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Role of diffusion tensor imaging in renal parenchymal changes
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Context: Diffusion Tensor Imaging (DTI) is a reliable noninvasive tool to assess renal function with medullary Fractional Anisotropy (FA) values showing the most consistent results. Aims: Evaluation of FA, Apparent Diffusion Coefficient (ADC) for detecting diabetic nephropathy (DN) using 1.5-Tesla magnetic resonance imaging (MRI). To determine FA and ADC values in chronic kidney disease (CKD) patients and controls, and comparing these with estimated glomerular filtiration rate (eGFR) and categorizing the stage of CKD. Patients and Methods: Thirty nondiabetic volunteers underwent DTI.The study included 83 diabetics, 30 frank urine proteinuric, 30 micro-albuminuric, 23 normo-albuminuric with only raised blood sugar patients.Patients were stratified by eGFR into groups: eGFR <60 and eGFR>60ml/min. ADC and FA values in cortex and medulla were compared between controls and study groups. Statistical Analysis Used: Analysis of variance and Pearson correlation using SPSS 16 were performed. Results: There was significant difference of FA medulla in controls versus albuminuric and micro-albuminuric versus frank proteinuric patients (P < 0.001).Also, there was significant difference between cortical ADC values between normal, microalbuminuric/proteinuric groups (P = 0.010, P =0.000, respectively). Significant difference between medullary FA values of patients with eGFR >60 and eGFR < 60 versus normal controls (P < 0.001) was noted.With declining renal function from normal to CKD category 5, a negative correlation between medullary FA (r= −0.785, P = 0.001) and ADC cortex values (r= −0.436, P = 0.001) was noted. A strong positive correlation between medullary FA and cortex ADC with eGFR (r = 0.598 and 0.344, respectively) was noted. Conclusion: Medullary FA of diabetics with relatively intact kidney function were significantly lower than those of controls. Hence, drop in medullary FA values can be an indicator of early nephropathy/patients at risk where eGFR is in near normal range. Cortical ADC and medullary FA demonstrated a significant correlation with eGFR with the latter showing a stronger positive correlation.
KeywordsApparent Diffusion Coefficient - chronic kidney disease - diabetic nephropathy - estimated glomerular filtration rate - Fractional anisotrophy
26 July 2021 (online)
© 2018. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).
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- 1 Modi GK, Jha V. The incidence of end-stage renal disease in India: A population-based study. Kidney Int 2006; 70: 2131-3
- 2 Babaei-Jadidi R, Karachalias N, Ahmed N, Battah S, Thornalley PJ. Prevention of incipient diabetic nephropathy by high-dose thiamine and benfotiamine. Diabetes 2003; 52: 2110-20
- 3 Gambaro G, Kinalska I, Oksa A, Pont’uch P, Hertlova M, Olsovsky J. et al. Oral sulodexide reduces albuminuria in microalbuminuric and macroalbuminuric type 1 and type 2 diabetic patients: The Di.N.A.S. randomized trial. J Am Soc Nephrol 2002; 13: 1615-25
- 4 Chandarana H, Lee VS. Lee Renal Functional MRI: Are We Ready for Clinical Application?. AJR Am J Roentgenol 2009; 192: 1550-7
- 5 Gaudiano C, Clementi V, Busato F, Corcioni B, Orrei MG, Ferramosca E. et al. Diffusion Tensor imaging and tractography of the kidneys: Assessment of chronic parenchymal diseases. EurRadiol 2013; 23: 1678-85
- 6 Lu L, Sedor JR, Gulani V, Schelling JR, O’Brien A, Flask CA. et al. Use of Diffusion Tensor MRI to Identify Early Changes in Diabetic Nephropathy. Am J Nephrol 2011; 34: 476-82
- 7 Wang WJ, Pui MH, Guo Y, Wang LQ, Wang HJ, Liu M. 3T magnetic resonance Diffusion Tensor imaging in chronic kidney disease. Abdom Imaging 2014; 39: 770-5
- 8 Feng Q, Ma Z, Wu J, Fang W. DTI for the assessment of disease stage in patients with glomerulonephritis-correlation with renal histology. EurRadiol 2015; 25: 92-8
- 9 Chen X, Xiao W, Li X, He J, Huang X, Tan Y. In vivo evaluation of renal function using diffusion weighted imaging and Diffusion Tensor imaging intype 2 diabetics with normoalbuminuria versus microalbuminuria. Front Med 2014; 8: 471-6