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Early detection of subclinical pathology in patients with stable kidney graft function by arterial spin labeling

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Abstract

Objectives

To evaluate the utility of arterial spin labeling (ASL) for the identification of kidney allografts with underlying pathologies, particularly those with stable graft function.

Methods

A total of 75 patients, including 18 stable grafts with normal histology (normal group), 21 stable grafts with biopsy-proven pathology (subclinical pathology group), and 36 with unstable graft function (unstable graft group), were prospectively examined by ASL magnetic resonance imaging. Receiver operating characteristic curves were generated to calculate the area under the curve (AUC), sensitivity, and specificity.

Results

Patient demographics among the 3 groups were comparable. Compared with the normal group, kidney allograft cortical ASL values decreased in the subclinical pathology group and the unstable graft group (204.7 ± 44.9 ml/min/100 g vs 152.5 ± 38.9 ml/min/100 g vs 92.3 ± 37.4 ml/min/100 g, p < 0.001). The AUC, sensitivity, and specificity for discriminating allografts with pathologic changes from normal allografts were 0.92 (95% CI, 0.83–0.97), 71.9%, and 100% respectively by cortical ASL and 0.82 (95% CI, 0.72–0.90), 54.4%, and 100% respectively by serum creatinine. The cortical ASL identified allografts with subclinical pathology among patients with stable graft function with an AUC of 0.80 (95% CI, 0.64–0.91), sensitivity of 57.1%, and specificity of 88.9%. Combined use of proteinuria and cortical ASL could improve the sensitivity and specificity to 76.2% and 100% respectively for distinguishing the subclinical pathology group from the normal group.

Conclusions

Cortical ASL is useful for the identification of allografts with underlying pathologies. More importantly, ASL showed promise as a non-invasive tool for the clinical translation of identifying kidney allografts with subclinical pathology.

Key Points

• Cortical ASL values were decreased in kidney allografts with subclinical pathologic changes as compared with normal allografts (152.5 ± 38.9 ml/min/100 g vs 204.7 ± 44.9 ml/min/100 g, p < 0.001).

• Cortical ASL differentiated allografts with pathologic changes and subclinical pathology group from normal group with an AUC of 0.92 (95% CI, 0.83–0.97) and 0.80 (95% CI, 0.64–0.91) respectively.

• Cortical ASL discriminated allografts with underlying pathologic changes from normal allografts with a specificity of 100%, and combined use of proteinuria and cortical ASL values could also achieve 100% specificity for discriminating allografts with subclinical pathology from normal allografts.

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Abbreviations

ASL:

Arterial spin labeling

AUC:

Area under the curve

CI:

Confidence interval

eGFR:

Estimated glomerular filtration rate

MRI:

Magnetic resonance imaging

ROC:

Receiver operating characteristic

ROI:

Region of interest

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Funding

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

Author information

Author notes

  1. Wei Wang and Yuanmeng Yu contributed equally to this work.

Authors and Affiliations

  1. National Clinical Research Center of Kidney Diseases, Jinling Hospital, Medical School of Nanjing University, 305 Zhongshan East Road, Xuanwu District, Nanjing, 210002, Jiangsu Province, China

    Wei Wang, Xue Li, Jinsong Chen & Jiqiu Wen

  2. Department of Nephrology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, China

    Wei Wang

  3. Department of Medical Imaging, Jinling Hospital, Clinical School of Southern Medical University, Nanjing, 210002, Jiangsu Province, China

    Yuanmeng Yu

  4. Department of MRI, The First People’s Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, 650032, Yunnan, China

    Yuanmeng Yu

  5. MR Research, GE Healthcare, Shanghai, China

    Yong Zhang

  6. Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu Province, China

    Longjiang Zhang

Authors
  1. Wei Wang
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Corresponding author

Correspondence to Jiqiu Wen.

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The scientific guarantor of this publication is Jiqiu Wen.

Conflict of interest

One of the authors of this manuscript (Yong Zhang) is an employee of GE Healthcare. The remaining authors declare no relationships with any companies whose products or services may be related to the subject matter of the article.

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No complex statistical methods were necessary for this paper.

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Written informed consent was obtained from all participating patients.

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Institutional Review Board approval was obtained.

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• performed at one institution

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Wang, W., Yu, Y., Li, X. et al. Early detection of subclinical pathology in patients with stable kidney graft function by arterial spin labeling. Eur Radiol 31, 2687–2695 (2021). https://doi.org/10.1007/s00330-020-07369-5

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  • DOI: https://doi.org/10.1007/s00330-020-07369-5

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