Living Renal Allograft Transplantation: Diffusion-weighted MR Imaging in Longitudinal Follow-up of the Donated and the Remaining Kidney

Eisenberger, Ute; Binser, Tobias; Thoeny, Harriet C.; Boesch, Chris; Frey, Felix J.; Vermathen, Peter

doi:10.1148/radiol.13122588

Cited by 44 publications

(70 citation statements)

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“…Diffusion parameters were determined using biexponential fitting to separate diffusion and microcirculation contributions, which yield the perfusion fraction (F P ), pure diffusion (ADC D ), 6 and the signal intensity at b 5 0 s/mm 2 (S 0 ).…”

Section: Discussionmentioning

confidence: 99%

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Diffusion tensor imaging of the human kidney: Does image registration permit scanning without respiratory triggering?

Seif

Mani

et al. 2016

Magnetic Resonance Imaging

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Purpose: To investigate if image registration of diffusion tensor imaging (DTI) allows omitting respiratory triggering for both transplanted and native kidneys Materials and Methods: Nine kidney transplant recipients and eight healthy volunteers underwent renal DTI on a 3T scanner with and without respiratory triggering. DTI images were registered using a multimodal nonrigid registration algorithm. Apparent diffusion coefficient (ADC), the contribution of perfusion (F P ), and the fractional anisotropy (FA) were determined. Relative root mean square errors (RMSE) of the fitting and the standard deviations of the derived parameters within the regions of interest (SD ROI ) were evaluated as quality criteria. Results: Registration significantly reduced RMSE in all DTI-derived parameters of triggered and nontriggered measurements in cortex and medulla of both transplanted and native kidneys (P < 0.05 for all). In addition, SD ROI values were lower with registration for all 16 parameters in transplanted kidneys (14 of 16 SD ROI values were significantly reduced, P < 0.04) and for 15 of 16 parameters in native kidneys (9 of 16 SD ROI values were significantly reduced, P < 0.05). Comparing triggered versus nontriggered DTI in transplanted kidneys revealed no significant difference for RMSE (P > 0.14) and for SD ROI (P > 0.13) of all parameters. In contrast, in native kidneys relative RMSE from triggered scans were significantly lower than those from nontriggered scans (P < 0.02), while SD ROI was slightly higher in triggered compared to nontriggered measurements in 15 out of 16 comparisons (significantly for two, P < 0.05). Conclusion: Registration improves the quality of DTI in native and transplanted kidneys. Diffusion parameters in renal allografts can be measured without respiratory triggering. In native kidneys, respiratory triggering appears advantageous.

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Section: Discussionmentioning

confidence: 99%

“…[4][5][6] Its derived quantitative parameter, the apparent diffusion coefficient (ADC) parameter, documents changes like fibrosis or edema. Moreover, DWI may also provide information on concurrent micro-circulation, including capillary perfusion, quantified with the "fraction of the perfusion" (F P ).…”

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Diffusion tensor imaging of the human kidney: Does image registration permit scanning without respiratory triggering?

Seif

Mani

et al. 2016

Magnetic Resonance Imaging

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“…DW-MRI with ADC allows functional evaluation of renal lesions and was proved to be reliable for diagnosing APN in native kidneys by several authors [14][15][16][17]. On the contrary, there are still relatively few studies in the literature on the use of DWI in transplanted kidneys, even if the initial results on its use for the assessment of early graft deterioration encountered in nearly 30% of renal allografts seem encouraging [21][22][23][24]. In particular, despite the pressing need of these patients for contrast-free MR imaging, to our knowledge there are no studies in which the feasibility and reproducibility of DW-MRI in detection and follow-up of APN in transplanted kidneys were analyzed.…”

Section: Discussionmentioning

confidence: 99%

“…So for instance, the values for ADC in healthy parenchyma in native kidneys reported in the literature range from 1.60 to 2.65 9 10 -3 mm 2 /s (500-1.300 s/mm 2 ) [14,15,21,23]. The comparison of our data on transplanted kidneys with the outcome of a study on native kidneys [14] carried out with a MR protocol similar to ours (gradient b values 0, 300 and 600 s/mm 2 ) shows an interesting feature: the ADC for APN foci is very similar for transplanted and native kidneys (1.43 ± 0.32 9 10 -3 vs. 1.46 ± 0.27 9 10 -3 mm 2 /s; p = 0.91), whereas the ADC for healthy parenchyma is significantly lower in transplanted kidneys than in native ones (2.06 ± 0.16 9 10 -3 vs. 2.16 ± 0.24 9 10 -3 mm 2 /s: p = 0.03).…”

Section: Discussionmentioning

confidence: 99%

Acute pyelonephritis in transplanted kidneys: can diffusion-weighted magnetic resonance imaging be useful for diagnosis and follow-up?

et al. 2016

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Purpose: To assess reliability of diffusion-weighted magnetic resonance imaging (DW-MRI) in the management of acute pyelonephritis (APN) foci in transplanted kidneys. Materials and methods: In the 2012-2014 period, 24 kidney-transplanted patients underwent MR screening for clinical suspicion of APN. Two readers independently analyzed all images, establishing presence and location of APN foci. The 22 patients who were positive at the MR exam constituted the study population. For each patient the apparent diffusion coefficient (ADC) was measured in the APN foci and in three sites of the healthy parenchyma (case-control comparison). The data were matched to the laboratory measurements for white blood cell, C-reactive protein, and serum creatinine. Results: Forty-six APN foci were found in 22/24 patients. At the acute stage, the difference in ADC between healthy parenchyma and APN foci was significant (2.06 ± 0.16 vs. 1.43 ± 0.32 9 10 -3 mm 2 /s; p < 0.0001). The performance of ADC as APN indicator was tested by the receiving operating characteristics (ROC) curve: the area under curve AUC = 0.99 witnessed an excellent discriminatory ability, with threshold APN/normal parenchyma 1.9 9 10 -3 mm 2 /s. At the 1-month follow-up 43/46 APN foci were no longer visible, with ADC values significantly higher than at the acute stage; all laboratory data were physiological, with WBC significantly reduced from the acute phase (5.2 ± 1.6 9 10 9 /L vs. 10.6 ± 4.8 9 10 9 /L; p < 0.0001). The other 3 patients underwent further therapy and exams, including a third MR.Conclusions: DW-MRI with ADC measurement seems to be a reliable tool in diagnosing and monitoring APN foci in transplanted kidneys, with clinical impact on patient management.

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“…The two‐component model was shown to be a better fit to the diffusion signal in the kidney than the one‐compartment models 16. Several studies showed IVIM parameters to be sensitive to pathological processes in the kidney, such as allograft rejection,17 renal tumors,18, 19 renal artery stenosis,20 renal dysfunction,21 cortical defects,22 and vesicoureteral reflux 23…”

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Intravoxel incoherent motion modeling in the kidneys: Comparison of mono-, bi-, and triexponential fit

Baalen

Leemans

Dik

et al. 2016

J. Magn. Reson. Imaging

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PurposeTo evaluate if a three‐component model correctly describes the diffusion signal in the kidney and whether it can provide complementary anatomical or physiological information about the underlying tissue.Materials and MethodsTen healthy volunteers were examined at 3T, with T 2‐weighted imaging, diffusion tensor imaging (DTI), and intravoxel incoherent motion (IVIM). Diffusion tensor parameters (mean diffusivity [MD] and fractional anisotropy [FA]) were obtained by iterative weighted linear least squares fitting of the DTI data and mono‐, bi‐, and triexponential fit parameters (D 1, D 2, D 3, f fast2, f fast3, and f interm) using a nonlinear fit of the IVIM data. Average parameters were calculated for three regions of interest (ROIs) (cortex, medulla, and rest) and from fiber tractography. Goodness of fit was assessed with adjusted R2 ( normalRadj2) and the Shapiro‐Wilk test was used to test residuals for normality. Maps of diffusion parameters were also visually compared.ResultsFitting the diffusion signal was feasible for all models. The three‐component model was best able to describe fast signal decay at low b values (b < 50), which was most apparent in normalRadj2 of the ROI containing high diffusion signals (ROIrest), which was 0.42 ± 0.14, 0.61 ± 0.11, 0.77 ± 0.09, and 0.81 ± 0.08 for DTI, one‐, two‐, and three‐component models, respectively, and in visual comparison of the fitted and measured S0. None of the models showed significant differences (P > 0.05) between the diffusion constant of the medulla and cortex, whereas the f fast component of the two and three‐component models were significantly different (P < 0.001).ConclusionTriexponential fitting is feasible for the diffusion signal in the kidney, and provides additional information. Level of Evidence: 2 Technical Efficacy: Stage 1J. MAGN. RESON. IMAGING 2017;46:228–239

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Living Renal Allograft Transplantation: Diffusion-weighted MR Imaging in Longitudinal Follow-up of the Donated and the Remaining Kidney

Cited by 44 publications

References 32 publications

Diffusion tensor imaging of the human kidney: Does image registration permit scanning without respiratory triggering?

Diffusion tensor imaging of the human kidney: Does image registration permit scanning without respiratory triggering?

Acute pyelonephritis in transplanted kidneys: can diffusion-weighted magnetic resonance imaging be useful for diagnosis and follow-up?

Intravoxel incoherent motion modeling in the kidneys: Comparison of mono-, bi-, and triexponential fit

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