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Evaluation of interstitial fibrosis in chronic kidney disease by multiparametric functional MRI and histopathologic analysis

  • Magnetic Resonance
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

To investigate the diagnostic value of functional MRI to assess renal interstitial fibrosis in patients with chronic kidney disease (CKD).

Methods

We prospectively recruited 80 CKD patients who underwent renal biopsies and 16 healthy volunteers to undergo multiparametric functional MRI examinations. The Oxford MEST-C classification was used to score the interstitial fibrosis. The diagnostic performance of functional MRI to discriminate interstitial fibrosis was evaluated by calculating the area under the receiver operating characteristic (ROC) curves.

Results

IgA nephropathy (60%) accounted for the majority of pathologic type in the CKD patients. Apparent diffusion coefficient (ADC) from diffusion-weighted imaging (DWI) was correlated with interstitial fibrosis (rho = −0.73). Decreased renal blood flow (RBF) derived from arterial spin labeling (rho = −0.78) and decreased perfusion fraction (f) derived from DWI (rho = −0.70) were accompanied by increased interstitial fibrosis. The T1 value from T1 mapping correlated with interstitial fibrosis (rho = 0.67) (all p < 0.01). The areas under the ROC curve for the discrimination of ≤ 25% vs. > 25% and ≤ 50% vs. > 50% interstitial fibrosis were 0.87 (95% confidence interval, 0.78 to 0.94) and 0.93 (0.86 to 0.98) by ADC, 0.84 (0.74 to 0.91) and 0.94 (0.86 to 0.98) by f, 0.93 (0.85 to 0.98) and 0.90 (0.82 to 0.96) by RBF, and 0.91 (0.83 to 0.96) and 0.77 (0.66 to 0.85) by T1, respectively.

Conclusions

Functional MRI parameters were strongly correlated with the interstitial fibrosis of CKD. Therefore, it might a powerful tool to assess interstitial fibrosis of CKD noninvasively.

Key Points

• In CKD patients, the renal cortical ADC value decreased and T1 value increased significantly compared with healthy volunteers.

• Functional MRI revealed significantly decreased renal perfusion in CKD patients compared with healthy volunteers.

• The renal cortical ADC, f, RBF, and T1 values were strongly correlated with the interstitial fibrosis of CKD.

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Abbreviations

ADC:

Apparent diffusion coefficient

ASL:

Arterial spin labeling

AUC:

Area under the curve

CKD:

Chronic kidney disease

DWI:

Diffusion-weighted imaging

IF:

Interstitial fibrosis

IVIM:

Intravoxel incoherent motion

pCASL:

Pseudo-continuous arterial spin labeling

RBF:

Renal blood flow

ROC:

Receiver operating characteristic

ROIs:

Regions of interest

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Funding

This work was supported by the Science and Technology Guided Project of Fujian Province (grant number: 2019D025); National Natural Science Foundation of China (grant number: 82171897); Shanghai Science and Technology Committee (grant number: 19411965500); Shanghai Municipal Key Clinical Specialty (grant number: shslczdzk03202); Clinical Research Plan of SHDC (grant number: SHDC2020CR1029B); Clinical Research Project of Zhongshan Hospital, Fudan University (grant number: 2020ZSLC61); and “Science and Technology Innovation Action Plan” Star Project/Star Cultivation (Sailing Special Project) (grant number: 22YF1443700).

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Authors and Affiliations

  1. Department of Radiology, Zhongshan Hospital, Shanghai Institute of Medical Imaging, Fudan University, 180, Fenglin Road, Shanghai, 200032, People’s Republic of China

    Wei Mao, Yuqin Ding, Bohong Cao, Jianjun Zhou & Mengsu Zeng

  2. Department of Nephrology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, People’s Republic of China

    Xiaoqiang Ding

  3. MR Applications Development, Siemens Shenzhen Magnetic Resonance Ltd, Shenzhen, China

    Caixia Fu

  4. MR Application Predevelopment, Siemens Healthcare GmbH, Erlangen, Germany

    Bernd Kuehn, Thomas Benkert, Robert Grimm & Dominik Nickel

  5. Department of Radiology, Zhongshan Hospital, Xiamen Branch, Fudan University, Xiamen, China

    Jianjun Zhou

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  1. Wei Mao
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Corresponding authors

Correspondence to Jianjun Zhou or Mengsu Zeng.

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Guarantor

The scientific guarantor of this publication is Jianjun Zhou.

Conflict of interest

Authors Caixia Fu, Bernd Kuehn, Thomas Benkert, Robert Grimm, Dominik Nickel are employees of Siemens. The remaining authors declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

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Written informed consent was obtained from all subjects in this study.

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Institutional Review Board approval was obtained.

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• performed at one institution

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Mao, W., Ding, X., Ding, Y. et al. Evaluation of interstitial fibrosis in chronic kidney disease by multiparametric functional MRI and histopathologic analysis. Eur Radiol 33, 4138–4147 (2023). https://doi.org/10.1007/s00330-022-09329-7

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  • DOI: https://doi.org/10.1007/s00330-022-09329-7

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