Intravoxel incoherent motion to assess brain microstructure and perfusion in patients with end-stage renal disease

Abstract

Background and purpose: This study aimed to investigate the clinical value of intravoxel incoherent motion (IVIM) diffusion-weighted imaging in evaluating the brain microstructure and perfusion changes in end-stage renal disease (ESRD) patients.

Methods: The routine head MRI sequences and IVIM were performed on 40 ESRD patients and 30 healthy subjects. The IVIM was executed with 10 b-values varying from 0 to 1000 seconds/mm² . All subjects were evaluated on neuropsychological test. Laboratory tests were conducted for ESRD patients.

Results: Compared with the control group, increased slow apparent diffusion coefficient values (ADC_slow ) were found in the left frontal lobe, hippocampus, bilateral temporal lobe, and the right occipital lobe (p < .05), and increased fast ADC values (ADC_fast ) were found in all regions of interest (all p < .001) in ESRD patients. In ESRD patients, ADC_fast in right frontal lobe (p = .041) and insular lobe (p = .045) was negatively correlated with the Montreal Cognitive Assessment score (MoCA), and ADC_fast in the right parietal lobe (p = .009) and hippocampus (p = .041) had positive correlation with hemoglobin levels. Using receiver operating characteristics (ROC) analysis, ADC_fast in the right frontal lobe, insular lobe, hippocampus, and parietal lobe separately showed fair to good efficacy in differentiating ESRD patients from healthy subjects, with the area under the ROC ranging from .853 to .903.

Conclusions: The microstructure and perfusion of the brain were impaired in ESRD patients. ADC_fast of the right frontal lobe, insular lobe, hippocampus, and parietal lobe could be effective biomarker for evaluating cognitive impairment in ESRD patients.

Keywords: cognitive impairment; end-stage renal disease; hemodialysis; intravoxel incoherent motion imaging.