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Diffusion-weighted imaging of the kidneys in haemolytic uraemic syndrome

  • Magnetic Resonance
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Abstract

Objectives

To evaluate the kidneys of patients with haemolytic uraemic syndrome (HUS) using diffusion-weighted imaging (DWI) and Doppler ultrasound (US) compared with healthy controls.

Materials and Methods

Fifteen patients (mean age 33.3 years; three male; 12 female) with diarrhoea-positive HUS and 15 healthy volunteers were prospectively evaluated with DWI and Doppler US. A total apparent diffusion coefficient (ADCTOT), and ADCs predominantly reflecting microperfusion (ADCLOW) and diffusion (ADCHIGH) were calculated. Doppler US evaluated renal vascularity and flow.

Results

When compared with controls, kidneys affected by HUS showed reduced cortical ADC values (ADCTOT 1.79±0.22 vs. 2.04±0.1x10-3 mm2/s, P 0.001), resulting in either low corticomedullary differences (11/15 patients) or an inverted corticomedullary pattern (4/15 patients). Reduction of cortical ADC values was associated with a decrease of cortical vascularity on Doppler US (ADCTOT, P<0.001; ADCLOW, P 0.047). Kidneys with complete absence of the cortical vasculature on Doppler US (four patients) also demonstrated limited diffusion (ADCHIGH, P 0.002). Low glomerular filtration rate, requirement for haemodialysis during hospitalization, and longer duration of haemodialysis were associated with decreased cortical diffusivity (ADCTOT: P 0.04, 0.007, and <0.001, respectively).

Conclusion

DWI shows qualitative and quantitative abnormalities in kidneys affected by HUS, thereby extending the non-invasive assessment of renal parenchymal damage.

Key Points

• In HUS, DWI is feasible for functional characterization of kidney involvement.

• Kidneys affected by HUS showed reduced cortical diffusivity.

• Decreased cortical diffusivity was associated with lower kidney function.

• Requirement and duration of haemodialysis was linked to degree of cortical alterations.

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Author information

Authors and Affiliations

  1. Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany

    Jochen Herrmann, Stephanie Galler, Bjoern P. Schoennagel, Peter Bannas, Jin Yamamura, Michael Groth & Gerhard Adam

  2. Department of Diagnostic and Interventional Radiology and Nuclear Medicine, Section of Pediatric Radiology, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany

    Jochen Herrmann, Jasmin D. Busch & Magdalini Tozakidou

  3. III. Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany

    Ulrich Wenzel

  4. Department for Psychiatry and Psychotherapy, Section for Addiction Research and Therapy, University Hospital of Tübingen, 72076, Tübingen, Germany

    Kay U. Petersen

  5. Siemens AG Healthcare, 20099, Hamburg, Germany

    Michaela Joekel

  6. Katholisches Marienkrankenhaus Hamburg Department of Diagnostic and Interventional Radiology, Alfredstr. 9, 22087, Hamburg, Germany

    Christian R. Habermann

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  1. Jochen Herrmann
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Corresponding author

Correspondence to Jochen Herrmann.

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Guarantor

The scientific guarantor of this publication is PD Dr. J. Herrmann.

Conflict of interest

The authors of this manuscript declare relationships with the following companies: Michaela Joekel, Siemens AG Healthcare, Hamburg, Germany.

Funding

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

Statistics and biometry

Two of the authors (Kay U. Petersen and Michael Groth) have significant statistical expertise.

Ethical approval

Institutional Review Board approval was obtained.

Informed consent

Written informed consent was obtained from all subjects (patients and controls) in this study.

Study subjects or cohorts overlap

No study subjects or cohorts have been previously reported.

Methodology

•prospective

•case-control study

•performed at one institution

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Herrmann, J., Wenzel, U., Galler, S. et al. Diffusion-weighted imaging of the kidneys in haemolytic uraemic syndrome. Eur Radiol 27, 4591–4601 (2017). https://doi.org/10.1007/s00330-017-4848-2

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  • DOI: https://doi.org/10.1007/s00330-017-4848-2

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