Multiparametric magnetic resonance imaging shows promising results to assess renal transplant dysfunction with fibrosis
Multiparametric magnetic resonance imaging shows promising results to assess renal transplant dysfunction with fibrosis
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DOI：
10.1016/j.kint.2019.09.030
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发表时间：
2020-02-01
影响因子：
19.6
通讯作者：
Taouli, Bachir
中科院分区：
文献类型：
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作者：
Bane, Octavia;Hectors, Stefanie J.;Taouli, Bachir
在此，我们评估了定量多参数磁共振成像（mpMRI）方案对评估肾移植肾功能障碍伴纤维化的诊断价值。本前瞻性单中心研究纳入了27例肾移植患者，包括15例功能稳定的同种异体移植物（eGFR平均值为71.5 ml/min/1.73 m（2））和12例慢性功能障碍/已确立的纤维化（eGFR平均值为30.1 ml/min/1.73 m（2））。16例患者在MRI前进行了肾活检（平均150天）。所有患者均在1.5T下接受mpMRI，包括体素内非相干运动弥散加权成像、弥散张量成像、血氧水平依赖性（BOLD R-2*）和T-1定量。计算皮质和髓质的真弥散D、假弥散D*、灌注分数PF、表观弥散系数（ADC）、各向异性分数（FA）、R-2* 和T-1。Δ T-1计算为（100 x（T-1皮质-T-1髓质）/T-1皮质）。分别在4名和10名患者中评估了重测重复性和观察者间重复性。mpMRI参数具有实质性的重测和观察者间重复性（变异系数低于15%），但髓质PF和D*（变异系数超过25%）除外。皮质ADC、D、髓质ADC和Δ T-1均显著降低，而皮质T-1在纤维化同种异体移植物中显著升高。皮质T-1与Banff纤维化和肾小管萎缩评分呈正相关。Delta T-1和皮质ADC的组合在检测慢性功能障碍伴纤维化方面具有出色的交叉验证诊断性能。皮质ADC和T-1在预测18个月时eGFR下降（4 ml/min/1.73 m2/年或更高）方面表现良好。因此，皮质ADC和T-1测量的组合显示了对肾移植物组织学和结果的非侵入性评估的有希望的结果。
Here we assessed the diagnostic value of a quantitative multiparametric magnetic resonance imaging (mpMRI) protocol for evaluation of renal allograft dysfunction with fibrosis. Twenty-seven renal transplant patients, including 15 with stable functional allografts (eGFR mean 71.5 ml/min/1.73m(2)), and 12 with chronic dysfunction/established fibrosis (eGFR mean 30.1 ml/min/1.73m(2)), were enrolled in this prospective single-center study. Sixteen of the patients had renal biopsy (mean 150 days) before the MRI. All patients underwent mpMRI at 1.5T including intravoxel-incoherent motion diffusion-weighted imaging, diffusion tensor imaging, blood oxygen level dependent (BOLD R-2*) and T-1 quantification. True diffusion D, pseudodiffusion D*, perfusion fraction PF, apparent diffusion coefficient (ADC), fractional anisotropy (FA), R-2* and T-1 were calculated for cortex and medulla. Delta T-1 was calculated as (100x(T-1 Cortex-T-1 Medulla)/T-1 Cortex). Test-retest repeatability and inter-observer reproducibility were assessed in four and ten patients, respectively. mpMRI parameters had substantial test-retest and interobserver repeatability (coefficient of variation under 15%), except for medullary PF and D* (coefficient of variation over 25%). Cortical ADC, D, medullary ADC and Delta T-1 were all significantly decreased, while cortical T-1 was significantly elevated in fibrotic allografts. Cortical T-1 showed positive correlation to the Banff fibrosis and tubular atrophy scores. The combination of Delta T-1 and cortical ADC had excellent cross-validated diagnostic performance for detection of chronic dysfunction with fibrosis. Cortical ADC and T-1 had good performance for predicting eGFR decline at 18 months (4 or more ml/min/1.73m(2)/year). Thus, the combination of cortical ADC and T-1 measurements shows promising results for the non-invasive assessment of renal allograft histology and outcomes.