Objective

Investigation of functional magnetic resonance (MR) imaging role in early diagnosis of diabetic nephropathy (DN) in patients with diabetes mellitus (DM) type 2, by quantification of the apparent diffusion coefficient (ADC) and fractional anisotropy (FA) values.

Material and methods

10 healthy volunteers and 91 DM type 2 patients were scanned using diffusion-weighted imaging (DWI) and diffusion tensor imaging (DTI) sequences. Patients were divided into four groups based on the estimated glomerular filtration value (eGFR). ADC and FA values, calculated in six regions of interest in each kidney (cortex and medulla), were compared to eGFR and laboratory parameters of renal function.

Results

ADC values of DM patients were higher in the cortex than in the medulla (p < 0.01), while FA values were higher in the medulla (p = 0.284). Creatinine, cystatin C negatively correlated with ADC (cortex, medulla, parenchyma). Medullary FA were lower in DM patients and positively correlated with the eGFR (p = 0.049). Tractography showed disturbed structure in patients with impaired renal function.

Discussion

Medullary FA value is a more sensitive parameter than parenchymal ADC in the early detection of renal damage in DM patients. ADC and FA values are significant in the diagnosis of DN; further research is needed for the update and refinement of the established recommendations.

中文翻译：

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弥散加权成像在 2 型糖尿病患者肾功能评估中的应用。

客观的

通过量化表观扩散系数 (ADC) 和分数各向异性 (FA) 值，研究功能性磁共振 (MR) 成像在 2 型糖尿病 (DM) 患者糖尿病肾病 (DN) 早期诊断中的作用。

材料与方法

使用弥散加权成像 (DWI) 和弥散张量成像 (DTI) 序列对 10 名健康志愿者和 91 名 2 型糖尿病患者进行扫描。根据估计的肾小球滤过值（eGFR）将患者分为四组。在每个肾脏（皮质和髓质）的六个感兴趣区域中计算的 ADC 和 FA 值与 eGFR 和肾功能实验室参数进行比较。

结果

DM 患者皮质中的 ADC 值高于髓质（p  < 0.01），而髓质中的 FA 值更高（p  = 0.284）。肌酐、胱抑素 C 与 ADC（皮质、髓质、实质）呈负相关。DM 患者的髓质 FA 较低，并且与 eGFR 呈正相关（p  = 0.049）。纤维束造影显示肾功能受损患者结构紊乱。

讨论

在 DM 患者肾损害的早期检测中，髓质 FA 值是比实质 ADC 更敏感的参数。ADC和FA值对DN的诊断有重要意义；需要进一步研究更新和完善既定建议。