Beck-Tölly Andrea, Eder Michael, Beitzke Dietrich, Eskandary Farsad, Agibetov Asan, Lampichler Katharina, Hamböck Martina, Regele Heinz, Kläger Johannes, Nackenhorst Maja, Böhmig Georg A
Division of Cardiovascular and Interventional Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria.
Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, Vienna, Austria.
Transplant Direct. 2020 Jul 15;6(8):e577. doi: 10.1097/TXD.0000000000001009. eCollection 2020 Aug.
Interstitial fibrosis (IF) is the common pathway of chronic kidney injury in various conditions. Magnetic resonance imaging (MRI) may be a promising tool for the noninvasive assessment of IF in renal allografts.
This prospective trial was primarily designed to investigate whether the results of T1-weighted MRI associate with the degree of IF. Thirty-two kidney transplant recipients were subjected to 1.5-Tesla MRI scans shortly before or after routine allograft biopsies. MRI parameters [T1 and T2 relaxation times; apparent diffusion coefficient (ADC)] were assessed for cortical and medullary sections.
Advanced IF (Banff ci score >1) was associated with higher cortical T1 (but not T2) values [1451 (median; interquartile range: 1331-1506) versus 1306 (1197-1321) ms in subjects with ci scores ≤1; = 0.011; receiver operating characteristic area under the curve for prediction of ci > 1: 0.76]. In parallel, T1 values were associated with kidney function and proteinuria. There was also a relationship between IF and corticomedullary differences on ADC maps (receiver operating characteristic area under the curve for prediction of ci ≤ 1: 0.79).
Our results support the use of MRI for noninvasive assessment of allograft scarring. Future studies will have to clarify the role of T1 (and ADC) mapping as a surrogate endpoint reflecting the progression of chronic graft damage.
间质纤维化（IF）是各种情况下慢性肾损伤的共同途径。磁共振成像（MRI）可能是一种用于无创评估肾移植中IF的有前景的工具。
这项前瞻性试验主要旨在研究T1加权MRI结果是否与IF程度相关。32名肾移植受者在常规移植肾活检前后不久接受了1.5特斯拉MRI扫描。对皮质和髓质部分评估MRI参数[T1和T2弛豫时间；表观扩散系数（ADC）]。
高级IF（Banff ci评分>1）与较高的皮质T1（而非T2）值相关[ci评分≤1的受试者中为1451（中位数；四分位间距：1331 - 1506）对1306（1197 - 1321）毫秒；P = 0.011；预测ci>1的曲线下受试者工作特征面积：0.76]。同时，T1值与肾功能和蛋白尿相关。IF与ADC图上的皮质髓质差异之间也存在关系（预测ci≤1的曲线下受试者工作特征面积：0.79）。
我们的结果支持使用MRI对移植肾瘢痕进行无创评估。未来的研究将必须阐明T1（和ADC）成像作为反映慢性移植肾损伤进展的替代终点的作用。
