Integrated Diffusion Tensor Imaging and Renal Parenchymal Volume for Early Detection and Grading of Split Renal Functional Impairment in Lupus Nephritis

Ye Wang; Chutong He; Shengsheng Lai; Xiangdong Xu; Xiaoyan Cai; Jingfa Li; Mengni Wu; Yujie He; Jiaxin Lin; Chun Wang; Mingming Wang; Yongzhou Xu; Xinhua Wei; Xinqing Jiang; Shiwen Yuan; Ruimeng Yang

doi:10.1016/j.acra.2023.12.046

Integrated Diffusion Tensor Imaging and Renal Parenchymal Volume for Early Detection and Grading of Split Renal Functional Impairment in Lupus Nephritis

Acad Radiol. 2024 Jan 15:S1076-6332(23)00725-0. doi: 10.1016/j.acra.2023.12.046. Online ahead of print.

Authors

Ye Wang¹, Chutong He¹, Shengsheng Lai², Xiangdong Xu¹, Xiaoyan Cai³, Jingfa Li⁴, Mengni Wu⁵, Yujie He¹, Jiaxin Lin¹, Chun Wang⁶, Mingming Wang¹, Yongzhou Xu⁷, Xinhua Wei¹, Xinqing Jiang¹, Shiwen Yuan³, Ruimeng Yang⁸

Affiliations

¹ Department of Radiology, the Second Affiliated Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong 510180, China (Y.W., C.H., X.X., Y.H., J.L., M.W., X.W., X.J., R.Y.).
² School of Medical Equipment, Guangdong Food and Drug Vocational College, Guangzhou, Guangdong 510520, China (S.L.).
³ Department of Rheumatology, the Second Affiliated Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong 510180, China (X.C., S.Y.).
⁴ Department of Nuclear Medicine, the Second Affiliated Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong 510180, China (J.L.).
⁵ Guangzhou First People's Hospital, Guangdong Medical University, Zhanjiang, Guangdong 524023, China (M.W.).
⁶ Department of Radiology, Bijie Second People's Hospital, Bijie, Guizhou 551700, China (C.W.).
⁷ Philips Healthcare, Guangzhou, Guangdong 510180, China (Y.X.).
⁸ Department of Radiology, the Second Affiliated Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong 510180, China (Y.W., C.H., X.X., Y.H., J.L., M.W., X.W., X.J., R.Y.). Electronic address: eyruimengyang@scut.edu.cn.

PMID: 38228455
DOI: 10.1016/j.acra.2023.12.046

Abstract

Rationale and objectives: To investigate the effectiveness of combining split diffusion tensor imaging (DTI) measurements with split renal parenchymal volume (RPV) for assessing split renal functional impairment in patients with lupus nephritis (LN).

Materials and methods: Seventy-four participants [48 LN patients and 26 healthy volunteers (HV)] were included in the study. All participant underwent conventional MR and DTI (b = 0, 400, and 600 s/mm²) examinations using a 3.0 T MRI scanner to determine the split renal DTI measurements and split RPV. In LN patients, renography glomerular filtration rate (rGFR) was measured using ^99mTc-DTPA scintigraphy based on Gates' method, serving as the reference standard to categorize all split kidneys of LN patients into LN with mild impairment (LN_m, n = 65 kidneys) and LN with moderate to severe (LN_ms, n = 31 kidneys) groups according to the threshold of 30 ml/min in spilt rGFR. All statistical analyses were performed using SPSS 25.0 and MedCalc 20.0 software packages.

Results: Only split medullary fractional anisotropy (FA) and the product of split medullary FA and RPV could distinguish pairwise subgroups among the HV and each LN subgroup (all p < 0.05). ROC curve analysis demonstrated that split medullary FA (AUC = 0.866) significantly outperformed other parameters in differentiating HV from LN_m groups, while the product of split medullary FA and split RPV was superior in distinguishing LN_m and LN_ms groups (AUC = 0.793) than other parameters. The combination of split medullary FA and split RPV showed best correlation with split rGFR (r = 0.534, p < 0.001).

Conclusion: Split medullary FA, and its combination with split RPV, are valuable biomarkers for detecting early functional changes in renal alterations and predicting disease progression in patients with LN.

Keywords: Diffusion tensor imaging; Lupus nephritis; Renal parenchymal volume; Split renal functional impairment.