Table 3.
Renal DWI applications in chronic kidney disease and kidney allograft dysfunction
| Disease group | Study | Sample size (n) | Age (years) | Histology | Aetiology | Renal dysfunction severity | Diffusion biomarkers | Main results |
|---|---|---|---|---|---|---|---|---|
| CKD | Inoue (2011) [38] | 119 | 52 ± 18 | Yes | No diabetes (n = 76), diabetes (n = 43) | Mean eGFR = 45 ± 30; CKD G1-5, A1-3 | ADC, (BOLD) | ADC as accurate index for evaluating renal tubulointerstitial alterations in the cortex |
| Li (2014) [39] | 71 | 41 ± 12 | Yes | Lupus nephritis | CKD G1-5, AX | ADC | ADC reflected the severity of renal pathology | |
| Liu (2015) [40] | 51 | 35 ± 14 | Yes | Minor glomerular abnormalities (n = 5), IgA nephropathy (n = 12), membranous nephropathy (n = 20), crescentic glomerulonephritis (n = 1), lupus nephritis (n = 5), anaphylactic purpura nephritis (n = 3), focal segmental glomerulosclerosis (n = 2), hypertensive renal damage (n = 1), hepatitis B virus-associated glomerulonephritis (n = 2) | eGFR = NA; CKD G1-4, AX | ADC, FA | Renal parenchymal FA correlated with renal function and pathological changes | |
| Rona (2016) [41] | 20 | 50 ± 18 | Yes | Renal amyloidosis | Mean eGFR NA, only eGFR > 60; CKD G3-5, AX | ADC | DWI is a useful and non-invasive tool in the diagnosis of secondary renal amyloidosis and differentiating renal amyloidosis from other CKD | |
| Wang (2014) [42] | 29 | 36 (20–50) | Yes | Mixed CKD | Mean eGFR = 116 ± 13 (CKD1, n = 5), 77 ± 10 (CKD2, n = 6), 37 ± 9 (CKD3, n = 7), 16 ± 2 (CKD4, n = 4), 7 ± 3 (CKD5, n = 7); CKD G1-5, AX | ADC, FA | Cortical and medullary ADC and FA inversely correlated with serum creatinine and blood urea nitrogen. No difference in ADC and FA between right and left kidneys | |
| Zhao (2014) [28] | 35 | 42 ± 17 | Yes | Membranous nephropathy (n = 6), minimal change nephropathy (n = 5), atypical membranous nephropathy (n = 5), focal proliferative IgA nephropathy (n = 5), mesangial proliferative glomerulonephritis (n = 3), hypertensive nephropathy (n = 1); unknown (n = 10) | Mean eGFR between 80 and 120 according to pathology group; CKD GX, AX | ADC | ADC strongly correlated with histological measures of fibrosis | |
| Ding (2016) [43] | 44 | 54 ± 13 | No | Mixed CKD | Mean eGFR= 18 ± 7 (sRI, n = 25), 60 ± 25 (non-sRI, n = 19); CKD G1-5, A1-3 | ADC | ADC linearly related with eGFR | |
| Ding (2016) [44] | 54 | 53 ± 13 | No | Mixed CKD | Mean eGFR= 17 ± 7 (sRI, n = 25), 65 ± 26 (non-sRI, n = 19); CKD G1-5, A2-3 | ADC, D, D*, F | ADC and D positively related with eGFR | |
| Emre (2016) [45] | 62 | 57 ± 10 | No | Diabetes mellitus (n = 26), hypertension (n = 19), chronic glomerulonephritis (n = 7), unknown (n = 10) | Mean srCr = 237 ± 167 CKD G1-5 AX | ADC | ADC significantly correlated with CKD clinical stage | |
| Ichikawa (2013) [46] | 365 | 67 (13–92) | No | Patient undergoing abdominal MRI | eGFR = NA; CKD G1-5, AX | ADC, D, D*, F | As renal dysfunction progresses, renal perfusion might be reduced earlier and affected more than diffusion in renal cortex | |
| Li (2013) [47] | 42 | 42 ± 12 | No | Mixed CKD | Mean GFR = 119 ± 22 (CKD1, n = 22), 76 ± 9 (CKD2, n = 9), 45 ± 10 (CKD3, n = 8), 22 ± 3 (CKD4, n = 3); CKD G1-4, AX | ADC | ADC significantly correlated with GFR | |
| Prasad (2015) [48] | 30 | 62 ± 10 | No | Diabetes (n = 11), hypertension (n = 7), interstitial nephritis (n = 3), lupus nephritis (n = 2), IgA nephropathy (n = 1), membranous glomerulopathy (n = 1), cardio-renal syndrome (n = 1), unknown (n = 4) | Mean eGFR = 43 ± 23; CKD G2-5, AX | ADC | When matched for age and sex, ADC significantly correlated with eGFR | |
| Xu (2010) [49] | 43 | 36 (18–59) | No | Chronic glomerulonephritis | eGFR NA; CKD G1-5, AX | ADC | DWI is feasible in the assessment of renal function, especially in the detection of early-stage renal failure of CKD | |
| CKD and diabetes | Cakmak (2014) [50] | 78 | (26–70) | No | Type 2 diabetes | Mean eGFR NA; CKD G1-5, AX | ADC | ADC significantly correlated with clinical stages of diabetic nephropathy |
| Chen (2014) [51] | 30 | 57 (38–73) | No | Type 2 diabetes | Normal renal function; CKD G1, A1-2 | ADC, FA | Combined ADC and FA values may provide a better quantitative approach for identifying diabetic nephropathy at early disease stage | |
| Razek (2017) [52] | 42 | 55 (47–60) | No | Type 2 diabetes | Mean srCr = 88 (61–194); CKD G1-5, A1-3 | ADC, FA | Cortical FA and ADC help to differentiate diabetic kidney from volunteers, may predict the presence of macroalbuminuria, correlate with urinary and serum biomarkers for diabetes | |
| Kidney allograft: chronic disease | Friedli (2016) [24] | 29 | 54 ± 14 | Yes | Transplant | Mean GFR = 48 ± 23; CKD G1-4, A1-3 | ADC | DWI can evaluate fibrosis in kidney allograft recipients and allows differentiation of the cortex and medulla |
| Friedli (2017) [53] | 27 | 53 ± 10 | Yes | Transplant | Mean GFR = 48 ± 23; CKD G1-4, A1-3 | ADC, D, D*, F | Difference between cortex and medulla ADC values (ΔADC) correlated with fibrosis in kidney allograft recipients | |
| Lanzman (2013) [37] | 40 | 50 ± 15 | No | Transplant | Mean eGFR = 49 ± 18 (CKD G1-3, n = 23); 17 ± 6 (CKD G4-5, n = 17); CKD G1-5, AX | ADC, FA | Medullary FA correlated with eGFR in transplant patients | |
| Ozcelik (2017) [54] | 70 | 42 ± 12 | No | Transplant | Mean eGFR = 74 ± 24; CKD G1-3, AX | ADC | ADC strongly correlated with creatinine and eGFR in transplant patients | |
| Palmucci (2012) [55] | 22 | 58 (20–79) | No | Transplant | CrCl ≥ 60 (n = 13) (30–60) (n = 10), ≤30 (n = 12); CKD G1-5, AX | ADC | ADC correlated with creatinine clearance in transplant patients | |
| Palmucci (2015) [56] | 30 | 51 (17–78) | No | Transplant | CrCl ≥ 60 (n = 13) (30–60) (n = 10), ≤30 (n = 12); CKD G1-5 AX | ADC, FA | Medullary ADC best parameter for renal function assessment in transplant patients | |
| Kidney allograft: acute dysfunction | Abou-El-Ghar (2012) [57] | 21 | 28 ± 10 | Yes | Transplant: acute cellular rejection (n = 10), ATN (n = 7), immunosuppressive toxicity (n = 4) | Mean srCr = 290 ± 88; acute kidney injury | ADC | DWI is a promising tool for the diagnosis of acute renal transplant dysfunction |
| Hueper (2016) [23] | 64 | 54 ± 15 | Yes | Transplant: initial graft dysfunction (n = 33), delayed graft dysfunction (n = 31) | Mean eGFR (at Day 7) = 23 ± 15; delayed graft function | ADC, D, D*, F, FA | Combined DTI and DWI detected allograft dysfunction early after kidney transplantation and correlated with allograft fibrosis | |
| Park (2014) [25] | 24 | 46 ± 13 | Yes | Transplant | Mean srCr = 184 ± 123; acute kidney injury | ADC, (BOLD) | DWI (in combination with BOLD MRI) may demonstrate early functional state of renal allografts, but may be limited in characterizing a cause of early renal allograft dysfunction | |
| Steiger (2017) [32] | 40 | 59 ± 13 | Yes | Transplant | Mean srCr = 258 [85–832]; acute kidney injury | ADC, F, D, D* | Combined qualitative and quantitative DWI might allow to determine the severity of histopathologic findings in biopsies of kidney transplant patients | |
| Fan (2016) [35] | 30 | 40 ± 13 | No | Transplant | eGFR = [5–99]; eGFR = (30–60) (n = 19), <30 (n = 11); post allograft | ADC, FA | DTI produces reliable results to assess renal allograft function early after transplantation | |
| Hueper (2011) [33] | 15 | 51 (9–75) | No | Transplant | srCr = (50–563); acute kidney injury | ADC, FA | Changes in allograft function and microstructure can be detected and quantified using DTI | |
| Ren (2016) [58] | 62 | 36 ± 11 | No | Transplant | eGFR = 93 ± 15 (eGFR ≥ 60, n = 37), 33 ± 18 (eGFR < 60, n = 25); 2–4 weeks post-allograft | D, D*, F (ASL) | DWI combined with ASL has better diagnostic efficacy in defining renal allograft function |
Age is expressed as mean ± SD or mean (range). eGFR and GFR values are in mL/min/1.73 m2. srCr values are in μmol/L. CKD stage is expressed as KDIGO stage GXAX. IgA, immunoglobulin A; BOLD, blood oxygenation level dependent; ASL, arterial spin labelling; D, diffusion coefficient; D*, pseudodiffusion coefficient; F, flowing fraction; GFR, glomerular filtration rate; CrCl, creatinine clearance; srCr, serum creatinine; sRI, severe renal injury. Only studies performed on at least 15 patients with CKD or kidney allograft dysfunction were included in the table.