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Selection for biopsy of kidney transplant patients by diffusion-weighted MRI

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Abstract

Objectives

To assess retrospectively whether diffusion-weighted magnetic resonance imaging (DW-MRI) allows physicians to determine the severity of histopathologic findings in biopsies of renal allograft patients with deteriorating renal function.

Methods

Forty consecutive kidney transplant patients underwent DW-MRI and biopsy. Patients were assigned to one group with severe and to another group with normal or mild histopathologic findings. These two groups were compared based on a qualitative DW-MRI assessment (homo-/heterogeneity) and the combination of qualitative and quantitative DW-MRI parameters (ADC, and intravoxel incoherent motion, IVIM, parameters: D, f, D*). Sensitivity, specificity, and accuracy were determined for each parameter.

Results

Biopsy findings were severe in 25 patients and normal or mild in 15 patients. Qualitative DW-MRI led to a sensitivity of 44.0% and a specificity of 93.3%. Combined qualitative and quantitative DW-MRI led to an accuracy of 80% for both the minimal ADC (ADCmin) and the minimal perfusion fraction (fmin) with a sensitivity of 84.0% and 92.0% and a specificity of 73.3% and 60.0%, respectively.

Conclusion

Combined qualitative and quantitative DW-MRI might allow physicians to determine the severity of histopathologic findings in biopsies of a high number of kidney transplant patients.

Key points

• Qualitative DW-MRI is highly specific when predicting the severity of kidney transplant biopsy.

• Allografts appearing heterogeneous on ADC are associated with severe histopathologic findings.

• Combining qualitative and quantitative DW-MRI parameters improves the classification’s sensitivity and accuracy.

• Kidney transplant biopsies might be spared by combining qualitative and quantitative DW-MRI.

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Abbreviations

DW-MRI:

Diffusion-weighted MRI

Mild histopathologic changes:

Grade I interstitial fibrosis and tubular atrophy

Severe histopathologic changes:

Grades II-III interstitial fibrosis and tubular atrophy rejection, and other changes not due to rejection such as glomerulonephritis, IgA nephropathy, BK virus nephropathy, acute tubular necrosis, and cyclosporine toxicity

ADC:

Apparent diffusion coefficient

IVIM:

Intravoxel incoherent motion

f :

Perfusion fraction

D* :

Pseudo-diffusion coefficient

D :

True diffusion coefficient

s-Crea:

Serum creatinine

ROIs:

Regions of interest

ROC:

Receiver operating characteristic

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Acknowledgements

We would like to thank Peter Vermathen; PhD for setting up the MRI protocols.

Author information

Authors and Affiliations

  1. Department of Radiology, Neuroradiology, and Nuclear Medicine, Institute of Diagnostic, Pediatric, and Interventional Radiology, Inselspital, Bern University Hospital, University of Bern, Inselspital, Freiburgstrasse 10, CH-3010, Bern, Switzerland

    Philipp Steiger, Sebastiano Barbieri, Michael Ith & Harriet C. Thoeny

  2. Department of Nephrology and Hypertension, Inselspital, Bern University Hospital, University of Bern, Inselspital, Freiburgstrasse 10, CH-3010, Bern, Switzerland

    Anja Kruse

Authors
  1. Philipp Steiger
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  2. Sebastiano Barbieri
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  3. Anja Kruse
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  4. Michael Ith
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  5. Harriet C. Thoeny
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Corresponding author

Correspondence to Harriet C. Thoeny.

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Guarantor

The scientific guarantor of this publication is Harriet C. Thoeny.

Conflict of interest

The authors of this manuscript declare no relationships with commercial companies.

Funding

The authors state that this work has not received any funding.

Statistics and biometry

S. Barbieri and M. Ith kindly provided statistical advice for this manuscript.

Both of the authors do have statistical expertise.

No complex statistical methods were necessary for this paper.

Ethical approval

Institutional Review Board approval was obtained.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Methodology

• retrospective

• diagnostic or prognostic study/observational/experimental

• performed at one institution

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Steiger, P., Barbieri, S., Kruse, A. et al. Selection for biopsy of kidney transplant patients by diffusion-weighted MRI. Eur Radiol 27, 4336–4344 (2017). https://doi.org/10.1007/s00330-017-4814-z

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  • DOI: https://doi.org/10.1007/s00330-017-4814-z

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