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Published on: June 23, 2015
Multiparametric MR Imaging for Detecting Early Chronic Kidney Disease and Grading Chronic Pathological Changes
Chengli Gu1, Aoran Yang1,2, Yang Zheng1
1Department of Radiology, Shengjing Hospital, China Medical University, Shenyang, Liaoning Province, China.
Background:
Conventional renal function markers, such as estimated glomerular filtration rate (eGFR), often fail to reflect occult renal parenchymal injury in early-stage chronic kidney disease (CKD). Renal biopsy is invasive, limiting longitudinal monitoring. Reliable noninvasive methods for early CKD detection and chronicity assessment are lacking.
Purpose:
To evaluate 3D MR elastography (3D-MRE), arterial spin labeling (ASL), and intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) for detecting early CKD and grading its chronic changes.
Study Type:
Prospective.
Subjects:
96 CKD patients with renal biopsy (44 ± 13 years, 55 men) and 30 healthy controls (43 ± 15 years, 18 men).
Field Strength/Sequence:
3.0 T; multifrequency (60, 90, and 120 Hz) 3D vector MRE, pseudo-continuous arterial spin labeling (pCASL), and multi-b-value (0-2000 s/mm2) IVIM-DWI.
Assessment:
MRE-derived renal stiffness (RS), ASL-derived renal blood flow (RBF), and IVIM-derived true diffusion coefficient (D), pseudodiffusion coefficient (D*), perfusion fraction (f), and apparent diffusion coefficient (ADC) were measured. CKD was staged from 1 to 5 according to eGFR, with Stages 1-2 defined as early CKD. Chronic changes were graded by chronicity score (CS), with CS > 4 indicating moderate-to-severe chronic changes.
Statistical Tests:
Mann-Whitney U test, Kruskal-Wallis test with Bonferroni correction, intraclass correlation coefficients (ICC), Bland-Altman analysis, Spearman's rank correlation, univariable and multivariable logistic regression, area under the receiver operating characteristic curve (AUC), and DeLong's test. p < 0.05 was considered significant.
Results:
The combined entire RS at 90 Hz (ERS@90) and the entire D achieved the highest AUC for distinguishing healthy controls from early CKD, significantly outperforming eGFR (AUC = 0.87 vs. 0.59). In early CKD, ERS@90 was the only independent discriminatory variable of moderate-to-severe chronic changes, significantly outperforming eGFR (AUC = 0.86 vs. 0.62).
Data Conclusion:
3D-MRE showed promise for noninvasive detection of early CKD and for identifying moderate-to-severe chronic changes.
Evidence Level:
1.
Technical Efficacy:
Stage 2.
Insights
3D MR elastography (3D-MRE) effectively detects early chronic kidney disease (CKD) and assesses disease severity, outperforming standard eGFR markers. This noninvasive technique shows promise for improved CKD monitoring.
Area of Science:
- Medical Imaging
- Nephrology
- Biophysics
Background:
- Conventional markers like eGFR miss early kidney injury in chronic kidney disease (CKD).
- Renal biopsy is invasive, hindering longitudinal monitoring.
- Noninvasive methods for early CKD detection and chronicity assessment are needed.
Purpose of the Study:
- To assess 3D MR elastography (3D-MRE), ASL, and IVIM-DWI for early CKD detection.
- To evaluate these techniques for grading chronic kidney changes.
Main Methods:
- Prospective study including 96 CKD patients and 30 healthy controls.
- Utilized 3.0T MRI with multifrequency 3D MRE, pCASL, and multi-b-value IVIM-DWI.
- Statistical analysis included logistic regression and ROC curve analysis.
Main Results:
- Combined renal stiffness (ERS@90) and diffusion coefficient (D) best distinguished controls from early CKD (AUC=0.87).
- ERS@90 independently identified moderate-to-severe chronic changes in early CKD (AUC=0.86).
- Both metrics significantly outperformed eGFR in diagnostic accuracy.
Conclusions:
- 3D-MRE demonstrates potential for noninvasive early CKD detection.
- 3D-MRE can identify moderate-to-severe chronic kidney disease changes.
- This technique offers a promising alternative to invasive methods for CKD assessment.
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