Evaluation of disease duration and effect of diabetes mellitus on renal parenchymal diffusion MRI signals in patients with chronic renal failure

Abstract

Objective: It is known that in chronic renal failure (CRF), diffusion weighted (DW) magnetic resonance imaging (MRI) ADC values of the renal parenchyma are reduced. However, the effect of CRF disease duration on renal ADC values is unknown. In this study, the effect of CRF disease duration and accompanying DM on renal parenchymal ADC values was investigated. In this study, abdominal MR examinations of 39 patients with 39 BMD and 30 DM patients whose eGFR was normal. Material and Method: In this study, abdominal MR examinations of 39 CRF and 30 DM patients (eGFR within normal limits) and 59 control subjects were evaluated retrospectively. CRF patients were divided into three groups according to disease duration (<5, 5> 10 < and >10) and were staged as 1-5 according to the eGFR results. ADC measurements were made by two different methods, including a focal small area and the entire parenchyma. The findings were evaluated by statistical analysis according to the duration of CRF, presence of DM, insulin use and dialysis status. Results: ADC values were significantly lower in CRF patients compared to the control group since stage 2 (p <0.05), while there was no significant difference between the control group and stage 1 CRF. ADC values were quite low in dialysis patients (p <0.001). Disease duration, presence of diabetes and insulin use did not significantly contribute to ADC values (p> 0.05). While no significant difference was observed in the ADC measurement results with both methods in the patient groups (p> 0.05), ROI measurements containing the entire parenchyma in the healthy group were statistically significantly lower (p <0.05). Conclusion: In CRF patients, the duration of CRF disease, the presence of DM and insulin use have no significant contribution to renal parenchymal ADC values.

Keywords

• Diffusion magnetic resonance imaging,renal failure,chronic,diabetic nephropathy

Kronik böbrek yetmezliğinde hastalık süresi ve diabetes mellitusun, renal parankim difüzyon MRI sinyallerine etkisinin değerlendirilmesi

Abstract

Amaç: Kronik böbrek yetmezliğinde (KBY), renal parankimin difüzyon ağırlıklı (DW) magnetik rezonans görüntüleme (MRI) ADC değerlerinde azalma olduğu bilinmektedir. Ancak KBY hastalık süresinin renal ADC değerlerine olan etkisi bilinmemektedir. Bu çalışmada KBY hastalık süresi ve eşlik eden DM’nin renal parankimal ADC değerlerine olan etkisi araştırılmıştır. Materyal ve Metod: Bu çalışmada 39 KBY ve eGFR’si normal sınırlarda 30 DM hastası ile 59 kişiden oluşan kontrol grubunun abdominal MR tetkikleri, retrospektif olarak değerlendirildi. KBY hastaları, hastalık süresine göre üç gruba ayrıldı (<5, 5>10< ve >10) ve eGFR’ye göre 1-5 olarak evrelendirildi. ADC ölçümleri, fokal küçük bir alan ve tüm parankimi içeren, iki farklı yöntem ile yapıldı. Bulgular KBY hastalık süresi, DM varlığı, insülin kullanımı ve dializ durumuna göre istatistiksel analize tabi tutularak değerlendirildi. Bulgular: ADC değerleri KBY hastalarında, evre 2 itibaren kontrol gurubuna göre anlamlı şekilde düşük (p<0.05) iken, kontrol grubu ve evre 1 KBY arasında anlamlı fark saptanmadı. Dializ hastalarında ise ADC değerleri oldukça düşüktü (p<0.001). Hastalık süresi, diyabeti varlığı ve insülin kullanımının ADC değerlerine anlamlı bir etkisi saptanmadı (p>0.05). Hasta gruplarındaki her iki yöntem ile ADC ölçüm sonuçlarında anlamlı farklılık izlenmezken (p>0.05), sağlıklı grupta tüm parankimi içeren ROI ölçümleri, istatiksel olarak anlamlı derecede düşük izlenmiştir (p<0,05). Sonuç: KBY hastalarında KBY hastalık süresi, DM varlığı ve insülin kullanımının renal parankimal ADC değerlerine anlamlı bir katkısı yoktur.

Keywords

• Difüzyon manyetik rezonans görüntüleme,böbrek yetmezliği,kronik,diabetes mellitus

References

1. REFERENCES 1. Goyal A, Sharma R, Bhalla AS, Gamanagatti S, Seth A. Diffusion-weighted MRI in assessment of renal dysfunction. Indian J Radiol Imaging. 2012;22(3):155.
2. 2. Mahmoud H, Buchanan C, Francis ST, Selby NM. Imaging the kidney using magnetic resonance techniques: structure to function. Curr Opin Nephrol Hypertens. 2016;25(6):487–93.
3. 3. Namimoto T, Yamashita Y, Mitsuzaki K, Nakayama Y, Tang Y, Takahashi M. Measurement of the apparent diffusion coefficient in diffuse renal disease by diffusion‐weighted echo‐planar MR imaging. J Magn Reson Imaging An Off J Int Soc Magn Reson Med. 1999;9(6):832–7.
4. 4. Albayrak E, Altunkaş A. Kronik Böbrek Hastalığında Böbrek Fonksiyonlarının Difüzyon Ağırlıklı Manyetik Rezonans Görüntüleme ile Değerlendirilmesi. Çağdaş Tıp Derg. 7(4):300–5.
5. 5. Thoeny HC, De Keyzer F, Oyen RH, Peeters RR. Diffusion-weighted MR imaging of kidneys in healthy volunteers and patients with parenchymal diseases: initial experience. Radiology. 2005;235(3):911–7.
6. 6. Xu Y, Wang X, Jiang X. Relationship between the renal apparent diffusion coefficient and glomerular filtration rate: preliminary experience. J Magn Reson Imaging An Off J Int Soc Magn Reson Med. 2007;26(3):678–81.
7. 7. Xu X, Fang W, Ling H, Chai W, Chen K. Diffusion-weighted MR imaging of kidneys in patients with chronic kidney disease: initial study. Eur Radiol. 2010;20(4):978–83.
8. 8. Toya R, Naganawa S, Kawai H, Ikeda M. Correlation between estimated glomerular filtration rate (eGFR) and apparent diffusion coefficient (ADC) values of the kidneys. Magn Reson Med Sci. 2010;9(2):59–64.

9. 9. Li Q, Li J, Zhang L, Chen Y, Zhang M, Yan F. Diffusion-weighted imaging in assessing renal pathology of chronic kidney disease: A preliminary clinical study. Eur J Radiol. 2014;83(5):756–62.
10. 10. Zhao J, Wang ZJ, Liu M, Zhu J, Zhang X, Zhang T, et al. Assessment of renal fibrosis in chronic kidney disease using diffusion-weighted MRI. Clin Radiol. 2014;69(11):1117–22.
11. 11. Yalçin-Şafak K, Ayyildiz M, Ünel SY, Umarusman-Tanju N, Akca A, Baysal T. The relationship of ADC values of renal parenchyma with CKD stage and serum creatinine levels. Eur J Radiol open. 2016;3:8–11.
12. 12. Carbone SF, Gaggioli E, Ricci V, Mazzei F, Mazzei MA, Volterrani L. Diffusion-weighted magnetic resonance imaging in the evaluation of renal function: a preliminary study. Radiol Med. 2007;112(8):1201–10.
13. 13. Xu X, Palmer SL, Lin X, Li W, Chen K, Yan F, et al. Diffusion-weighted imaging and pathology of chronic kidney disease: initial study. Abdom Radiol. 2018;43(7):1749–55.
14. 14. Çakmak P, Yağcı AB, Dursun B, Herek D, Fenkçi SM. Renal diffusion-weighted imaging in diabetic nephropathy: correlation with clinical stages of disease. Diagnostic Interv Radiol. 2014;20(5):374.
15. 15. Chen X, Xiao W, Li X, He J, Huang X, Tan Y. In vivo evaluation of renal function using diffusion weighted imaging and diffusion tensor imaging in type 2 diabetics with normoalbuminuria versus microalbuminuria. Front Med. 2014;8(4):471–6.