Department of Medical Imaging, Jinling Hospital, Clinical School of Southern Medical University, Nanjing, 210002, Jiangsu, China.
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.
Eur Radiol. 2021 Sep;31(9):6696-6707. doi: 10.1007/s00330-021-07818-9. Epub 2021 Mar 18.
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.
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 (ADC), 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.
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 ADC (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).
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.
• 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).
比较缩小视野（FOV）下体素内不相干运动（IVIM）扩散加权成像（DWI）和动脉自旋标记（ASL）在评估肾移植纤维化和预测长期功能障碍方面的价值。
本前瞻性研究纳入了 175 例接受缩小 FOV IVIM DWI、ASL 和活检的肾移植受者。根据活检结果，将肾移植纤维化分为 ci0、ci1、ci2 和 ci3 纤维化。共 83 例参与者随访中位数为 39（IQR，21-42）个月，根据随访估算肾小球滤过率将其分为稳定和受损的移植肾功能组。计算并比较总表观扩散系数（ADC）、纯扩散 ADC、假性灌注 ADC、IVIM DWI 的灌注分数 f 和 ASL 的肾血流（RBF）。计算受试者工作特征曲线（ROC）的曲线下面积（AUC）以评估诊断和预测性能。
ci0 与 ci1（147.9±46.3 与 126.0±49.4 ml/min/100 g，p =.02）和 ci2 与 ci3（92.9±46.9 与 70.8±37.8 ml/min/100 g，p =.03）之间的 RBF 不同。稳定组的 RBF 高于受损组（144.73±49.33 与 102.19±47.58 ml/min/100 g，p <.001）。RBF 在区分肾移植纤维化和预测长期移植肾功能障碍方面的 AUC 高于皮质 ADC（ci0 与 ci1-3，0.76 与 0.59，p <.001；ci0-1 与 ci2-3，0.79 与 0.68，p =.01；ci0-2 与 ci3，0.79 与 0.68，p =.01；0.76 与 0.60，p =.04，分别）。
与缩小 FOV IVIM DWI 相比，ASL 是一种更有前途的技术，可用于无创性区分肾移植纤维化程度和预测长期移植肾功能障碍。
与 rFOV IVIM DWI 的总 ADC 相比，ASL 的 RBF 可区分无纤维化（ci0）与轻度纤维化（ci1）（p =.02）和中度纤维化（ci2）与重度纤维化（ci3）（p =.04）。
RBF 在区分纤维化（无纤维化[ci0]与纤维化[ci1-3]、轻度纤维化[ci0-1]与中度至重度纤维化[ci2-3]、非严重纤维化[ci0-2]与严重纤维化[ci3]方面的表现优于扩散参数，p <.001；0.79 与 0.68，p =.01；0.79 与 0.68，p =.01）。
与缩小 FOV IVIM DWI 相比，ASL 是一种更有前途的技术，可用于无创性预测长期移植肾功能障碍（AUC = 0.76 与 0.60，p =.04）。
