Diagnostic and prognostic performance of renal compartment volume and the apparent diffusion coefficient obtained from magnetic resonance imaging in mild, moderate and severe diabetic kidney disease

Kaixuan Zhao; Sheng Li; Yan Liu; Qiuling Li; Huan Lin; Zhigang Wu; Erdmann Seeliger; Thoralf Niendorf; Zaiyi Liu; Wenjian Wang

doi:10.21037/qims-23-149

Diagnostic and prognostic performance of renal compartment volume and the apparent diffusion coefficient obtained from magnetic resonance imaging in mild, moderate and severe diabetic kidney disease

Quant Imaging Med Surg. 2023 Jun 1;13(6):3973-3987. doi: 10.21037/qims-23-149. Epub 2023 May 4.

Authors

Kaixuan Zhao^#^{1

2

3}, Sheng Li^#⁴, Yan Liu⁵, Qiuling Li⁴, Huan Lin^{2

3}, Zhigang Wu⁶, Erdmann Seeliger⁷, Thoralf Niendorf⁸, Zaiyi Liu^{2

3}, Wenjian Wang⁴

Affiliations

¹ Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
² Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China.
³ Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image Analysis and Application, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
⁴ Division of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China.
⁵ Department of Medical Imaging Center, Nanfang Hospital, Southern Medical University, Guangzhou, China.
⁶ Philips Healthcare (Shenzhen) Ltd., Shenzhen, China.
⁷ Institute of Translational Physiology, Charité-Universitätsmedizin Berlin, Berlin, Germany.
⁸ Berlin Ultrahigh Field Facility (B.U.F.F.), Max Delbrueck Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany.

^# Contributed equally.

Abstract

Background: Diabetic kidney disease (DKD) is the leading cause of end-stage renal disease (ESRD). There are unmet needs for noninvasive diagnosis and prognosis prediction of DKD in clinical practice. This study examines the diagnostic and prognostic value of magnetic resonance (MR) markers of renal compartment volume and the apparent diffusion coefficient (ADC) for mild, moderate, and severe DKD.

Methods: This study was registered at the Chinese Clinical Trial Registry Center (registration number: ChiCTR-RRC-17012687). Sixty-seven DKD patients were prospectively randomly enrolled and underwent clinical examination and diffusion-weighted magnetic resonance imaging (DW-MRI). Patients with comorbidities that affected renal volumes or components were excluded. Ultimately, 52 DKD patients were included in the cross-sectional analysis. The ADC in the renal cortex (ADC_cortex)_, ADC in the renal medulla (ADC_medulla) and difference between ADC_cortex and ADC_medulla (ΔADC) were measured using a twelve-layer concentric objects (TLCO) approach. Renal compartment volumes of the parenchyma and pelvis were derived from T2-weighted MRI. Due to lost contact or ESRD diagnosed before follow-up (n=14), only 38 DKD patients remained for follow-up (median period =8.25 years) to investigate the correlations between MR markers and renal outcomes. The primary outcomes were the composite of doubling of the primary serum creatinine concentration or ESRD.

Results: ADC_cortex presented superior performance in discriminating DKD with normal and declined estimated glomerular filtration rate (eGFR) over ADC_medulla, ΔADC and renal compartment volumes with an AUC of 0.904 (sensitivity of 83% and specificity of 91%) and was moderately correlated with the clinical biomarkers eGFR and proteinuria (P<0.05). The Cox survival analysis demonstrated that ADC_cortex rather than ΔADC is a predictor of renal outcomes with a hazard ratio of 3.4 (95% CI: 1.1-10.2, P<0.05) independent of baseline eGFR and proteinuria.

Conclusions: ADC_cortex is a valuable imaging marker for the diagnosis and prediction of renal function decline in DKD.

Keywords: Diabetic kidney disease (DKD); apparent diffusion coefficient (ADC); diagnosis and prognosis; diffusion-weighted imaging; magnetic resonance imaging (MRI).