Role of Diffusion Tensor Imaging in Functional Assessment of Transplant Kidneys at 3-Tesla MRI

Abstract

Objectives The main purpose of this article is to measure the fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values of cortex and medulla of renal allograft using 3-Tesla diffusion tensor imaging (DTI) in renal transplant patients with normal and graft dysfunction and to assess the correlation between diffusion tensor parameters (ADC and FA) and the estimated glomerular filtration rate (eGFR) value.

Materials and Methods Fifty renal transplant recipients who received either living or cadaveric renal allografts were included in the study. Blood samples for serum creatinine and eGFR value were taken on the same day prior to the magnetic resonance study and the patients were assigned to three groups (A, B, C) according to allograft function (eGFR levels). The mean ADC and FA values of the cortex/medulla in upper, mid, and lower poles were calculated from the DTI sequence. Statistical analysis was performed using paired sample Student’s t-test and one-way analysis of variance test.

Results The mean ADC values of the cortex were higher than the medulla that was statistically significant. However, the mean FA values were significantly higher in the medulla than the cortex. Mean ADCs and FA of the renal cortex and medulla were significantly higher in group A patients with normal renal function than in group B and C with poor renal functions. The corticomedullary difference in the FA values was more in group A. However, this difference was lower in group B and more so in group C.

Conclusion ADC and FA values in the renal cortex and medulla exhibit a good correlation with allograft function and were significantly lower in transplants with dysfunction than those with good function. FA values appear to be more sensitive than eGFR and ADC for detection of early pathological changes in the graft dysfunction.

Keywords

diffusion tensor imaging - functional assessment - transplant kidneys

Publication History

Article published online:
18 May 2020

• References

• 1 Abecassis M, Bartlett ST, Collins AJ. et al. Kidney transplantation as primary therapy for end-stage renal disease: a National Kidney Foundation/Kidney Disease Outcomes Quality Initiative (NKF/KDOQITM) conference. Clin J Am Soc Nephrol 2008; 3 (02) 471-480
• 2 Agarwal SK, Srivastava RK. Chronic kidney disease in India: challenges and solutions. Nephron Clin Pract 2009; 111 (03) c197-c203, discussion c203
• 3 Sund S, Reisaeter AV, Fauchald P, Bentdal O, Hall KS, Hovig T. Living donor kidney transplants: a biopsy study 1 year after transplantation, compared with baseline changes and correlation to kidney function at 1 and 3 years. Nephrol Dial Transplant 1999; 14 (10) 2445-2454
• 4 Michaely HJ, Sourbron S, Dietrich O, Attenberger U, Reiser MF, Schoenberg SO. Functional renal MR imaging: an overview. Abdom Imaging 2007; 32 (06) 758-771
• 5 Laissy JP, Idée JM, Fernandez P, Floquet M, Vrtovsnik F, Schouman-Claeys E. Magnetic resonance imaging in acute and chronic kidney diseases: present status. Nephron Clin Pract 2006; 103 (02) c50-c57
• 6 Thoeny HC, Zumstein D, Simon-Zoula S. et al. Functional evaluation of transplanted kidneys with diffusion-weighted and BOLD MR imaging: initial experience. Radiology 2006; 241 (03) 812-821
• 7 Chandarana H, Lee VS. Renal functional MRI: are we ready for clinical application. ? AJR Am J Roentgenol 2009; 192 (06) 1550-1557
• 8 Eisenberger U, Thoeny HC, Binser T. et al. Evaluation of renal allograft function early after transplantation with diffusion-weighted MR imaging. Eur Radiol 2010; 20 (06) 1374-1383
• 9 Blondin D, Lanzman RS, Klasen J. et al. Diffusion-attenuated MRI signal of renal allografts: comparison of two different statistical models. AJR Am J Roentgenol 2011; 196 (06) W701-5
• 10 Thoeny HC, De Keyzer F, Oyen RH, Peeters RR. Diffusion-weighted MR imaging of kidneys in healthy volunteers and patients with parenchymal diseases: initial experience. Radiology 2005; 235 (03) 911-917
• 11 Notohamiprodjo M, Dietrich O, Horger W. et al. Diffusion tensor imaging (DTI) of the kidney at 3 Tesla-feasibility, protocol evaluation and comparison to 1.5 Tesla. Invest Radiol 2010; 45 (05) 245-254
• 12 Zheng Z, Shi H, Zhang J, Zhang Y. Renal water molecular diffusion characteristics in healthy native kidneys: assessment with diffusion tensor MR imaging. PLoS One 2014; 9 (12) e113469
• 13 Blondin D, Lanzman RS, Mathys C. et al. [Functional MRI of transplanted kidneys using diffusion-weighted imaging]. RoFo Fortschr Geb Rontgenstr Nuklearmed 2009; 181 (12) 1162-1167
• 14 Abou-El-Ghar ME, El-Diasty TA, El-Assmy AM, Refaie HF, Refaie AF, Ghoneim MA. Role of diffusion-weighted MRI in diagnosis of acute renal allograft dysfunction: a prospective preliminary study. Br J Radiol 2012; 85 (1014) e206-e211
• 15 Kaul A, Sharma RK, Gupta RK. et al. Jaisuresh. Assessment of allograft function using diffusion-weighted magnetic resonance imaging in kidney transplant patients. Saudi J Kidney Dis Transpl 2014; 25 (06) 1143-1147
• 16 Lanzman RS, Ljimani A, Pentang G. et al. Kidney transplant: functional assessment with diffusion-tensor MR imaging at 3T. Radiology 2013; 266 (01) 218-225
• 17 Hueper K, Gutberlet M, Rodt T. et al. Diffusion tensor imaging and tractography for assessment of renal allograft dysfunction-initial results. Eur Radiol 2011; 21 (11) 2427-2433
• 18 Fukuda Y, Ohashi I, Hanafusa K. et al. Anisotropic diffusion in kidney: apparent diffusion coefficient measurements for clinical use. J Magn Reson Imaging 2000; 11 (02) 156-160