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Detection of renal allograft fibrosis with MRI: arterial spin labeling outperforms reduced field-of-view IVIM

  • Magnetic Resonance
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objective

To compare the value of reduced field-of-view (FOV) intravoxel incoherent motion (IVIM) diffusion-weighted imaging (DWI) and arterial spin labeling (ASL) for assessing renal allograft fibrosis and predicting long-term dysfunction.

Methods

This prospective study included 175 renal transplant recipients undergoing reduced FOV IVIM DWI, ASL, and biopsies. Renal allograft fibrosis was categorized into ci0, ci1, ci2, and ci3 fibrosis according to biopsy results. A total of 83 participants followed for a median of 39 (IQR, 21–42) months were dichotomized into stable and impaired allograft function groups based on follow-up estimated glomerular filtration rate. Total apparent diffusion coefficient (ADCT), pure diffusion ADC, pseudo-perfusion ADC, perfusion fraction f from IVIM DWI, and renal blood flow (RBF) from ASL were calculated and compared. The area under the receiver operating characteristic curve (AUC) was calculated to assess the diagnostic and predictive performances.

Results

RBF was different in ci0 vs ci1 (147.9 ± 46.3 vs 126.0 ± 49.4 ml/min/100 g, p = .02) and ci2 vs ci3 (92.9 ± 46.9 vs 70.8 ± 37.8 ml/min/100 g, p = .03). RBF in the stable group was higher than that in the impaired group (144.73 ± 49.33 vs 102.19 ± 47.58 ml/min/100 g, p < .001). AUCs in distinguishing renal allograft fibrosis and predicting long-term allograft dysfunction for RBF were higher than cortical ADCT (ci0 vs ci1–3, 0.76 vs 0.59, p < .001; ci0–1 vs ci2–3, 0.79 vs 0.68, p = .01; ci0–2 vs ci3, 0.79 vs 0.68, p = .01; 0.76 vs 0.60, p = .04, respectively).

Conclusion

Compared to reduced FOV IVIM DWI, ASL was a more promising technique for noninvasively distinguishing renal allograft fibrosis degree and predicting long-term allograft dysfunction.

Key Points

• Compared to total ADC from rFOV IVIM DWI, RBF from ASL can distinguish no fibrosis (ci0) vs mild fibrosis (ci1) (p = .02) and moderate fibrosis (ci2) vs severe fibrosis (ci3) (p = .04).

• RBF had superior performance than diffusion parameters in discriminating fibrosis (no fibrosis [ci0] vs fibrosis [ci1–3], mild fibrosis [ci0–1] vs moderate to severe fibrosis [ci2–3], non-severe [ci0–2] vs severe [ci3] fibrosis; AUC = 0.76 vs 0.59, p < .001; 0.79 vs 0.68, p = .01; 0.79 vs 0.68, p = .01).

• Compared to reduced FOV IVIM DWI, ASL was a more promising technique for noninvasively predicting long-term allograft dysfunction (AUC = 0.76 vs 0.60, p = .04).

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Abbreviations

ADC:

Apparent diffusion coefficient

ASL:

Arterial spin labeling

AUC:

Area under the receiver operating characteristic curve

DWI:

Diffusion-weighted imaging

eGFR:

Estimated glomerular filtration rate

FOV:

Field of view

ICC:

Intraclass correlation coefficient

IVIM:

Intravoxel incoherent motion

RBF:

Renal blood flow

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Acknowledgements

We thank Dr. Mingchao Zhang of the National Clinical Research Center of Kidney Diseases, Nanjing University School of Medicine, Nanjing, China, for his help with analysis of the biopsy specimens.

Funding

The authors state that this work has not received any funding.

Author information

Author notes

  1. Yuan Meng Yu and Wei Wang contributed equally to this work.

Authors and Affiliations

  1. Department of Medical Imaging, Jinling Hospital, Clinical School of Southern Medical University, Nanjing, 210002, Jiangsu, China

    Yuan Meng Yu, Guang Ming Lu & Long Jiang Zhang

  2. Department of MRI, The First People’s Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, No. 157 Jinbi Road, Kunming, 650032, Yunnan, China

    Yuan Meng Yu

  3. National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing Medical University, 305 East Zhong Shan Road, Nanjing, 210002, China

    Wei Wang & Jiqiu Wen

  4. Department of Nephrology, Shanghai General Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China

    Wei Wang

  5. MR Research, GE Healthcare, Shanghai, 201203, China

    Yong Zhang

  6. Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China

    Guang Ming Lu & Long Jiang Zhang

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  1. Yuan Meng Yu
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Correspondence to Long Jiang Zhang.

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Yu, Y.M., Wang, W., Wen, J. et al. Detection of renal allograft fibrosis with MRI: arterial spin labeling outperforms reduced field-of-view IVIM. Eur Radiol 31, 6696–6707 (2021). https://doi.org/10.1007/s00330-021-07818-9

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  • DOI: https://doi.org/10.1007/s00330-021-07818-9

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