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Capability of intravoxel incoherent motion and diffusion tensor imaging to detect early kidney injury in type 2 diabetes

  • Magnetic Resonance
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Abstract

Objectives

To prospectively investigate the capability of intravoxel incoherent motion (IVIM) and conventional diffusion tensor imaging (DTI) to identify early kidney function injury in type 2 diabetes.

Methods

Forty-one diabetes patients (normoalbuminuria: n = 27; microalbuminuria: n = 14) and 28 volunteers were recruited. All participants were examined using DTI and IVIM with 3.0-T MRI. DTI parameters (mean diffusivity [MD], fractional anisotropy [FA]), and IVIM parameters (true diffusion coefficient [D], pseudo-diffusion coefficient [D*], and pseudo-diffusion component fraction [f]) were measured in the renal parenchyma (cortex and medulla) by two experienced radiologists independently. Image features were compared among the groups using separate one-way analyses of variance. Diagnostic performances of various diffusion parameters for predicting diabetic renal damage were compared.

Results

The medullary D and FA values were significantly different among the microalbuminuria subgroup, normoalbuminuria subgroup, and control group (all p < 0.001). In medulla, area under the curve (AUC) values for combined FA and D were significantly higher than single FA (AUC = 0.938, 0.769, respectively; p = 0.003), and the combined AUC of FA and D was numerically higher than that of single D (0.938 vs 0.878, p > 0.05). AUC of combined FA and D was 0.985, not significantly different from individual AUC for FA and D (AUC = 0.909 and 0.952, respectively; all p > 0.05) in differentiating the microalbuminuria subgroup from the control group.

Conclusion

IVIM-derived D and DTI-derived FA values were better than other parameters for evaluating early kidney impairment of diabetes. The single indicator FA and D performed as well as the combined diagnostic indicator in the medulla for differentiating the microalbuminuria subgroup from the control group.

Key Points

• We speculated that early renal progression in type 2 diabetes result from restricted tubular flow and kidney tubule dysregulation may precede or at least accompany abnormal glomerular changes.

• In medulla, the AUC values of FA and D and the combination of FA and D obtained by comparing the microalbuminuria subgroup with the control group were 0.909, 0.952, and 0.985, respectively.

• IVIM-derived D and DTI-derived FA are effective MR biomarkers to evaluate early alterations of the renal function in patients with diabetes.

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Abbreviations

ACR:

Albumin-to-creatinine rate

AUC:

Area under the curve

D :

True diffusion coefficient

D*:

Pseudo-diffusion coefficient

DTI:

Diffusion tensor imaging

DWI:

Diffusion-weighted imaging

eGFR:

Estimated glomerular filtration rate

f :

Pseudo-diffusion component fraction

FA:

Fractional anisotropy

FOV:

Field of view

HbA1c:

Glycosylated hemoglobin

IVIM:

Intravoxel incoherent motion

MD:

Mean diffusivity

ROC:

Receiver operating characteristic curve

ROI:

Region of interest

TE:

Echo time

TR:

Repetition time

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Acknowledgements

We would like to thank Editage (www.editage.cn) for the English language editing.

Funding

This study has received funding by the National Natural Science Foundation of China (Grant 82071886) and the Scientific Research Foundation for Advanced Talents, Xiang’an Hospital of Xiamen University (no. PM201809170011).

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Authors and Affiliations

  1. Department of Radiology, Xiang’an Hospital of Xiamen University, Xiamen, 361005, China

    Haoran Zhang, Dafa Shi, Xiang Yao, Yanfei Li, Xuedan Liu, Yang Sun, Jie Ding, Siyuan Wang, Guangsong Wang & Ke Ren

  2. Department of Radiology, The First Hospital of China Medical University, Shenyang, China

    Peng Wang

  3. Xiamen Key Laboratory of Endocrine-Related Cancer Precision Medicine, Xiamen, China

    Ke Ren

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  1. Haoran Zhang
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Correspondence to Ke Ren.

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The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

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Zhang, H., Wang, P., Shi, D. et al. Capability of intravoxel incoherent motion and diffusion tensor imaging to detect early kidney injury in type 2 diabetes. Eur Radiol 32, 2988–2997 (2022). https://doi.org/10.1007/s00330-021-08415-6

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