Relationship between MRI findings and renal histopathology in IgG4-related tubulointerstitial nephritis

Abstract

ABSTRACT Objectives Magnetic resonance imaging (MRI) is expected to be a valuable tool for evaluating disease activity in immunoglobulin G4 (IgG4)-related tubulointerstitial nephritis (IgG4-TIN). However, the correlation between MRI findings and renal histopathological findings remains to be elucidated. This study aimed to clarify the correlation. Methods This retrospective cross-sectional study investigated 26 patients with biopsy-proven IgG4-TIN who underwent simultaneous percutaneous kidney biopsies and abdominal MRI examinations. We reviewed kidney biopsy specimens and scored the degree of inflammatory cell infiltration and interstitial fibrosis. We assessed abdominal MRI, specifically examining T1-weighted imaging (T1WI), T2-weighted imaging (T2WI), and diffusion-weighted imaging (DWI), for the presence of abnormal signals in the inferior pole of the kidney. Spearman’s correlation coefficient test was conducted to examine the relationship between the images and histological findings. Results For T1WI, eight cases showed a positive low-intensity signal, and 18 cases were negative. For T2WI, 19 cases were positive for a low-intensity signal, and seven cases were negative. In DWI, 23 cases were positive for a high-intensity signal, and one was negative. T1WI low-intensity signal and T2WI low-intensity signal were significantly correlated with interstitial fibrosis score (correlation coefficients 0.52 and 0.64). Conclusion Low-intensity signal on T2WI is useful for predicting the degree of fibrosis in IgG4-TIN.