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Non-invasive assessment of early stage diabetic nephropathy by DTI and BOLD MRI
You-Zhen Feng1, Yao-Jiang Ye1, Zhong-Yuan Cheng1
1Medical Imaging Center, First Affiliated Hospital, Jinan University, Guangzhou, Guangdong, China.
Objective:
Patients with diabetes mellitus, diabetic nephropathy (DN) and healthy donor were analyzed to test whether the early DN patients can be detected using both blood oxygenation level dependent (BOLD) and diffusion tensor imaging.
Methods:
This study was approved by the Ethics Committee of our hospital. MR images were acquired on a 3.0-Tesla MR system (Discovery MR750, General Electric, Milwaukee, WI). 30 diabetic patients were divided into NAU (normal to mildly increased albuminuria, N = 15) and MAU (moderately increased albuminuria, N = 15) group based on the absence or presence of microalbuminuria. 15 controls with sex- and age-matched were enrolled in the study. Prior to MRI scan, all participants were instructed to collect their fresh morning urine samples for quantitative measurement of urinary microalbumin and urinary creatinine. Then, the estimations of serum creatinine, serum uric acid, HbAlc and fasting plasma glucose as well as fundus examinations were performed in all subjects. Then, the values of albumin-creatinine ratio (ACR) and estimated glomerular filtration rate were also calculated. All subjects underwent renal diffusion tensor imaging (DTI) and BOLD acquisition after fasting for 4 h. Regions of interest were placed in renal medulla and cortex for evaluating apparent diffusion coefficient (ADC), fractional anisotropy (FA) and R2* values by two experienced radiologists. The consistency between the two observations was estimated using intragroup correlation coefficients. To test differences in ADC, FA and R2* values across the three groups, the data were analyzed using separate one-way ANOVAs. Post-hoc pair wise comparisons were then performed using t-test. To investigate the clinical relevance of imaging parameters in both regions across the three groups, the correlations of values of the ACR/estimated glomerular filtration rate and of the ADC/FA/R2* were calculated.
Results:
There was a high level of consistency of those ADC, FA and R2* values across the three groups on both renal cortex and medulla measured by the two doctors. The FA value of medulla in MAU group was lower than that in control (p < 0.01). The R2* value of medulla in the NAU group was higher than that in the control (p < 0.01), and the R2* value of medulla in the MAU group was lower than that in the control (p = 0.009) . Moreover, the current study revealed a decreasing trend in FA values of the renal medulla from the control group to NAU and MAU groups. Finally, a weak negatively correlation between medullary R2* and ACR was found in current study.
Conclusion:
Medullary R2* value might be a new more sensitive predictor of early DN. Meanwhile, BOLD imaging detected the medullary hypoxia at the simply diabetic stage, while DTI didn't identify the medullary directional diffusion changes at this stage. Based on our assumption mentioned above, it's presumable that BOLD imaging may be more sensitive for assessment of the early renal function changes than DTI. These imaging techniques are more accurate and practical than conventional tests.
Advances In Knowledge:
Non-invasive MRI was used to detect renal function changes at early DN stage.
Insights
Blood oxygenation level dependent (BOLD) imaging may detect early diabetic nephropathy (DN) by identifying medullary hypoxia. This MRI technique shows promise as a sensitive, non-invasive tool for assessing early renal function changes in diabetic patients.
Area of Science:
- Medical imaging
- Nephrology
- Diabetology
Background:
- Diabetic nephropathy (DN) is a significant complication of diabetes mellitus.
- Early detection of DN is crucial for timely intervention and management.
- Current diagnostic methods may lack sensitivity in detecting early renal functional changes.
Purpose of the Study:
- To evaluate the utility of blood oxygenation level dependent (BOLD) and diffusion tensor imaging (DTI) in detecting early diabetic nephropathy (DN).
- To assess whether these MRI techniques can identify renal functional changes in patients with varying stages of albuminuria.
- To compare the sensitivity of BOLD and DTI in detecting early renal alterations.
Main Methods:
- Acquisition of renal diffusion tensor imaging (DTI) and BOLD MRI on a 3.0-Tesla MR system.
- Inclusion of 30 diabetic patients (15 normal to mildly increased albuminuria - NAU, 15 moderately increased albuminuria - MAU) and 15 healthy controls.
- Analysis of apparent diffusion coefficient (ADC), fractional anisotropy (FA), and R2* values in the renal medulla and cortex, correlated with clinical parameters like albumin-creatinine ratio (ACR) and estimated glomerular filtration rate (eGFR).
Main Results:
- A decreasing trend in medullary FA values was observed from controls to NAU and MAU groups.
- Medullary R2* values were higher in the NAU group and lower in the MAU group compared to controls.
- A weak negative correlation was found between medullary R2* and ACR, suggesting BOLD imaging detects medullary hypoxia in early diabetic stages.
Conclusions:
- Medullary R2* value shows potential as a sensitive predictor for early DN.
- BOLD imaging appears more sensitive than DTI in detecting medullary hypoxia and early renal function changes in diabetic patients.
- These non-invasive MRI techniques offer a more accurate and practical approach for assessing early renal function changes compared to conventional tests.
