Ni Xuefeng, Wang Wei, Li Xue, Li Yanjun, Chen Jinsong, Shi Donghong, Wen Jiqiu
National Clinical Research Center of Kidney Disease, Jinling Hospital, Medical School of Nanjing University, Nanjing, China.
National Clinical Research Center of Kidney Disease, Jinling Hospital, Nanjing Medical University, Nanjing, China.
J Magn Reson Imaging. 2020 Aug;52(2):565-574. doi: 10.1002/jmri.27071. Epub 2020 Feb 7.
Although biopsy is essential for the diagnosis and management of kidney transplant recipients, it is invasive. Intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) is a noninvasive technique that can assess both capillary perfusion and tissue diffusion.
To evaluate the capability of IVIM-DWI as a differentiation of kidney transplant patients who need clinical intervention from those who need not.
Prospective.
In all, 33 kidney transplant patients who needed clinical intervention and 19 who need not.
FIELD STRENGTH/SEQUENCE: 3.0T; IVIM-DWI with a single-shot echo planar imaging sequence.
All patients underwent kidney transplant biopsy and IVIM-DWI scans. Patients were dichotomized into those who needed clinical intervention (CHANGE group) and those who need not (Non-CHANGE group) based on biopsy results. The values of total apparent diffusion coefficient (ADC ), diffusion coefficient (D), and perfusion fraction (f) were acquired from renal cortex and medulla, respectively. The area under the curve (AUC) was calculated and compared.
Independent Student's t-test, receiver-operating characteristic curve, and Spearman correlation analysis.
All the cortical and medullary DWI parameters in the CHANGE group were significantly lower than those in the Non-CHANGE group (all P ≤ 0.012). Except for medullary fp, all DWI parameters in both the cortex and the medulla were inversely correlated with both the chronic (ρ ranging from -0.33 to -0.54, all P ≤ 0.02) and acute (ρ ranging from -0.35 to -0.60, all P ≤ 0.01) composite scores. Cortical ADC and D had the largest AUC and specificity of 0.84 and 75.8%, respectively. Combined use of cortical D and medullary fp at each optimal cutoff point yielded a specificity of 90.9%.
DWI demonstrated potential as a noninvasive biomarker to allow the stratification of patients into categories in which kidney allograft biopsy results are or are not likely to change clinical management.
1 TECHNICAL EFFICACY STAGE: 5 J. Magn. Reson. Imaging 2020;52:565-574.
尽管活检对于肾移植受者的诊断和管理至关重要，但它具有侵入性。体素内不相干运动扩散加权成像（IVIM-DWI）是一种非侵入性技术，可评估毛细血管灌注和组织扩散。
评估IVIM-DWI区分需要临床干预和不需要临床干预的肾移植患者的能力。
前瞻性研究。
总共33例需要临床干预的肾移植患者和19例不需要临床干预的肾移植患者。
场强/序列：3.0T；采用单次激发回波平面成像序列的IVIM-DWI。
所有患者均接受了肾移植活检和IVIM-DWI扫描。根据活检结果，将患者分为需要临床干预的患者（变化组）和不需要临床干预的患者（非变化组）。分别从肾皮质和髓质获取总表观扩散系数（ADC）、扩散系数（D）和灌注分数（f）的值。计算并比较曲线下面积（AUC）。
独立样本t检验、受试者操作特征曲线和Spearman相关性分析。
变化组的所有皮质和髓质DWI参数均显著低于非变化组（所有P≤0.012）。除髓质fp外，皮质和髓质的所有DWI参数均与慢性（ρ范围为-0.33至-0.54，所有P≤0.02）和急性（ρ范围为-0.35至-0.60，所有P≤0.01）综合评分呈负相关。皮质ADC和D的AUC最大，特异性分别为0.84和75.8%。在每个最佳截断点联合使用皮质D和髓质fp，特异性为90.9%。
DWI显示出作为一种非侵入性生物标志物的潜力，可将患者分层为肾移植活检结果可能或不可能改变临床管理的类别。
1 技术效能阶段：5 《磁共振成像杂志》2020年；52：565-574。
