Wang Wei, Yu Yuanmeng, Chen Jinsong, Zhang Longjiang, Li Xue
National Clinical Research Center of Kidney Diseases, Jinling Clinical Medical College of Nanjing Medical University, Nanjing, 210002, Jiangsu, China.
Department of Nephrology, Shanghai Tenth People's Hospital, Shanghai, China.
Insights Imaging. 2024 Feb 16;15(1):49. doi: 10.1186/s13244-024-01613-y.
To evaluate the added benefit of diffusion-weighted imaging (DWI) over clinical parameters in predicting kidney allograft function decline.
Data from 97 patients with DWI of the kidney allograft were retrospectively analyzed. The DWI signals were analyzed with both the mono-exponential and bi-exponential models, yielding total apparent diffusion coefficient (ADC), true diffusion (D), pseudo-diffusion (D*), and perfusion fraction (fp). Three predictive models were constructed: Model 1 with clinical parameters, Model 2 with DWI parameters, and Model 3 with both clinical and DWI parameters. The predictive capability of each model was compared by calculating the area under the receiver-operating characteristic curve (AUROC).
Forty-five patients experienced kidney allograft function decline during a median follow-up of 98 months. The AUROC for Model 1 gradually decreased with follow-up time > 40 months, whereas Model 2 and Model 3 maintained relatively stable AUROCs. The AUROCs of Model 1 and Model 2 were not statistically significant. Multivariable analysis showed that the Model 3 included cortical D (HR = 3.93, p = 0.001) and cortical fp (HR = 2.85, p = 0.006), in addition to baseline estimated glomerular filtration rate (eGFR) and proteinuria. The AUROCs for Model 3 were significantly higher than those for Model 1 at 60-month (0.91 vs 0.86, p = 0.02) and 84-month (0.90 vs 0.83, p = 0.007) follow-up.
DWI parameters were comparable to clinical parameters in predicting kidney allograft function decline. Integrating cortical D and fp into the clinical model with baseline eGFR and proteinuria may add prognostic value for long-term allograft function decline.
Our findings suggested that cortical D and fp derived from IVIM-DWI increased the performance to predict long-term kidney allograft function decline. This preliminary study provided basis for the utility of multi-b DWI for managing patients with a kidney transplant.
• Both clinical and multi-b DWI parameters could predict kidney allograft function decline. • The ability to predict kidney allograft function decline was similar between DWI and clinical parameters. • Cortical D and fp derived from IVIM-DWI increased the performance to predict long-term kidney allograft function decline.
评估弥散加权成像（DWI）在预测肾移植受者肾功能下降方面相对于临床参数的附加价值。
回顾性分析97例接受肾移植受者DWI检查的数据。采用单指数模型和双指数模型分析DWI信号，得出总表观扩散系数（ADC）、真扩散系数（D）、伪扩散系数（D*）和灌注分数（fp）。构建三个预测模型：模型1采用临床参数，模型2采用DWI参数，模型3采用临床和DWI参数。通过计算受试者工作特征曲线下面积（AUROC）比较各模型的预测能力。
45例患者在中位随访98个月期间出现肾移植受者肾功能下降。模型1的AUROC在随访时间>40个月后逐渐下降，而模型2和模型3的AUROC保持相对稳定。模型1和模型2的AUROC无统计学差异。多变量分析显示，模型3除了包括基线估计肾小球滤过率（eGFR）和蛋白尿外，还包括皮质D（HR = 3.93，p = 0.001）和皮质fp（HR = 2.85，p = 0.006）。在60个月（0.91对0.86，p = 0.02）和84个月（0.90对0.83，p = 0.007）随访时，模型3的AUROC显著高于模型1。
DWI参数在预测肾移植受者肾功能下降方面与临床参数相当。将皮质D和fp与基线eGFR和蛋白尿纳入临床模型可能会增加对长期移植肾功能下降的预后价值。
我们的研究结果表明，基于体素内不相干运动弥散加权成像（IVIM-DWI）得出的皮质D和fp提高了预测长期肾移植受者肾功能下降的效能。这项初步研究为多b值DWI在肾移植患者管理中的应用提供了依据。
• 临床和多b值DWI参数均可预测肾移植受者肾功能下降。• DWI和临床参数预测肾移植受者肾功能下降的能力相似。• 基于IVIM-DWI得出的皮质D和fp提高了预测长期肾移植受者肾功能下降的效能。
