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Published on: June 23, 2015
T1 mapping magnetic resonance imaging predicts decline of kidney function
Aurélie Huber1, Ibtisam Aslam2, Lindsey Crowe2
1Department of Medicine, Division of Nephrology and Hypertension, University Hospitals of Geneva, Geneva, Switzerland.
Background:
Renal cortical interstitial fibrosis, typically assessed by biopsy, is crucial for kidney function prognosis. Magnetic resonance imaging (MRI) is a promising method to assess fibrosis non-invasively. Diffusion-weighted (DW) MRI correlates with renal fibrosis and predicts kidney function decline in chronic kidney disease (CKD) and kidney allograft patients. This study evaluates whether T1 and T2 mapping predict kidney function decline and if their simultaneous use enhances the predictive power of a DW-MRI-based model.
Methods:
We prospectively included 197 patients (42 CKD, 155 allograft kidneys). Each underwent a biopsy followed by multiparametric MRI without contrast within 1 week. Over a median follow-up of 2.2 years, laboratory parameters were recorded. The primary endpoint was a rapid decline in kidney function [glomerular filtration rate (GFR) reduction >30%] or replacement therapy initiation. The ability of T1 and T2 mapping sequences to predict poor renal outcome was examined using multivariable Cox regression models, incorporating MRI-derived parameters, estimated GFR (eGFR) and proteinuria.
Results:
Renal outcome occurred in 54 patients after a median of 1.1 years (interquartile range 0.9-2.1). Univariable survival analysis showed cortical T1 was associated with poor renal outcome {hazard ratio [HR] 3.02 [95% confidence interval (CI) 1.44-6.33]}, while T2 sequences had no significant predictive value. Adding cortical T1 to the established model (ΔADC, eGFR, proteinuria) did not improve the HR [from 4.62 (95% CI 1.56-13.67) to 4.36 (95% CI 1.46-13.02)] and marginally increased Harrell's C-index (0.77 to 0.79). Adjusting the regression model for ΔT2 yielded no enhancement in predictive power.
Conclusions:
Cortical T1 is strongly associated with poor renal outcome but did not enhance prognostic power of the DW-MRI-based model.
Insights
Cortical T1 mapping on MRI shows strong association with poor kidney outcomes in patients with chronic kidney disease and kidney transplants. However, it did not improve the predictive accuracy of existing diffusion-weighted MRI models for kidney function decline.
Area of Science:
- Radiology and Imaging Science
- Nephrology and Kidney Disease Research
- Biomedical Engineering and Medical Physics
Background:
- Renal cortical interstitial fibrosis is a key indicator for kidney function prognosis, traditionally assessed via biopsy.
- Diffusion-weighted (DW) Magnetic Resonance Imaging (MRI) offers a non-invasive approach to evaluate renal fibrosis and predict kidney function decline in Chronic Kidney Disease (CKD) and kidney transplant patients.
- T1 and T2 mapping MRI sequences are being investigated for their potential to non-invasively assess renal fibrosis and predict kidney function prognosis.
Purpose of the Study:
- To evaluate the predictive capability of T1 and T2 mapping MRI sequences for kidney function decline in patients with CKD and kidney allografts.
- To determine if the combined use of T1 and T2 mapping enhances the prognostic power of established DW-MRI models for predicting renal outcomes.
- To investigate the association between MRI-derived T1 and T2 mapping parameters and renal fibrosis progression.
Main Methods:
- Prospective study including 197 patients (42 CKD, 155 kidney allografts) who underwent multiparametric MRI without contrast.
- Biopsy was performed, followed by MRI within one week; laboratory parameters (eGFR, proteinuria) were monitored over a median follow-up of 2.2 years.
- Multivariable Cox regression models were used to assess the predictive ability of T1 and T2 mapping, incorporating DW-MRI parameters (ΔADC), eGFR, and proteinuria for the primary endpoint of rapid GFR decline or initiation of renal replacement therapy.
Main Results:
- Cortical T1 mapping showed a significant association with poor renal outcomes (HR 3.02, 95% CI 1.44-6.33) in univariable analysis.
- T2 mapping sequences did not demonstrate significant predictive value for renal outcomes.
- Incorporating cortical T1 into the established DW-MRI model (ΔADC, eGFR, proteinuria) did not significantly improve the hazard ratio (HR 4.36 vs. 4.62) or substantially increase Harrell's C-index (0.79 vs. 0.77).
Conclusions:
- Cortical T1 mapping is a significant independent predictor of poor renal outcomes in patients with kidney disease and allografts.
- Despite its prognostic association, cortical T1 mapping did not enhance the predictive performance of the existing DW-MRI-based model for kidney function decline.
- T2 mapping sequences provided no additional prognostic information when combined with DW-MRI parameters.
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