Diffusion Tensor Imaging in early prediction of renal fibrosis in patients with renal disease: Functional and histopathological correlations

Abstract

Aim Renal fibrosis (RF) is a well‐known marker of chronic kidney disease (CKD) progression. However, renal biopsy is an available tool for evaluation of RF, non‐invasive tools are needed not only to detect but also to monitor the progression of fibrosis. The aim of this study is to evaluate the role of diffusion tensor imaging (DTI) in the assessment of renal dysfunction and RF in patients with renal disease. Methods Fifty‐six patients with renal disorders and 22 healthy controls were recruited. All participants underwent DTI. Renal biopsy was performed for all patients. Mean renal medullary and cortical fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values were compared between patients and healthy controls and correlated to serum creatinine (SCr), estimated glomerular filtration rate (eGFR), 24‐h urinary protein (24h‐UPRO) and renal histopathological scores. Results Cortical FA values were significantly higher (P = .001), while cortical ADC values were significantly lower in the patients’ group (P = .002). Cortical FA values positively correlated to SCr (P = .006) and negatively correlated to eGFR (P = .03), while cortical ADC negatively correlated to percentage of sclerotic glomeruli, atrophic tubules and interstitial fibrosis (P = .001 for all variables). Medullary ADC negatively correlated to tubular atrophy (P = .02). The diagnostic performance of DTI for detecting RF was supported by ROC curve. Multiple linear regression analysis revealed that the mean cortex ADC was significantly decreased by 0.199 mg/dL for patients with >50% glomerulosclerosis in renal biopsy. Conclusion DTI appears to represent a valuable tool for the non‐invasive assessment of renal dysfunction and renal fibrosis.

Signaling Pathways Involved in Diabetic Renal Fibrosis

“…Although kidney biopsy is the only specific diagnostic method for renal fibrosis, non-invasive techniques such as diffusion tensor imaging (DTI) ( Nassar et al, 2021 ) and molecular imaging of ECM ( Bülow and Boor, 2019 ) are valuable in the assessment of renal interstitial fibrosis.…”

Noninvasive diagnosis of interstitial fibrosis in chronic kidney disease: a systematic review and meta-analysis

“…Then, five studies were further excluded due to inadequate data. Finally, 21 studies [ 7 , 19–38 ] were incorporated into the meta-analysis. The detailed literature screening progress is depicted in Figure 1 .…”

“…However, for the diagnosis of early and mild fibrosis, using SWE as an example, there is not yet a consensus among centers on the diagnostic threshold of parameters. Eight studies [ 7 , 23 , 26 , 28 , 31 , 34–36 ] utilized MRI techniques to detect RF, and commonly used techniques, such as diffusion-weighted imaging/apparent diffusion coefficient (DWI/ADC), intravoxel incoherent motion (IVIM), diffusion tensor imaging (DTI), and gadolinium-enhanced imaging, were compared with pathological diagnoses to assess the severity of fibrosis. The studies suggested that MRI was more effective in assessing moderate to severe fibrosis.…”

“…The association between interstitial fibrosis and tubular atrophy (IFTA) and the severity of CKD was closely intertwined [ 6 ]. Moderate and severe IFTA alongside glomerulosclerosis escalated the risk of declined renal function by three- and fourfold, respectively, in comparison to mild IFTA [ 7 , 8 ]. Existing methods for monitoring RF are currently inefficient [ 9 ].…”