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Updated: Sep 11, 2025
Multilevel Microdissection and Functional-Structural Profiling of Human Renal Arterial Branches
Published on: September 5, 2025
Multiparametric diffusion-weighted MRI for renal microstructural assessment in patients with primary aldosteronism at
Deying Wen1, Ailin Liang1, Qinglin Du1
1West China Hospital of Sichuan University, Chengdu, China.
Purpose:
To utilize multiparametric diffusion-weighted imaging (DWI) to detect and quantify renal microstructural alterations in patients with primary aldosteronism (PA) at varying direct renin concentrations (DRC), and to explore the correlations between DWI-derived biomarkers and renal function biochemical indices.
Materials And Methods:
This study included 50 patients and 32 healthy controls (HCs). Participants underwent 3.0 T MRI using monoexponential, intravoxel incoherent motion, and stretched-exponential DWI models. Two observers independently analyzed diffusion parameters, including apparent diffusion coefficient (ADC), fraction of fast diffusion (f), slow diffusion coefficient (Ds), fast diffusion coefficient (Df), distributed diffusion coefficient (DDC), and anomalous exponent (α). Group comparisons were conducted using t-tests, Mann-Whitney U tests, or ANOVA; receiver operating characteristic (ROC) curve analysis was used. Correlations between diffusion parameters and renal function biomarkers were analyzed using Pearson or Spearman correlation tests.
Results:
Compared to HCs, PA patients with abnormal DRC exhibited significantly lower cortical and medullary ADC, f, and DDC values and higher cortical α. ROC analysis demonstrated that combining these parameters achieved an AUC of 0.884 with 90.0% sensitivity and 81.5% specificity for distinguishing DRC-abnormal patients from HCs. Medullary f was reduced in the abnormal DRC group versus normal DRC group. The ROC analysis for distinguishing these two groups yielded an AUC of 0.790, with a sensitivity of 85.30% and a specificity of 62.50%. Correlations showed an inverse relationship between medullary Ds and creatinine, a positive correlation between medullary f and uric acid, and a negative correlation of cortical DDC with creatinine and cystatin C.
Conclusion:
Multiparametric DWI enables precise detection and quantification of renal microstructural abnormalities in PA patients. Patients with abnormal DRC exhibit more pronounced renal microstructural alterations compared to DRC-normal group. Notably, observed correlations between specific diffusion metrics and renal function biomarkers underscore their potential clinical applicability for non-invasive monitoring of PA-associated renal injury.
Insights
Multiparametric diffusion-weighted imaging (DWI) detects renal microstructural changes in primary aldosteronism (PA). Abnormal direct renin concentrations (DRC) correlate with altered kidney function biomarkers, aiding non-invasive PA monitoring.
Area of Science:
- Radiology
- Nephrology
- Medical Imaging
Background:
- Primary aldosteronism (PA) can lead to renal microstructural damage.
- Assessing renal alterations in PA, especially concerning direct renin concentrations (DRC), is crucial for patient management.
- Non-invasive imaging techniques are needed to quantify these changes.
Purpose of the Study:
- To employ multiparametric diffusion-weighted imaging (DWI) for detecting and quantifying renal microstructural changes in PA patients.
- To investigate the relationship between DWI-derived biomarkers and varying direct renin concentrations (DRC).
- To explore correlations between DWI biomarkers and renal function indices.
Main Methods:
- Fifty PA patients and 32 healthy controls (HCs) underwent 3.0T MRI with monoexponential, intravoxel incoherent motion, and stretched-exponential DWI models.
- Diffusion parameters (ADC, f, Ds, Df, DDC, α) were analyzed by two independent observers.
- Statistical analyses included t-tests, Mann-Whitney U, ANOVA, ROC curve analysis, and correlation tests (Pearson/Spearman).
Main Results:
- PA patients with abnormal DRC showed lower cortical/medullary ADC, f, DDC, and higher cortical α compared to HCs (AUC=0.884).
- Medullary f was reduced in the abnormal DRC group versus the normal DRC group (AUC=0.790).
- Renal function biomarkers correlated with diffusion metrics: medullary Ds inversely with creatinine, medullary f positively with uric acid, and cortical DDC negatively with creatinine/cystatin C.
Conclusions:
- Multiparametric DWI effectively detects and quantifies renal microstructural abnormalities in PA.
- Abnormal DRC is associated with more significant renal microstructural alterations.
- DWI biomarkers show potential for non-invasive monitoring of PA-related kidney injury.
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