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Validation of the corticomedullary difference in magnetic resonance imaging-derived apparent diffusion coefficient

Lena Berchtold1, Iris Friedli2, Lindsey A Crowe2

  • 1Service and Laboratory of Nephrology, Department for Statistics, Department of Internal Medicine Specialties and of Physiology and Metabolism, University Hospital and University of Geneva, Geneva, Switzerland.

Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association
|January 5, 2019
PubMed
Abstract

Insights

A novel MRI technique, corticomedullary ADC difference (ΔADC), shows strong correlation with kidney fibrosis. This method, along with estimated glomerular filtration rate (eGFR), can identify patients with significant kidney fibrosis.

Area of Science:

  • Nephrology
  • Radiology
  • Medical Imaging

Background:

  • Kidney interstitial fibrosis (IF) is a key predictor of renal prognosis.
  • Current assessment relies on invasive kidney biopsy.
  • Diffusion MRI offers a non-invasive alternative but faces variability; a novel protocol calculating corticomedullary ADC difference (ΔADC) was developed.

Purpose of the Study:

  • To validate the novel ΔADC measurement for assessing kidney fibrosis.
  • To compare ΔADC with estimated glomerular filtration rate (eGFR) and other MRI parameters in fibrosis detection.
  • To evaluate the combined diagnostic performance of ΔADC, ΔT1, and eGFR for identifying extensive kidney fibrosis.

Main Methods:

  • A monocentric cross-sectional study included 164 patients undergoing renal biopsy.
  • Diffusion-weighted imaging and T1/T2 mapping MRI were performed within one week post-biopsy.
  • MRI results were correlated with histological assessment of fibrosis.

Main Results:

  • ΔADC demonstrated a high correlation with kidney interstitial fibrosis (r=-0.52, P<0.001) and eGFR (r=0.37, P<0.01).
  • Absolute cortical ADC and T1 values showed poor correlation with fibrosis.
  • ΔADC, ΔT1, and eGFR were independently associated with kidney fibrosis, with their combination yielding good specificity for detecting extensive fibrosis.

Conclusions:

  • ΔADC is a more reliable MRI marker for kidney fibrosis than absolute ADC values.
  • ΔADC, ΔT1, and eGFR are independent predictors of kidney fibrosis.
  • The combination of ΔADC, ΔT1, and eGFR effectively identifies patients with extensive kidney fibrosis.
Keywords:
MRIchronic kidney diseasecortexdiffusionfibrosis

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