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Diffusion-weighted magnetic resonance imaging in the evaluation of renal function: A preliminary study

La risonanza magnetica in diffusione nella valutazione della funzione renale: studio preliminare

  • Uro-Genital Radiology Radiologia Uro-Genitale
  • Published:
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Abstract

Purpose

Magnetic resonance diffusion-weighted imaging (MR-DWI) is useful to assess proton motion by the computation of an apparent diffusion coefficient (ADC). This property could be used to assess renal damage, with special regard to unilateral dysfunction. The aim of this study was to estimate the correlation between ADC and the stage of chronic renal failure (CRF) using a spin-echo echo-planar imaging (SE-EPI) sequence with the sensitivity encoding (SENSE) technique.

Materials and methods

Fourteen patients (nine men and five women, mean age 49 years, range 22–66 years) underwent an MR examination on a 1.5-T system. Seven patients had a history of hypertension or CRF, one had Takayasu disease and one had nephrovascular hypertension. Five subjects without known kidney disease were used as controls. The glomerular filtration rate (GFR) assessed by Cockcroft-Gault’s equation was used as a functional marker. The imaging protocol consisted of T1- and T2-weighted sequences followed by a SE-EPI acquisition with a diffusion gradient of 600 s/mm2 and SENSE factor 2 and pixel-by-pixel ADC map reconstruction. In five patients, the SE-EPI-DWI sequence was repeated after i.v. administration of 1 mg of furosemide.

Results

ADC was of 2.44±0.24×10−3 mm2/s in patients with normal GFR and of 2.05±0.33×10−3 mm2/s (p<0.05) in subjects with altered GFR; a significant difference was found between stage III and IV (p<0.01), whereas no differences were found between stage I and II (p=0.27) and between stage II and III (p=0.39). A good correlation was found between GFR and ADC (r=0.79; p<0.01), with no significant change after furosemide administration (p=0.7).

Conclusions

DWI is a feasible MR technique for assessing renal damage. Further studies with scintigraphic correlation are needed to confirm these results and to establish reference values for this imaging technique.

Riassunto

Scopo

La risonanza magnetica (RM) in diffusione (diffusion weighted, DW) permette di ottenere dati quantitativi sul movimento dei protoni liberi di acqua determinando il coefficiente di diffusione apparente (apparent diffusion coefficient, ADC). Questa capacità potrebbe essere usata per stabilire il danno parenchimale renale, in particolare nelle disfunzione unilaterali. Scopo del presente lavoro è quello di valutare la correlazione tra ADC e grado di insufficienza renale cronica utilizzando una sequenza SE Eco-planare (SS-EPI) a cui è stato applicato la tecnica di SENSitivity Encoding (SENSE).

Materiali e metodi

Quattordici pazienti (9 maschi e 5 femmine, età media 49 anni, range 22–66) sono stati sottoposti ad esame RM con sistema ad alto campo 1,5 T; in 5 pazienti non vi erano dati anamnestici e bioumorali di nefropatia, mentre in 7 era presente storia di ipertensione arteriosa e/o IRC ingravescente, in 1 di malattia di Takayasu e in 1 di ipertensione nefrovascolare. Il protocollo prevedeva acquisizioni T1 e T2 dipendenti, nonché una sequenza SE-EPI pesata in diffusione (b-factor 600 s/mm2) con fattore SENSE 2 e ricostruzione di mappe dell’ADC. In 5 casi la SS-EPI-DW è stata ripetuta dopo somministrazione di furosemide. Il filtrato glomerulare è stato ottenuto mediante metodo di Cockroft-Gault.

Risultati

L’ADC nei soggetti normali ed i pazienti in stadio I è stato di 2,44±0,24×10−3 mm2/s, mentre quello dei pazienti in stadio II–IV è stato di 2,05±0,33×10−3 mm2/s (p<0,05). Non è stata rilevata una differenza significativa dell’ADC tra stadio I e stadio II (p=0,27) e tra stadio II e stadio III (p=0,39), mentre la differenza è stata significativa tra pazienti in stadio III e IV(p<0,01). Si è rilevata una significativa correlazione tra la clearance della creatinina (ClCr(CG)) e l’ ADC parenchimale (r=0,79; p<0,01). La furosemide non ha determinato modificazioni dell’ADC (p=0,7).

Conclusioni

La RM-DW permette di ottenere valori quantitativi del coefficiente di diffusione correlabili con la funzione renale separata, senza somministrare mezzo di contrasto e con rapidi tempi d’esame. Ulteriori studi di correlazione con i dati scintigrafici e su più ampie casistiche sono necessari al fine di confermare tali risultati e stabilire valori di riferimento per questa metodica.

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Authors and Affiliations

  1. DAI dell’Immagine, S.C. Radiologia Universitaria, I-53100, Siena, Italy

    S. F. Carbone, V. Ricci, F. Mazzei, M. A. Mazzei & L. Volterrani

  2. U.O. Nefrologia, Azienda Ospedaliero-Senese, Policlinico S. Maria alle Scotte, I-53100, Siena, Italy

    E. Gaggioli

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  1. S. F. Carbone
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  2. E. Gaggioli
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  3. V. Ricci
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  4. F. Mazzei
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  5. M. A. Mazzei
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  6. L. Volterrani
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Correspondence to S. F. Carbone.

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Carbone, S.F., Gaggioli, E., Ricci, V. et al. Diffusion-weighted magnetic resonance imaging in the evaluation of renal function: A preliminary study. Radiol med 112, 1201–1210 (2007). https://doi.org/10.1007/s11547-007-0217-6

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  • DOI: https://doi.org/10.1007/s11547-007-0217-6

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