Prospective Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Radiol. Aug 28, 2018; 10(8): 83-90
Published online Aug 28, 2018. doi: 10.4329/wjr.v10.i8.83
In vivo evaluation of early renal damage in type 2 diabetic patients on 3.0 T MR diffusion tensor imaging
Yu-Ting Wang, Xiong Yan, Hong Pu, Long-Lin Yin
Yu-Ting Wang, Xiong Yan, Hong Pu, Long-Lin Yin, Department of Radiology, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu 611731, Sichuan Province, China
Author contributions: Wang YT designed the main ideas and wrote the paper; Yan X, Pu H and Yin LL helped collect relevant data.
Supported by the Fundamental Research Funds for the Central Universities, University of Electronic Science and Technology of China, No. ZYGX2015J125.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the Sichuan Provincial People’s Hospital.
Conflict-of-interest statement: The authors declare no conflicts of interests.
Open-Access: This article is an open-access article, which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Yu-Ting Wang, MD, Department of Radiology, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu 611731, Sichuan Province, China. wangyuting_330@163.com
Telephone: +86-28-87394725
Received: May 3, 2018
Peer-review started: May 4, 2018
First decision: June 6, 2018
Revised: June 26, 2018
Accepted: July 10, 2018
Article in press: July 10, 2018
Published online: August 28, 2018
Processing time: 117 Days and 20.2 Hours
Abstract
AIM

To investigate the utility of renal diffusion tensor imaging (DTI) to detect early renal damage in patients with type 2 diabetes.

METHODS

Twenty-six diabetic patients (12 with microalbuminuria (MAU), and 14 with normoalbuminuria) and fourteen healthy volunteers were prospectively included in this study. Renal DTI on 3.0 T MR was performed, and estimated glomerular filtration rate (eGFR) was recorded for each subject. Mean cortical and medullary fractional anisotropy (FA) values were calculated by placing multiple representative regions of interest. Mean FA values were statistically compared among groups. Correlations between FA values and eGFR were evaluated.

RESULTS

Both cortical and medullary FA were significantly reduced in diabetic patients compared to healthy controls (0.403 ± 0.064 vs 0.463 ± 0.047, P = 0.004, and 0.556 ± 0.084 vs 0.645 ± 0.076, P = 0.002, respectively). Cortical FA was significantly lower in diabetic patients with NAU than healthy controls (0.412 ± 0.068 vs 0.463 ± 0.047, P = 0.02). Medullary FA in diabetic patients with NAU and healthy controls were similar (0.582 ± 0.096 vs 0.645 ± 0.076, P = 0.06). Both cortical FA and medullary FA correlated with eGFR (r = 0.382, P = 0.015 and r = 0.552, P = 0.000, respectively).

CONCLUSION

FA of renal parenchyma on DTI might serve as a more sensitive biomarker of early diabetic nephropathy than MAU.

Keywords: Renal diffusion tensor imaging; Fractional anisotropy; Diabetic nephropathy; Microalbuminuria; Estimated GFR; Correlation

Core tip: Early diagnosis of diabetic nephropathy (DN) facilitates timely treatment, and therefore, improves patient outcomes. Microalbuminuria (MAU), a standard biomarker of DN, has limited sensitivity and reproducibility. Diffusion tensor imaging (DTI) quantifies the directional nature of water diffusion and is especially suited for highly oriented organs such as the kidney. DTI parameter changes were reported in several renal pathologic conditions. This study exhibited reductions of renal fractional anisotropy (FA) in diabetic patients, even with normoalbuminuria, which raises the possibility of detecting early DN with higher sensitivity than MAU. Furthermore, renal FA demonstrated statistical correlation with eGFR, making it a potential functional biomarker.