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Diffusion-weighted imaging in the assessment of renal function in patients with diabetes mellitus type 2

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Abstract

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.

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Abbreviations

DM:

Diabetes mellitus

DN:

Diabetic nephropathy

DTI:

Diffusion tensor imaging

DWI:

Diffusion-weighted imaging

FA:

Fractional anisotropy

ADC:

Apparent diffusion coefficient

GFR:

Glomerular filtration rate

FIESTA:

Fast imaging employing steady-state acquisition

FSPGR:

Fast-spoiled gradient

ROI:

Region of interest

Cys C:

Cystatin C

eGFR:

Estimate glomerular filtration rate

CKD-EPI:

Chronic Kidney Disease Epidemiology Collaboration

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Acknowledgements

The authors thank Dr Anna Caroli from Institute Mario Negri, Medical Imaging Unit, Bergamo, Italy, and Azim Celik, Ph.D, Regional Research Manager—Eastern Europe and Turkey, GE Healthcare, for the help with reviewing the manuscript.

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Authors and Affiliations

  1. Centre of Radiology, Clinical Centre of Vojvodina, Hajduk Veljkova 1-9, 21000, Novi Sad, Serbia

    Tijana Mrđanin, Olivera Nikolić, Una Molnar & Viktor Till

  2. Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia

    Olivera Nikolić, Milena Mitrović & Viktor Till

  3. Clinic for Endocrinology, Diabetes and Metabolite Diseases, Clinical Center of Vojvodina, Novi Sad, Serbia

    Milena Mitrović

Authors
  1. Tijana Mrđanin
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  2. Olivera Nikolić
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  5. Viktor Till
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Contributions

TM took the lead in writing the manuscript, performed the acquisition of the data, processed, analyzed and interpreted the data. ON conceived and supervised the study, processed and analyzed the data, added in interpreting the results, worked on the manuscript. UM drafted the manuscript, designed figures and tables and worked out the technical details. MM contributed to the study by choosing the relevant patients with DM type 2. VT contributed to the statistical analysis of the data.

Corresponding author

Correspondence to Tijana Mrđanin.

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The authors have declared that no conflict of interest exists.

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Research invloving human and animal rights

This article does not contain any studies involving animals performed by any of the authors.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants involved in the study

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Supplementary file1 (PDF 39 kb)

Appendices

Appendix

See Figs. 1, 2, Tables 1, 2, 3 and 4.

Fig. 1
figure 1

Positions of six ROIs in both kidney’ cortex and medulla (upper, middle, lower pole) on FSPGR T1 weighted FS image (left), complementary ADC map (middle) and FA map (right). Healthy man, 28 years old, BMI 32.1 kg/m2, Cr 75 µmol/l, Cys C 0.843 mg/l, eGFR 124 ml/min/1.73 m2. Preserved corticomedullary differentiation

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Fig. 2
figure 2

Mean ADC and FA values in the control group and patients with DM type 2 according to the ROI position. Note: Parenchyma implies medulla and cortex

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Table 1 Parameters of MR sequences for kidneys
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Table 2 Results of Pearson’s correlation test between laboratory parameters and ADC, FA values in patients with DM type 2
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Table 3 Patient distribution according to eGFR
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Table 4 Results of the correlation test between different groups of patients
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Mrđanin, T., Nikolić, O., Molnar, U. et al. Diffusion-weighted imaging in the assessment of renal function in patients with diabetes mellitus type 2. Magn Reson Mater Phy 34, 273–283 (2021). https://doi.org/10.1007/s10334-020-00869-x

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