The Use of Diffusion Weighted Imaging and Intravoxel Incoherent Motion to Assess Edema and Perfusion in Abdominal Organs during Endotoxemia

Abstract

Diffusion weighted magnetic resonance imaging (DW-MRI) technique probing the microscopic movement of water molecules in tissue, allows for the quantification of water diffusivity and the contribution of perfusion to the total amount of water. In the last decades, its use in organs other than the brain has increased and it has successfully been applied to abdominal organs; otherwise the use of DWI for the assessment of perfusion (by measuring perfusion fraction and edema (by measuring the apparent diffusion coefficient—ADC) of entire organs is not a clinical standard. The aim of this paper is to assess whether DWI, specifically IVIM, can accurately assess edema (the amount of water contained in a tissue) and perfusion in abdominal organs (liver, spleen, intestine and kidneys) in an endotoxemic porcine model. Endotoxemia was induced in 20 piglets and they were divided into three groups: HM group (HighMAP, mean arterial pressure was maintained >65 mmHg by noradrenaline infusion), LM group (LowMAP, MAP was maintained between 50 and 60 mmHg) and LTD (the thoracic duct was ligated to increase abdominal edema). In addition, a fourth group of healthy controls (four animals) underwent MRI. Edema was also assessed by wet–dry weight in liver, spleen and intestine; and perfusion was assessed by hemodynamics, lactate concentration and SvO2. ADC was found to be higher in the intestine of the LTD group compared with the other groups, in accordance with wet–dry weight. In addition, ADC in kidneys was found to be correlated to glomerular filtration rate. f was correlated with hemodynamics in kidneys and liver. The presented data show that there is a potential for clinical use of the technique in septic patients.