New Magnetic Resonance Imaging Index for Renal Fibrosis Assessment: A Comparison between Diffusion-Weighted Imaging and T1 Mapping with Histological Validation.
New Magnetic Resonance Imaging Index for Renal Fibrosis Assessment: A Comparison between Diffusion-Weighted Imaging and T1 Mapping with Histological Validation.
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DOI：
10.1038/srep30088
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发表时间：
2016-07-21
影响因子：
4.6
通讯作者：
Vallée JP
中科院分区：
文献类型：
--
作者：
Friedli I;Crowe LA;Berchtold L;Moll S;Hadaya K;de Perrot T;Vesin C;Martin PY;de Seigneux S;Vallée JP
需要无创地评估肾间质纤维化，这是所有肾脏疾病的共同过程并预测肾脏预后。在这项转化研究中，磁共振成像（MRI）T1标测和一种新的分段弥散加权成像（DWI）技术，表观弥散系数（ADC），首先在两个良好对照的动物模型中与肾纤维化进行比较，以评估检测限。然后在33例肾移植受者（KAR）中进行活检验证。将预测性MRI指标ΔT1和ΔADC（定义为皮质-髓质差异）与组织学进行比较。在大鼠中，T1和ADC均与纤维化和炎症相关，显示正常和患病肾脏之间的差异。在KAR中，MRI指标对间质炎症不敏感。相比之下，ΔADC优于ΔT1，与纤维化具有更强的负相关性（R2 = 0.64对R2 = 0.29 p < 0.001）。在皮质纤维化超过40%的KAR中，ΔADC趋于负值。使用判别分析方法，ΔADC作为检测纤维化水平或更高水平的标志物，特异性和灵敏度分别为100%和71%。这种新的指数有可能在临床环境中无创评估纤维化。
A need exists to noninvasively assess renal interstitial fibrosis, a common process to all kidney diseases and predictive of renal prognosis. In this translational study, Magnetic Resonance Imaging (MRI) T1 mapping and a new segmented Diffusion-Weighted Imaging (DWI) technique, for Apparent Diffusion Coefficient (ADC), were first compared to renal fibrosis in two well-controlled animal models to assess detection limits. Validation against biopsy was then performed in 33 kidney allograft recipients (KARs). Predictive MRI indices, ΔT1 and ΔADC (defined as the cortico-medullary differences), were compared to histology. In rats, both T1 and ADC correlated well with fibrosis and inflammation showing a difference between normal and diseased kidneys. In KARs, MRI indices were not sensitive to interstitial inflammation. By contrast, ΔADC outperformed ΔT1 with a stronger negative correlation to fibrosis (R2 = 0.64 against R2 = 0.29 p < 0.001). ΔADC tends to negative values in KARs harboring cortical fibrosis of more than 40%. Using a discriminant analysis method, the ΔADC, as a marker to detect such level of fibrosis or higher, led to a specificity and sensitivity of 100% and 71%, respectively. This new index has potential for noninvasive assessment of fibrosis in the clinical setting.