Wen Deying, Liang Ailin, Du Qinglin, Li Wen, Zhao Ling, Qiu Yue, Wang Tengxin, Li Zheng, Liang Huilou, Zhang Bo, Ren Yan, Sun Jiayu
West China Hospital of Sichuan University, Chengdu, China.
GE Healthcare, MR Research, Beijing, China.
Abdom Radiol (NY). 2025 Aug 18. doi: 10.1007/s00261-025-05168-4.
To utilize multiparametric diffusion-weighted imaging (DWI) to detect and quantify renal microstructural alterations in patients with primary aldosteronism (PA) at varying direct renin concentrations (DRC), and to explore the correlations between DWI-derived biomarkers and renal function biochemical indices.
This study included 50 patients and 32 healthy controls (HCs). Participants underwent 3.0 T MRI using monoexponential, intravoxel incoherent motion, and stretched-exponential DWI models. Two observers independently analyzed diffusion parameters, including apparent diffusion coefficient (ADC), fraction of fast diffusion (f), slow diffusion coefficient (Ds), fast diffusion coefficient (Df), distributed diffusion coefficient (DDC), and anomalous exponent (α). Group comparisons were conducted using t-tests, Mann-Whitney U tests, or ANOVA; receiver operating characteristic (ROC) curve analysis was used. Correlations between diffusion parameters and renal function biomarkers were analyzed using Pearson or Spearman correlation tests.
Compared to HCs, PA patients with abnormal DRC exhibited significantly lower cortical and medullary ADC, f, and DDC values and higher cortical α. ROC analysis demonstrated that combining these parameters achieved an AUC of 0.884 with 90.0% sensitivity and 81.5% specificity for distinguishing DRC-abnormal patients from HCs. Medullary f was reduced in the abnormal DRC group versus normal DRC group. The ROC analysis for distinguishing these two groups yielded an AUC of 0.790, with a sensitivity of 85.30% and a specificity of 62.50%. Correlations showed an inverse relationship between medullary Ds and creatinine, a positive correlation between medullary f and uric acid, and a negative correlation of cortical DDC with creatinine and cystatin C.
Multiparametric DWI enables precise detection and quantification of renal microstructural abnormalities in PA patients. Patients with abnormal DRC exhibit more pronounced renal microstructural alterations compared to DRC-normal group. Notably, observed correlations between specific diffusion metrics and renal function biomarkers underscore their potential clinical applicability for non-invasive monitoring of PA-associated renal injury.
利用多参数扩散加权成像（DWI）检测并量化原发性醛固酮增多症（PA）患者在不同直接肾素浓度（DRC）下的肾脏微观结构改变，并探讨DWI衍生生物标志物与肾功能生化指标之间的相关性。
本研究纳入50例患者和32名健康对照者（HCs）。参与者接受3.0 T磁共振成像，采用单指数、体素内不相干运动和拉伸指数DWI模型。两名观察者独立分析扩散参数，包括表观扩散系数（ADC）、快速扩散分数（f）、慢速扩散系数（Ds）、快速扩散系数（Df）、分布扩散系数（DDC）和异常指数（α）。采用t检验、曼-惠特尼U检验或方差分析进行组间比较；使用受试者操作特征（ROC）曲线分析。采用Pearson或Spearman相关检验分析扩散参数与肾功能生物标志物之间的相关性。
与HCs相比，DRC异常的PA患者皮质和髓质的ADC、f和DDC值显著降低，皮质α升高。ROC分析表明，联合这些参数区分DRC异常患者与HCs的曲线下面积（AUC）为0.884，灵敏度为90.0%，特异度为81.5%。异常DRC组的髓质f低于正常DRC组。区分这两组的ROC分析AUC为0.790，灵敏度为85.30%，特异度为62.50%。相关性分析显示，髓质Ds与肌酐呈负相关，髓质f与尿酸呈正相关，皮质DDC与肌酐和胱抑素C呈负相关。
多参数DWI能够精确检测和量化PA患者的肾脏微观结构异常。与DRC正常组相比，DRC异常患者的肾脏微观结构改变更为明显。值得注意的是，特定扩散指标与肾功能生物标志物之间的相关性表明，它们在无创监测PA相关肾损伤方面具有潜在的临床应用价值。
