Bura Andrejus, Stonciute-Balniene Gintare, Velickiene Laura, Bumblyte Inga Arune, Vaiciuniene Ruta, Jankauskas Antanas
Nephrology Department, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania.
Radiology Department, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania.
Medicina (Kaunas). 2025 Jul 13;61(7):1268. doi: 10.3390/medicina61071268.
: Non-invasive imaging biomarkers for the early detection of chronic kidney allograft injury are needed to improve long-term transplant outcomes. T1 mapping by magnetic resonance imaging (MRI) has emerged as a promising method to assess renal structure and function. This study aimed to determine the potential of MRI as a diagnostic tool for evaluating graft function and structural changes in kidney grafts 1 year after transplantation. : Thirty-four kidney transplant recipients were prospectively recruited, with 27 completing the follow-up at one year. Renal MRI at 3T was performed to acquire T1, T2, and apparent diffusion coefficient (ADC) maps. Clinical parameters, including estimated glomerular filtration rate (eGFR), albumin-to-creatinine ratio (ACR), protein-to-creatinine ratio (PCR), and histological IF/TA scores, were collected. MRI parameters were compared across the groups stratified by clinical and histological markers. Diagnostic accuracy was assessed using receiver operating characteristic (ROC) analysis. : At 1 year, T1 corticomedullary differentiation (CMD) values were significantly higher in patients with elevated ACR (≥3 mg/mmol), PCR (≥15 mg/mmol), and mild to moderate or severe IF/TA, reflecting a reduction in the corticomedullary gradient. T1 CMD demonstrated moderate-to-good diagnostic performance in detecting ACR (AUC 0.791), PCR (AUC 0.730), and IF/TA (AUC 0.839). No significant differences were observed in T2 or ADC values across these groups. T1 CMD also showed a significant positive correlation with ACR but not with eGFR, suggesting a closer association with structural rather than functional deterioration. : T1 mapping, particularly T1 CMD, shows promise as a non-invasive imaging biomarker for detecting chronic allograft injury and monitoring renal function 1 year after kidney transplantation.
为改善长期移植结果，需要用于早期检测慢性肾移植损伤的非侵入性成像生物标志物。磁共振成像（MRI）的T1映射已成为评估肾脏结构和功能的一种有前景的方法。本研究旨在确定MRI作为评估移植肾移植后1年移植物功能和结构变化的诊断工具的潜力。：前瞻性招募了34名肾移植受者，其中27名在1年后完成随访。在3T下进行肾脏MRI以获取T1、T2和表观扩散系数（ADC）图。收集临床参数，包括估计肾小球滤过率（eGFR）、白蛋白与肌酐比值（ACR）、蛋白质与肌酐比值（PCR）以及组织学IF/TA评分。在按临床和组织学标志物分层的组间比较MRI参数。使用受试者操作特征（ROC）分析评估诊断准确性。：在1年时，ACR（≥3mg/mmol）、PCR（≥15mg/mmol）以及轻度至中度或重度IF/TA患者的T1皮质髓质分化（CMD）值显著更高，反映皮质髓质梯度降低。T1 CMD在检测ACR（AUC 0.791）、PCR（AUC 0.730）和IF/TA（AUC 0.839）方面表现出中度至良好的诊断性能。这些组间在T2或ADC值上未观察到显著差异。T1 CMD也与ACR呈显著正相关，但与eGFR无相关性，表明与结构而非功能恶化的关联更紧密。：T1映射，尤其是T1 CMD，有望作为一种非侵入性成像生物标志物，用于检测肾移植后1年的慢性移植物损伤并监测肾功能。
