Affiliation:
1. Medical School of Chinese PLA Beijing China
2. Department of Radiology First Medical Center of Chinese PLA General Hospital Beijing China
3. Department of Nephrology First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People's Liberation Army, National Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research Beijing China
4. Hospital Management Institute, Department of Innovative Medical Research Chinese PLA General Hospital Beijing China
Abstract
BackgroundIdentification of non‐diabetic renal disease (NDRD) in patients with type 2 diabetes mellitus (T2DM) may help tailor treatment. Intravoxel incoherent motion diffusion‐weighted imaging (IVIM‐DWI) is a promising tool to evaluate renal function but its potential role in the clinical differentiation between diabetic nephropathy (DN) and NDRD remains unclear.PurposeTo investigate the added role of IVIM‐DWI in the differential diagnosis between DN and NDRD in patients with T2DM.Study TypeProspective.PopulationSixty‐three patients with T2DM (ages: 22–69 years, 17 females) confirmed by renal biopsy divided into two subgroups (28 DN and 35 NDRD).Field Strength/Sequence3 T/ T2 weighted imaging (T2WI), and intravoxel incoherent motion diffusion‐weighted imaging (IVIM‐DWI).AssessmentThe parameters derived from IVIM‐DWI (true diffusion coefficient [D], pseudo‐diffusion coefficient [D*], and pseudo‐diffusion fraction [f]) were calculated for the cortex and medulla, respectively. The clinical indexes related to renal function (eg cystatin C, etc.) and diabetes (eg diabetic retinopathy [DR], fasting blood glucose, etc.) were measured and calculated within 1 week before MRI scanning. The clinical model based on clinical indexes and the IVIM‐based model based on IVIM parameters and clinical indexes were established and evaluated, respectively.Statistical TestsStudent's t‐test; Mann–Whitney U test; Fisher's exact test; Chi‐squared test; Intraclass correlation coefficient; Receiver operating characteristic analysis; Hosmer–Lemeshow test; DeLong's test. P < 0.05 was considered statistically significant.ResultsThe cortex D*, DR, and cystatin C values were identified as independent predictors of NDRD in multivariable analysis. The IVIM‐based model, comprising DR, cystatin C, and cortex D*, significantly outperformed the clinical model containing only DR, and cystatin C (AUC = 0.934, 0.845, respectively).Data ConclusionThe IVIM parameters, especially the renal cortex D* value, might serve as novel indicators in the differential diagnosis between DN and NDRD in patients with T2DM.Evidence Level2Technical EfficacyStage 2
Funder
National Natural Science Foundation of China
Subject
Radiology, Nuclear Medicine and imaging