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Intravoxel Incoherent Motion Magnetic Resonance Imaging in Partially Nephrectomized Kidneys
Moritz Jörg Schneider1, Olaf Dietrich, Michael Ingrisch
1From the *Josef Lissner Laboratory for Biomedical Imaging, Institute for Clinical Radiology, †Institute for Clinical Radiology, and ‡Department of Urology, Ludwig-Maximilians-University Hospital Munich, Munich; and §Department of Diagnostic and Interventional Radiology, University Hospital Tübingen, Tübingen, Germany.
Objective:
The aim of this study was to investigate the effects of partial nephrectomy (PN) in kidneys with solid renal masses on the apparent diffusion coefficient (ADC) and on intravoxel incoherent motion (IVIM)-based parameters using diffusion-weighted magnetic resonance imaging (DWI).
Methods:
Fifteen patients with renal masses underwent DWI before and 1 week after PN on a clinical 3 T scanner using a single-shot echo planar imaging sequence with 10 diffusion weightings. Motion-corrected images were quantified using a monoexponential model fit to calculate ADCs and a segmented biexponential fit to calculate IVIM parameters f (perfusion fraction), Dslow and Dfast ("slow" and "fast" diffusion coefficients), as well as the pseudoflow (PF) Dfast × f. The median values derived from multislice (minimum of 3 slices) regions of interest encompassing the kidney cortex were used for statistical analysis. Estimated glomerular filtration rate values were calculated based on serum creatinine levels on each examination day using the Modification of Diet in Renal Disease formula.
Results:
The follow-up measurement yielded significantly lower values in the partially nephrectomized kidneys compared with contralateral kidneys for the parameters ADC (P = 0.002), Dfast (P = 0.43), f (P = 0.001), and PF (P = 0.0008). Comparing baseline and follow-up, partially nephrectomized kidneys showed a significant decrease for ADC (P = 0.01), Dfast (P = 0.43), f (P = 0.002), and PF (P = 0.002). Nonnephrectomized kidneys expressed a significant increase for ADC (P = 0.01) and PF (P = 0.01). Follow-up Modification of Diet in Renal Disease showed positive correlations with all DWI parameters in the partially nephrectomized kidneys (ADC: r(2) = 0.63, P = 0.0004; Dfast: r(2) = 0.59, P = 0.0009; f: r(2) = 0.36, P = 0.018; PF: r(2) = 0.60, P = 0.00075) except for Dslow.
Conclusions:
Our study suggests that quantitative parameters derived from DWI are highly indicative of renal function. Apparent diffusion coefficients showed substantial differences in the renal cortex after PN, whereas an IVIM analysis delivered additional insight into kidney physiology. Quantitative DWI, particularly perfusion-related IVIM parameters, therefore demonstrated great potential as truly noninvasive biomarker to obtain information about single kidney function.
Insights
Partial nephrectomy (PN) significantly alters apparent diffusion coefficient (ADC) and intravoxel incoherent motion (IVIM) parameters in kidneys, indicating changes in renal function. Quantitative diffusion-weighted imaging (DWI) shows promise as a noninvasive biomarker for assessing single kidney function post-PN.
Area of Science:
- Radiology and Imaging Science
- Nephrology and Urology
- Biomedical Engineering
Background:
- Solid renal masses often necessitate partial nephrectomy (PN), a procedure that impacts kidney function.
- Accurate assessment of individual kidney function is crucial for managing patients undergoing PN.
- Diffusion-weighted magnetic resonance imaging (DWI) offers a noninvasive method to evaluate tissue microstructure and function.
Purpose of the Study:
- To investigate the effects of partial nephrectomy (PN) on apparent diffusion coefficient (ADC) and intravoxel incoherent motion (IVIM) parameters in kidneys with solid renal masses.
- To assess the utility of quantitative DWI parameters as noninvasive biomarkers for single kidney function after PN.
Main Methods:
- Fifteen patients with renal masses underwent DWI before and 1 week after PN using a 3 T scanner.
- Apparent diffusion coefficients (ADCs) and IVIM parameters (f, Dslow, Dfast, PF) were calculated using monoexponential and biexponential models.
- Estimated glomerular filtration rate (eGFR) was calculated using the Modification of Diet in Renal Disease (MDRD) formula.
Main Results:
- Partially nephrectomized kidneys showed significantly lower ADC, f, and PF values compared to contralateral kidneys post-PN.
- A significant decrease in ADC, f, and PF was observed in partially nephrectomized kidneys from baseline to follow-up.
- Nonnephrectomized kidneys showed a significant increase in ADC and PF, while eGFR correlated positively with most DWI parameters in partially nephrectomized kidneys.
Conclusions:
- Quantitative DWI parameters, including ADC and IVIM-derived metrics, are highly indicative of renal function after PN.
- IVIM analysis provides additional insights into kidney physiology beyond standard ADC measurements.
- Quantitative DWI, especially perfusion-related IVIM parameters, holds significant potential as a noninvasive biomarker for single kidney function assessment.
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