Multiparametric magnetic resonance imaging allows non-invasive functional and structural evaluation of diabetic kidney disease

Makvandi, Kianoush; Hockings, Paul D.; Jensen, Gert; Unnerstall, Tim; Leonhardt, Henrik; Jarl, Lisa V.; Englund, Camilla; Francis, Susan; Sundgren, Anna K.; Hulthe, Johannes; Baid-Agrawal, Seema

Abstract

Background: We sought to develop a novel non-contrast multiparametric MRI (mpMRI) protocol employing several complementary techniques in a single scan session for a comprehensive functional and structural evaluation of diabetic kidney disease (DKD). Methods: In the cross-sectional part of this prospective observational study, 38 subjects ages 1879 years with type 2 diabetes and DKD [estimated glomerular filtration rate (eGFR) 1560 mL/min/1.73 m2] and 20 age- A nd gender-matched healthy volunteers (HVs) underwent mpMRI. Repeat mpMRI was performed on 23 DKD subjects and 10 HVs. By measured GFR (mGFR), 2 DKD subjects had GFR stage G2, 16 stage G3 and 20 stage G4/G5. A wide range of MRI biomarkers associated with kidney haemodynamics, oxygenation and macro/microstructure were evaluated. Their optimal sensitivity, specificity and repeatability to differentiate diabetic versus healthy kidneys and categorize various stages of disease as well as their correlation with mGFR/albuminuria was assessed. Results: Several MRI biomarkers differentiated diabetic from healthy kidneys and distinct GFR stages (G3 versus G4/G5); mean arterial flow (MAF) was the strongest predictor (sensitivity 0.94 and 1.0, specificity 1.00 and 0.69; P =. 04 and. 004, respectively). Parameters significantly correlating with mGFR were specific measures of kidney haemodynamics, oxygenation, microstructure and macrostructure, with MAF being the strongest univariate predictor (r = 0.92; P <. 0001). Conclusions: A comprehensive and repeatable non-contrast mpMRI protocol was developed that, as a single, non-invasive tool, allows functional and structural assessment of DKD, which has the potential to provide valuable insights into underlying pathophysiology, disease progression and analysis of efficacy/mode of action of therapeutic interventions in DKD.

Citation

Makvandi, K., Hockings, P. D., Jensen, G., Unnerstall, T., Leonhardt, H., Jarl, L. V., …Baid-Agrawal, S. (2022). Multiparametric magnetic resonance imaging allows non-invasive functional and structural evaluation of diabetic kidney disease. Clinical Kidney Journal, 15(7), 1387–1402. https://doi.org/10.1093/ckj/sfac054

• Journal Article Type: Article
• Acceptance Date: Jan 25, 2022
• Online Publication Date: Feb 24, 2022
• Publication Date: 2022-07
• Deposit Date: Mar 21, 2022
• Publicly Available Date: Mar 21, 2022
• Journal: Clinical Kidney Journal
• Print ISSN: 2048-8505
• Electronic ISSN: 2048-8513
• Publisher: Oxford University Press (OUP)
• Peer Reviewed: Peer Reviewed
• Volume: 15
• Issue: 7
• Pages: 1387–1402
• DOI: https://doi.org/10.1093/ckj/sfac054
• Keywords: Transplantation; Nephrology
• Public URL: https://nottingham-repository.worktribe.com/output/7642147
• Publisher URL: https://academic.oup.com/ckj/article/15/7/1387/6535627