The role of diffusion-weighted imaging in the diagnosis of early kidney damage

Year 2023, Volume: 9 Issue: 2, 328 - 337, 04.03.2023

Şeyhmus Kavak

https://doi.org/10.18621/eurj.1203796

Abstract

Objective: This study aimed to determine a threshold value for distinguishing early-stage chronic kidney disease (CKD) from moderate and advanced stages as well as patients with early-stage CKD from those with normal renal function using apparent diffusion coefficient (ADC) and normalized ADC values.

Methods: This retrospective study enrolled 257 patients. Diffusion-weighted images were obtained with a set of b = 50,400,800 values. In each patient, six ADC values were measured from upper, middle, and lower areas of both kidneys, and three ADC values were measured from the spleen. Patients with CKD were classified into five subgroups and healthy patients were classified into two subgroups according to their glomerular filtration rate (GFR).

Results: The renal ADC values were found to be positively correlated with GFR (r = 0.790, p < 0.001) and negatively correlated with creatinine levels (r = −0.709, p < 0.001). The mean ADC values of the stage 1 and 2 CKD groups were found to be significantly higher than those of advanced-stage CKD groups (p < 0.001), and these values were significantly lower in the stage 1 and 2 CKD groups than in the healthy group (p < 0.001). With a cut-off value of ≥1.791 for ADC, the sensitivity was 76.5% and the specificity was 85% while distinguishing between patients with early- and advanced-stage CKD.

Conclusion: Renal and normalized ADC values are strongly correlated with CKD stages, and with the use of appropriate threshold values, the difference between early and advanced stages of CKD can be predicted.

Keywords

Diffusion-weighted imaging, apparent diffusion coefficient, chronic kidney disease

References

• 1. Iino Y. Nihon rinsho. Jpn J Clin Med 2008;66:1645-9.
• 2. Kiberd BA, Clase CM. Cumulative risk for developing end-stage renal disease in the US population. J Am Soc Nephrol 2002;13:1635-44.
• 3. Prigent A. Monitoring renal function and limitations of renal function tests. Semin Nucl Med 2008;38:32-46.
• 4. Shemesh O, Golbetz H, Kriss JP, Myers BD. Limitations of creatinine as a filtration marker in glomerulopathic patients. Kidney Int 1985;28:830-8.
• 5. Deo A, Fogel M, Cowper SE. Nephrogenic systemic fibrosis: a population study examining the relationship of disease development to gadolinium exposure. Clin J Am Soc Nephrol 2007;2:264-7.
• 6. Wang WJ, Pui MH, Guo Y, Wang LQ, Wang HJ, Liu M. 3T magnetic resonance diffusion tensor imaging in chronic kidney disease. Abdom Imaging 2014;39:770-5.
• 7. 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;69:1117-22.
• 8. Feng Q, Ma Z, Wu J, Fang W. DTI for the assessment of disease stage in patients with glomerulonephritis--correlation with renal histology. Eur Radiol 2015;25:92-8.
• 9. National Kidney Foundation K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis 2002;39:S1-266.
• 10. Inker LA, Eneanya ND, Coresh J, Tighiouart H, Wang D, Sang Y, et al; Chronic Kidney Disease Epidemiology Collaboration. New creatinine- and cystatin C-based equations to estimate GFR without race. N Engl J Med 2021;385:1737-49.
• 11. Donner A. Eliasziw M. Sample size requirements or reliability studies. Stat Med 1987;6:441-8.
• 12. Prasad PV, Priatna A. Functional imaging of the kidneys with fast MRI techniques. Eur J Radiol 1999;29:133-48.
• 13. Muller MF, Prasad PV, Bimmler D, Kaiser A, Edelman RR. Functional imaging of the kidney by means of measurements of the apparent diffusion coefficient. Radiology 1994;193:711-5.
• 14. Prasad PV, Thacker J, Li LP, Haque M, Li W, Koenigs H, et al. Multi-parametric evaluation of chronic kidney disease by MRI: a preliminary cross-sectional study. PLoS One 2015;10:e0139661.
• 15. Nangaku M. Hypoxia and tubulointerstitial injury: a final common pathway to end-stage renal failure. Nephron Exp Nephrol 2004;98:e8-e12.
• 16. Palm F, Nordquist L. Renal tubulointerstitial hypoxia: cause and consequence of kidney dysfunction. Clin Exp Pharmacol Physiol 2011;38:474-80.
• 17. Emre T, Kiliçkesmez Ö, Büker A, İnal BB, Doğan H, Ecder T. Renal function and diffusion-weighted imaging: a new method to diagnose kidney failure before losing half function. Radiol Med 2016;121:163-72.
• 18. Arora V, Khatana J, Singh K. Does diffusion-weighted magnetic resonance imaging help in the detection of renal parenchymal disease and staging/prognostication in chronic kidney disease? Pol J Radiol 2021;86:e614-9.
• 19. Yalçin-Safak K, Ayyildiz M, Ünel SY, Umarusman-Tanju N, Akça A, Baysal T. The relationship of ADC values of renal parenchyma with CKD stage and serum creatinine levels. Eur J Radiol Open 2015:9;3:8-11.
• 20. 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;112:1201-10.
• 21. 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 1999;9:832-7.
• 22. Xu Y, Wang X, Jiang X. Relationship between the renal apparent diffusion coefficient and glomerular filtration rate: preliminary experience. J Magn Reson Imaging 2007;26:678-81.
• 23. Goyal A, Sharma R, Bhalla AS, Gamanagatti S, Seth A. Diffusion-weighted MRI in assessment of renal dysfunction. Indian J Radiol Imaging 2012;22:155-9.
• 24. Liu H, Zhou Z, Li X, Li C, Wang R, Zhang Y, et al. Diffusion-weighted imaging for staging chronic kidney disease: a meta-analysis. Br J Radiol 2018;91:20170952.
• 25. Lavdas I, Rockall A, Castelli F, Sandhu RS, papadaki A, Honeyfield L, et al. Apparent diffusion coefficient of normal abdominal organs and bone marrow from whole-body DWI at 1.5 T: the effect of sex and age. AJR Am J Roentgenol 2015;205:242-50.
• 26. Ries M, Jones RA, Bassesu F, Moonen CT, Grenier N. Diffusion tensor MRI of the human kidney. J Magn Reson Imaging 2001;14:42-9.
• 27. Thoeny HC, Zumstein D, Simon-Zoula S, Eisenberger U, De Keyser F, Hofmann L, et al. Functional evaluation of transplanted kidneys with diffusion-weighted and BOLD MR imaging: initial experience. Radiology 2006; 241:812-21.
• 28. 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;9:59-64.
• 29. 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;235:911-7.
• 30. Kim BR, Song JS, Choi EJ, Hwang SB, Hwang HP. Diffusion-weighted imaging of upper abdominal organs acquired with multiple B-value combinations: value of normalization using spleen as the reference organ. Korean J Radiol 2018;19:389-96.