Chen Xinyi, Ge Chao, Zhang Yuling, Ma Yajie, Zhang Yuling, Li Bei, Chu Zhiqiang, Ji Qian
The First Central Clinical School, Tianjin Medical University, Tianjin, China.
Department of Radiology, Tianjin First Central Hospital, Tianjin, China.
Magn Reson Med Sci. 2024 Oct 4. doi: 10.2463/mrms.mp.2023-0148.
To evaluate the clinical value of early renal changes in type 2 diabetes mellitus (T2DM) using multiparameter MRI.
The study included 41 diabetics (normoalbuminuria: n = 23; microalbuminuria: n = 18) and 30 healthy controls. All subjects underwent intravoxel incoherent motion diffusion-weighted imaging (IVIM), blood oxygen level dependent (BOLD) and arterial spin labeling (ASL) examinations. One-way analysis of variance was used to compare MRI parameters among the three groups. Pearson correlation analysis was used to evaluate the relationship between MRI parameters and estimated glomerular filtration rate (eGFR) and albumin-creatinine ratio (ACR). Receiver operating characteristic analysis was performed to assess the diagnostic performance.
There were statistical differences in cortical D, D*, f, renal blood flow (RBF) and medulla D, D*, f, R2* among the three groups (P < 0.05). The cortical or medullary D, cortical f, and RBF were significantly positively correlated with eGFR (all P < 0.01). The cortical or medullary D, D*, f, cortical RBF were negatively correlated with ACR (all P < 0.05).To evaluate early kidney changes and degree of diabetes, cortical combined D and RBF (AUC [area under the curve] = 0.796 and 0.947, respectively) was better than single D or RBF (all P > 0.05); medullary combined D and R2* (AUC = 0.899 and 0.923, respectively) was better than single D or R2* (all P > 0.05), except single D (P = 0.005) in differentiating normoalbuminuria group from control group.
The early changes of renal diffusion and perfusion, oxygenation level, and blood flow in T2DM could be evaluated noninvasively and quantitatively using IVIM, BOLD and ASL. Renal medullary combined IVIM-derived D and BOLD-derived R2* and cortical combined IVIM-derived D and ASL-derived RBF were better for evaluating early renal changes in T2DM.
利用多参数磁共振成像（MRI）评估2型糖尿病（T2DM）早期肾脏变化的临床价值。
该研究纳入了41例糖尿病患者（正常白蛋白尿：n = 23；微量白蛋白尿：n = 18）和30例健康对照者。所有受试者均接受体素内不相干运动扩散加权成像（IVIM）、血氧水平依赖性功能磁共振成像（BOLD）和动脉自旋标记（ASL）检查。采用单因素方差分析比较三组间的MRI参数。采用Pearson相关分析评估MRI参数与估计肾小球滤过率（eGFR）和白蛋白-肌酐比值（ACR）之间的关系。进行受试者工作特征分析以评估诊断性能。
三组间皮质D、D*、f、肾血流量（RBF）以及髓质D、D*、f、R2存在统计学差异（P < 0.05）。皮质或髓质D、皮质f和RBF与eGFR显著正相关（均P < 0.01）。皮质或髓质D、D、f、皮质RBF与ACR负相关（均P < 0.05）。为评估早期肾脏变化和糖尿病程度，皮质联合D和RBF（曲线下面积[AUC]分别为0.796和0.947）优于单一的D或RBF（均P > 0.05）；髓质联合D和R2*（AUC分别为0.899和0.923）优于单一的D或R2*（均P > 0.05），但在区分正常白蛋白尿组与对照组时单一的D除外（P = 0.005）。
利用IVIM、BOLD和ASL可对T2DM患者肾脏的扩散、灌注、氧合水平及血流的早期变化进行无创性定量评估。肾髓质联合IVIM衍生的D和BOLD衍生的R2*以及皮质联合IVIM衍生的D和ASL衍生的RBF在评估T2DM早期肾脏变化方面效果更佳。
