histological classification was moderate in the test (κ = 0.507; P < 0.001) and validation (κ = 0.530; P < 0.001) sets. CONCLUSIONS DKI can be used to assess bowel fibrosis. The new MRI-based classification can help to distinguish between fibrotic and inflammatory intestinal strictures in patients with CD.
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Mao W, Ding Y, Ding X, Wang Y, Fu C, Zeng M, Zhou J. Pathological assessment of chronic kidney disease with DWI: Is there an added value for diffusion kurtosis imaging? J Magn Reson Imaging 2021; 54:508-517. [PMID: 33634937 DOI: 10.1002/jmri.27569] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 02/04/2021] [Accepted: 02/04/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) is a worldwide health problem, precise functional and pathological assessment is beneficial to better treatment. Diffusion kurtosis imaging (DKI) can evaluate non-Gaussian diffusion and may help to assess renal pathology and function. PURPOSE To assess pathological and functional alterations in CKD using DKI compared with diffusion-weighted imaging (DWI). STUDY TYPE Prospective study. POPULATION 70 CKD patients and 20 healthy volunteers. FIELD STRENGTH 1.5 T. ASSESSMENT All participants underwent DKI, and apparent diffusion coefficient (ADC), mean diffusivity (MD), and mean kurtosis (MK) of renal parenchyma were acquired. Correlation between renal parenchymal ADC, MD, MK, and estimated glomerular filtration rate (eGFR), pathological scores were assessed. The diagnostic efficacy of ADC, MD, and MK for assessing the degree of renal pathological injury were compared. STATISTICAL TESTS ANOVA, Spearman correlation analysis, and ROC curve analysis. RESULTS The cortical ADC, MD were significantly higher than medulla for all participants, whereas medullary MK was significantly higher than cortex (P < 0.01). Whether eGFR reduced or not, renal parenchymal MK were significantly higher in patients than controls (P < 0.05). Positive correlation was found between eGFR and ADC (cortex, r = 0.562; medulla, r = 0.527), and negative correlation between eGFR and MK (cortex, r = -0.786; medulla, r = -0.709) (all P < 0.001). There was positive correlation between MK and glomerular injury (cortex, r = 0.681; medulla, r = 0.652), tubulointerstitial lesion (cortex, r = 0.650; medulla, r = 0.599) (all P < 0.001). For discrimination between mild and m-s renal injury group, the AUC values of ADC, MD, MK were cortex: 0.723, 0.655, 0.864 and medulla: 0.718, 0.581, 0.829. The AUC values of ADC, MD, MK were cortex: 0.708, 0.679, 0.770 and medulla: 0.713, 0.830, 0.780 for differentiating control group from mild renal injury group. DATA CONCLUSION DKI is practicable for noninvasive assessment of renal pathology and function of CKD, DKI offer better diagnostic performance than DWI. Evidence Level 1 Technical Efficacy 2.
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Affiliation(s)
- Wei Mao
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Medical Imaging, Shanghai, 200032, China
| | - Yuqin Ding
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Medical Imaging, Shanghai, 200032, China
| | - Xiaoqiang Ding
- Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Yaqiong Wang
- Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Caixia Fu
- Siemens Shenzhen Magnetic Resonance Ltd., Shenzhen, China
| | - Mengsu Zeng
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Medical Imaging, Shanghai, 200032, China
| | - Jianjun Zhou
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Medical Imaging, Shanghai, 200032, China.,Department of Radiology, Xiamen Branch, Zhongshan Hospital, Fudan University, Xiamen, China
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22
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Srivastava A, Tomar B, Prajapati S, Gaikwad AB, Mulay SR. Advanced non-invasive diagnostic techniques for visualization and estimation of kidney fibrosis. Drug Discov Today 2021; 26:2053-2063. [PMID: 33617976 DOI: 10.1016/j.drudis.2021.02.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 12/22/2020] [Accepted: 02/12/2021] [Indexed: 12/17/2022]
Abstract
Kidney fibrosis is marked by excessive extracellular matrix deposition during disease progression. Unfortunately, existing kidney function parameters do not predict the extent of kidney fibrosis. Moreover, the traditional histology methods for the assessment of kidney fibrosis require liquid and imaging biomarkers as well as needle-based biopsies, which are invasive and often associated with kidney injury. The repetitive analyses required to monitor the disease progression are therefore difficult. Hence, there is an unmet medical need for non-invasive and informative diagnostic approaches to monitor kidney fibrosis during the progression of chronic kidney disease. Here, we summarize the modern advances in diagnostic imaging techniques that have shown promise for non-invasive estimation of kidney fibrosis in pre-clinical and clinical studies.
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Affiliation(s)
- Anjali Srivastava
- Division of Pharmacology, CSIR-Central Drug Research Institute, Lucknow, 226031, India
| | - Bhawna Tomar
- Division of Pharmacology, CSIR-Central Drug Research Institute, Lucknow, 226031, India
| | - Smita Prajapati
- Division of Pharmacology, CSIR-Central Drug Research Institute, Lucknow, 226031, India
| | - Anil Bhanudas Gaikwad
- Department of Pharmacy, Birla Institute of Technology and Science Pilani, Pilani Campus, 333031, India
| | - Shrikant R Mulay
- Division of Pharmacology, CSIR-Central Drug Research Institute, Lucknow, 226031, India.
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Yu YM, Ni QQ, Wang ZJ, Chen ML, Zhang LJ. Multiparametric Functional Magnetic Resonance Imaging for Evaluating Renal Allograft Injury. Korean J Radiol 2020; 20:894-908. [PMID: 31132815 PMCID: PMC6536799 DOI: 10.3348/kjr.2018.0540] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 12/19/2018] [Indexed: 02/06/2023] Open
Abstract
Kidney transplantation is the treatment of choice for patients with end-stage renal disease, as it extends survival and increases quality of life in these patients. However, chronic allograft injury continues to be a major problem, and leads to eventual graft loss. Early detection of allograft injury is essential for guiding appropriate intervention to delay or prevent irreversible damage. Several advanced MRI techniques can offer some important information regarding functional changes such as perfusion, diffusion, structural complexity, as well as oxygenation and fibrosis. This review highlights the potential of multiparametric MRI for noninvasive and comprehensive assessment of renal allograft injury.
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Affiliation(s)
- Yuan Meng Yu
- Department of Medical Imaging, Jinling Hospital, Clinical School of Southern Medical University, Nanjing, China
| | - Qian Qian Ni
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Zhen Jane Wang
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Meng Lin Chen
- Medical Imaging Teaching and Research Office, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Long Jiang Zhang
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, China.
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Assessment of renal fibrosis in a rat model of unilateral ureteral obstruction with diffusion kurtosis imaging: Comparison with α-SMA expression and 18F-FDG PET. Magn Reson Imaging 2020; 66:176-184. [DOI: 10.1016/j.mri.2019.08.035] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 08/30/2019] [Accepted: 08/31/2019] [Indexed: 12/11/2022]
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25
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Hu Q, Zhang WJ, Lin ZQ, Wang XY, Zheng HY, Wei HM, He HG. Combined Acoustic Radiation Force Impulse and Conventional Ultrasound in the Quantitative Assessment of Immunoglobulin a Nephropathy. ULTRASOUND IN MEDICINE & BIOLOGY 2019; 45:2309-2316. [PMID: 31202455 DOI: 10.1016/j.ultrasmedbio.2019.05.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 05/02/2019] [Accepted: 05/10/2019] [Indexed: 06/09/2023]
Abstract
We investigated the value of combined acoustic radiation force impulse (ARFI) imaging and conventional ultrasound (US) in identifying renal histopathological fibrosis with immunoglobulin A nephropathy. A total of 146 patients with immunoglobulin A nephropathy, pathologically confirmed by renal biopsy were grouped according to Oxford classification and Katafuchi grading, were included in the test group, and 39 healthy volunteers were included in the control group. Receiver operating characteristic (ROC) curves were constructed to compare the diagnostic accuracy of ARFI, renal lengths, parenchymal thicknesses and interlobular arterial resistance index (RI) and their combinations in identifying Katafuchi grading at renal biopsy. Shear wave velocity (SWV), renal length, renal parenchyma thickness and the interlobular arterial RI were correlated with Katafuchi grading, mesangial hypercellularity (M) and tubular atrophy/interstitial fibrosis (T) (r = -0.504 to -0.407, p < 0.01) but were not correlated with endocapillary hypercellularity (E) or segmental glomerulosclerosis (S). The area under the curves of SWV value + conventional US index (renal length, renal parenchyma thickness and interlobular arterial RI) was higher than those of the SWV value or of the conventional US index alone. The combination of ARFI imaging and conventional US can improve the diagnostic performance in quantitative evaluation pathologic damage in patients with immunoglobulin A nephropathy.
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Affiliation(s)
- Qiao Hu
- Department of Diagnostic Ultrasound, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China.
| | - Wang-Jian Zhang
- Department of Environmental Health Sciences, School of Public Health, University at Albany, State University of New York, Rensselaer, NY, USA
| | - Zi-Qiang Lin
- Department of Mathematics, State University of New York, Albany, NY, USA
| | - Xiao-Yan Wang
- Department of Diagnostic Ultrasound, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Hong-Yu Zheng
- Department of Diagnostic Ultrasound, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Hai-Ming Wei
- Department of Pathology, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Hong-Guang He
- Department of Nephrology, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
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