Assessment of renal function using intravoxel incoherent motion diffusion‐weighted imaging and dynamic contrast‐enhanced MRI

Abstract

Objective To assess the correlation between each of intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) and dynamic contrast-enhanced MRI (DCE-MRI) metrics in renal parenchyma with renal function, in a cohort of patients with chronic liver disease. Materials and Methods Thirty patients with liver disease underwent abdominal MRI at 1.5T, including a respiratory-triggered IVIM-DWI sequence and a coronal 3D FLASH DCE-MRI acquisition. Diffusion signals in the renal cortex and medulla were fitted to the IVIM model to estimate the diffusion coefficient (D), pseudodiffusion coefficient (D*) and perfusion fraction (PF). Apparent diffusion coefficient (ADC) was calculated using all b-values. GFR, cortical and medullary renal plasma flow (RPF), mean transit times (MTT) of vascular and tubular compartments and the whole kidney, were calculated from DCE-MRI data by fitting to a three-compartment model. eGFR was calculated from serum creatinine measured 30 ± 27 days of MRI. Results ADC, PF, and RPF were significantly higher in renal cortex vs medulla (p < 10−5). DCE-MRI GFR significantly correlated with, but under-estimated eGFR (Spearman’s r/p=0.49/0.01). IVIM-DWI parameters were not significantly correlated with eGFR. DCE-MRI GFR correlated weakly with D (cortex, r/p=0.3/0.03; medulla r/p=0.27/0.05) and ADC (cortex r/p=0.28/0.04; medulla r/p=0.34/0.01). Weak correlations were observed for pooled cortical and medullar RPF with PF (r/p=0.32/10−3) and with ADC (r/p=0.29/0.0025). Significant negative correlations were observed for vascular MTT with cortical D* (r/p=−0.38/0.004) and D*×PF (r/p=−0.34/0.01). Conclusion The weak correlations between renal IVIM and DCE-MRI perfusion parameters imply that these functional measures could be complementary.

Chronic kidney disease: Pathological and functional evaluation with intravoxel incoherent motion diffusion‐weighted imaging

“…DWI is a powerful MRI technique used for imaging molecular movement or diffusion that reflects changes in microstructure of biological tissues . Previous studies have confirmed that IVIM‐DWI can be used to assess renal function . However, renal pathology plays an important role in guiding therapy and follow‐up of CKD patients.…”

“…27 Previous studies have confirmed that IVIM-DWI can be used to assess renal function. 13,14,[28][29][30][31] However, renal pathology plays an important role in guiding therapy and follow-up of CKD patients. We applied IVIM-DWI to evaluate alterations of renal function and pathology, especially in patients of CKD stage 1 (with normal or high eGFR) in various renal diseases, which may lead to chronic renal insufficiency.…”

Renal Functional MRI and Its Application

“…Although perfusion parameters can be acquired from IVIM models, they are weakly correlated with the parameters derived from DCE‐MRI, such as the GFR and the mean transit time (MTT). Therefore, when assessing perfusion, these two methods are complementary . In addition, compared with the monoexponential model, the three‐parameter model reaches a more precise fit to the diffusion signal decay.…”

Functional Magnetic Resonance Imaging of the Kidneys—With and Without Gadolinium-Based Contrast

“…Similar results were found in patients with acute UUO 36 , by comparing DWI before and after removal of UUO. While all the above studies indicate that DWI-measured diffusion coefficient is associated with renal functional impairment, good correlation was not detected between the DWI parameters and contrast-enhanced MRI measured GFR and RPF 48 . This discouraging result could be due to high estimation errors of the parameters, or as the authors suggested that water diffusion is more independent of GFR or RPF than we imagine.…”