Abstract
BackgroundChronic allograft injury (CAI) is a significant reason for which many grafts were lost. The study was conducted to assess the usefulness of diffusional kurtosis imaging (DKI) technology in the non-invasive assessment of CAI.MethodsBetween February 2019 and October 2019, 110 renal allograft recipients were included to analyze relevant DKI parameters. According to estimated glomerular filtration rate (eGFR) (mL/min/ 1.73 m2) level, they were divided to 3 groups: group 1, eGFR ≥ 60 (n = 10); group 2, eGFR 30–60 (n = 69); group 3, eGFR < 30 (n = 31). We performed DKI on a clinical 3T magnetic resonance imaging system. We measured the area of interest to determine the mean kurtosis (MK), mean diffusivity (MD), and apparent diffusion coefficient (ADC) of the renal cortex and medulla. We performed a Pearson correlation analysis to determine the relationship between eGFR and the DKI parameters. We used the receiver operating characteristic curve to estimate the predicted values of DKI parameters in the CAI evaluation. We randomly selected five patients from group 2 for biopsy to confirm CAI.ResultsWith the increase of creatinine, ADC, and MD of the cortex and medulla decrease, MK of the cortex and medulla gradually increase. Among the three different eGFR groups, significant differences were found in cortical and medullary MK (P = 0.039, P < 0.001, P < 0.001, respectively). Cortical and medullary ADC and MD are negatively correlated with eGFR (r = − 0.49, − 0.44, − 0.57, − 0.57, respectively; P < 0.001), while cortical and medullary MK are positively correlated with eGFR (r = 0.42, 0.38; P < 0.001). When 0.491 was set as the cutoff value, MK's CAI assessment showed 87% sensitivity and 100% specificity. All five patients randomly selected for biopsy from the second group confirmed glomerulosclerosis and tubular atrophy/interstitial fibrosis.ConclusionThe DKI technique is related to eGFR as allograft injury progresses and is expected to become a potential non-invasive method for evaluating CAI.
Highlights
Chronic allograft injury (CAI) is a significant reason for which many grafts were lost
Diffusional Kurtosis imaging The corticomedullary difference is displayed by diffusional kurtosis imaging. (Fig. 2)
As first investigated in dynamic contrastenhanced (DCE) [16],parameters likeDWI [17, 18], diffusion tensor imaging (DTI) [6, 19, 20], arterial spin labeling (ASL) [21, 22], BOLD [23, 24] were used for allograft renal imaging to assess the allograft function
Summary
Chronic allograft injury (CAI) is a significant reason for which many grafts were lost. The study was conducted to assess the usefulness of diffusional kurtosis imaging (DKI) technology in the non-invasive assessment of CAI. For patients with end-stage renal disease, kidney transplantation may be the best treatment option. Despite advances in surgical methods and immunosuppressants, the long-term effects of kidney allografts have not changed significantly in the last two decades. Chronic allograft injury (CAI) is the most common cause of kidney allograft failure, which can lead to a certain degree of delay. The characteristics of CAI are glomerulosclerosis, tubular atrophy, vascular occlusive changes, and interstitial fibrosis. Detection and exact CAI evaluation are critical to manage treatment and postpone or prevent irreversible damage to the transplanted renal [2, 3]
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