Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan.
Department of Electrical Engineering, National Chung-Hsing University, Taiwan.
Biomed Res Int. 2022 Oct 18;2022:2832996. doi: 10.1155/2022/2832996. eCollection 2022.
A non-invasive way of assessing post-transplant renal graft function has been needed. This study aimed to assess the micro-structural and micro-functional status of graft kidneys by using intravoxel incoherent motion- (IVIM-) diffusion-weighted imaging (DWI) to investigate delayed graft function (DGF) immediately after transplantation.
A prospective study was conducted on 37 patients, 14 with early graft function (EGF) and 23 with DGF (9 with complication, 14 without) who underwent IVIM-DWI, most often within 1-7 days after kidney transplantation. A total of 37 cases were collected and all the participants have been well-informed and signed their consents. In addition, the study conducted in this paper was approved by the Ethics Committee of Clinical Research, Taichung Veterans General Hospital (IRB number: CE14065). Using biexponential analysis of slow diffusion coefficient ( ), fast diffusion coefficient ( ), and perfusion fraction was performed. The apparent diffusion coefficient (ADC) was calculated by use of a monoexponential model. All parameters were measured from three different regions-of-interest (ROI), covering the entire renal parenchyma, cortex, and medulla.
, perfusion fraction, and ADC were significantly higher in patients with EGF than DGF (all values values <0.001). Especially, ADC measured from ROI covering the entire kidney parenchyma had the best cut-off value (1.93m/msec) with the highest area under the receiver operating characteristic curve (AUC 0.943) in differentiating EGF from DGF. For analysis of pair-wise differences, only the perfusion fraction values, measured from the ROI covering the renal cortex, were significantly higher in 14 DGF patients with no complications than in the 9 DGF patients with complications, with the best cut-off value of 12.3% and the AUC of 0.844.
Noninvasive IVIM-DWI reliably differentiates DGF from EGF after kidney transplantation, and it may aid in identifying posttransplant complications and indications for renal biopsy.
需要一种非侵入性的方法来评估移植后肾脏的功能。本研究旨在通过体素内不相干运动（IVIM）扩散加权成像（DWI）评估移植后即刻移植物的微观结构和微观功能状态，以研究延迟移植物功能（DGF）。
对 37 例患者进行前瞻性研究，14 例为早期移植物功能（EGF），23 例为 DGF（9 例合并并发症，14 例无并发症），这些患者经常在肾移植后 1-7 天内进行 IVIM-DWI。共收集 37 例，所有参与者均知情同意并签署知情同意书。此外，本文进行的研究得到了台中荣民总医院临床研究伦理委员会的批准（IRB 编号：CE14065）。采用双指数分析慢扩散系数（）、快扩散系数（）和灌注分数。使用单指数模型计算表观扩散系数（ADC）。所有参数均由三个不同的感兴趣区（ROI）测量，包括整个肾实质、皮质和髓质。
EGF 患者的、灌注分数和 ADC 均显著高于 DGF 患者（所有 P 值均<0.001）。特别是，覆盖整个肾实质的 ROI 测量的 ADC 具有最佳截断值（1.93m/msec），ROC 曲线下面积（AUC）最高（0.943），可区分 EGF 与 DGF。对于两两比较分析，仅在无并发症的 14 例 DGF 患者中，覆盖肾皮质 ROI 的灌注分数值显著高于有并发症的 9 例 DGF 患者，最佳截断值为 12.3%，AUC 为 0.844。
IVIM-DWI 可无创可靠地区分肾移植后 DGF 与 EGF，有助于识别移植后并发症和肾活检指征。
