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Assessment of Renal Function Using noncontrast-enhanced MRI: 3D-FIESTA with spatial labeling with multiple inversion pulses and Diffusion-weighted imaging
Ping Liang1, Chuou Xu2, Jiali Li2, Anqin Li2, Daoyu Hu2, and Zhen Li2

1Radiology, Tongji Hospital, Huazhong University of Science and Technology, Wuhan China, China, 2Department of Radiology, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, Hubei, China

Synopsis

Previous researchs had proved that corticomedullary differentiation contrast ratio obtained from SLEEK was significantly positively correlated with eGFR. But they did not quantitatively analyze the diagnostic performance of SLEEK and did not compare it to other imaging methods. We obtained the area under the curve (AUC) by making the ROC curve to compare the diagnostic performance between SLEEK and DWI. DWI, previous reports have shown that ADC values are positively correlated with eGFR, may be an effective methods to evalaute renal function. Therefor we compared SLEEK with DWI to assess the diagnostic value of SLEEK.

Purpose

To assess whether noncontrast-enhanced MRI with spatial labeling with multiple inversion pulses (SLEEK) can improve the visibility of renal corticomedullary differentiation quantitatively by ROC curves in patients with renal dysfunction compared with the Diffusion-weighted imaging (DWI) and evaluated the association between renal cortical thickness and estimated glomerular filtration rate (eGFR).

Materials and Methods

Seventy eight patients with or without renal dysfunction underwent abdominal MRI at 1.5T including a coronal SLEEK sequence and an axial DWI sequence. Patients according to the eGFR were divided into three groups (Group 1, eGFR＞90ml/min/1.73m2; Group 2, 60ml/min/1.73m2＜eGFR＜90ml/min/1.73m2; and Group3, eGFR＜60ml/min/1.73m2). Image analysis was performed by two radiologists to generate a signal intensity (SI) by SLEEK and an apparent diffusion coefficient (ADC) by mono-exponential model DWI. The estimated GFR (eGFR) was measured within 10 days before MRI examination.

Results

The area under the ROC curve (AUC) of SLEEK combined DWI (0.653) was higher than SLEEK (0.646) or DWI (0.609) separately. Combined SLEEK and DWI generated the higher specificity (94.6%), but the sensitivity (35%) was not as good as SLEEK (52.5%) or DWI (60%). The mean corticomedullary contrast ratio, which was positively correlated with eGFR (p=0.004, r=0.322), was significantly higher in SLEEK with TI=1000ms than in DWI with b value of 1000 s/mm2 in all three groups (p=0.001). There was a significant difference in corticomedullary contrast ratio in SLEEK between group1 and group3 (p=0.006), however, there were no significant differences between group1 and group2 (p=0.285) or group2 and group3 (p=0.064). In the SLEEK, a significantly positive correlation was observed between minimal renal cortical thickness and eGFR (P<0.001, r=0.729).

Discussion

Our study found that corticomedullary differentiation contrast ratio obtained from SLEEK was significantly positively correlated with eGFR, which was similar to previous findings.[14] But they did not quantitatively analyze the diagnostic performance of SLEEK and did not compare it to other imaging methods. We obtained the area under the curve (AUC) by making the ROC curve to compare the diagnostic performance between SLEEK and DWI and we found that combined SLEEK and DWI generated the highest AUC (0.653) and corresponding sensitivity and specificity were 94.6% and 35%, respectively. Combined SLEEK and DWI can improve specificity, but the sensitivity is not as good as applying SLEEK or DWI alone.

Regardless of the simple mono-exponential model or bi-exponential model for DWI, previous reports have shown that ADC values are positively correlated with eGFR, [13, 17, 18] however, in our study, DWI's ability to distinguish corticomedullary contrast ratios was not as good as SLEEK, even in the third group (eGFR <60 ml/min/1.73m2), corticomedullary contrast ratio in SLEEK images with optimal TI was approximately 2 times that in DWI images.

Conclusion

Noncontrast-enhanced MRI with SLEEK can improve the recognition of renal corticomedullary differentiation in patients with renal dysfunction compared with DWI and assess renal function quantitatively. SLEEK combined with DWI can be a better technique to evaluate the function of kidney.

Acknowledgements

No acknowledgement found.

References

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Figures

  1. ROC curves for diagnostic performance of SLEEK, DWI, SLEEK combined DWI in differentiating the patients with normal renal function(eGFR>90ml/min/1.73m2) and abnormal renal function (eGFR<90ml/min/1.73m2). The SLEEK combined DWI diagnostic efficiency and its AUC is 0.653.

Representative coronal kidney images of SLEEK, selected from group 1, group 2, group 3, respectively(1-3). And representative axial kidney images of DWI were also from different groups(4-6). The corticomedullary differentiation between SLEEK and DWI among three groups were visual and distinct.

Conparison of corticomedullary contrast ratio. Corticomedullary contrast ratio was significantly higher in SLEEK images with optimal TI=1000ms than in DWI images in all three groups. Comparing the three eGFR groups, there was a significant difference in group1 and group3

Positive correlation was seen between corticomedullary contrast ratio in SLEEK images with optimal TI and eGFR (P=0.004, r = 0.332)

Comparison of minimal renal cortical thickness among three groups. A significant difference was seen in minimal renal cortical thickness measured by SLEEK images (P<0.001) among the three groups, even in group 1 and group 2.

Proc. Intl. Soc. Mag. Reson. Med. 27 (2019)
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