Rejection evaluation after renal transplantation using MR diffusion tensor imaging

Deger, Emin; Çelik, Azim; Dheir, Hamad; Turunç, V.; Yardımcı, Ahmet; Torun, Mert; Cihangiroğlu, Mutlu

doi:10.1177/0284185117733777

Cited by 12 publications

(15 citation statements)

References 30 publications

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“…For imaging of renal structures, diffusion tensor imaging (DTI) is a more sensitive MRI-based approach that has been applied by Lanzman et al By sampling several different diffusion directions, DTI addresses the issue of anisotropic diffusion properties due to the radial orientation of main anatomic structures like vessels and tubules. DTI is an effective tool for the assessment of the fractional anisotropy, which is a measure for directionality of diffusion in tissues [63, 64].…”

Section: Mrimentioning

confidence: 99%

Renal Allograft Rejection: Noninvasive Ultrasound- and MRI-Based Diagnostics

Jehn

Schuette-Nuetgen

Kentrup

et al. 2019

Contrast Media & Molecular Imaging

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To date, allogeneic kidney transplantation remains the best available therapeutic option for patients with end-stage renal disease regarding overall survival and quality of life. Despite the advancements in immunosuppressive drugs and protocols, episodes of acute allograft rejection, a sterile inflammatory process, continue to endanger allograft survival. Since effective treatment for acute rejection episodes is available, instant diagnosis of this potentially reversible graft injury is imperative. Although histological examination by invasive core needle biopsy of the graft remains the gold standard for the diagnosis of ongoing rejection, it is always associated with the risk of causing substantial graft injury as a result of the biopsy procedure itself. At the same time, biopsies are not immediately feasible for a considerable number of patients taking anticoagulants due to the high risk of complications such as bleeding and uneven distribution of pathological changes within the graft. This can result in the wrong diagnosis due to the small size of the tissue sample taken. Therefore, there is a need for a tool that overcomes these problems by being noninvasive and capable of assessing the whole organ at the same time for specific and fast detection of acute allograft rejection. In this article, we review current state-of-the-art approaches for noninvasive diagnostics of acute renal transplant inflammation, i.e., rejection. We especially focus on nonradiation-based methods using magnetic resonance imaging (MRI) and ultrasound.

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Section: Mrimentioning

confidence: 99%

Renal Allograft Rejection: Noninvasive Ultrasound- and MRI-Based Diagnostics

Jehn

Schuette-Nuetgen

Kentrup

et al. 2019

Contrast Media & Molecular Imaging

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“…FA was demonstrated to be closely associated with renal function in the literature focusing on human subjects . Feng et al found that the values of ADC and FA in medulla varied over the course of chronic glomerulonephritis .…”

Section: Discussionmentioning

confidence: 99%

“…FA was demonstrated to be closely associated with renal function in the literature focusing on human subjects. 5,8,10 Feng et al found that the values of ADC and FA in medulla varied over the course of chronic glomerulonephritis. 43 FA in the cortex showed an insignificant change following surgery but decreased significantly in the medulla, which might be explained by AKI, as indicated by severe histological changes that resulted from renal tubule dilation under high-pressure renal pelvic perfusion, and as a consequence, the axial diffusion increased.…”

Section: Discussionmentioning

confidence: 99%

“…The main function of the kidney is related to water transport. Diffusion MRI, which is widely used to study water movement, has been demonstrated as a simple, noninvasive and accurate method to detect changes in renal microstructure and microcirculation, both of which are closely linked to the renal function of chronic renal impairment . Diffusion MRI was proposed as a potential modality for the evaluation of renal function .…”

Section: Introductionmentioning

confidence: 99%

“…Diffusion MRI, which is widely used to study water movement, has been demonstrated as a simple, noninvasive and accurate method to detect changes in renal microstructure and microcirculation, both of which are closely linked to the renal function of chronic renal impairment. [5][6][7][8][9][10] Diffusion MRI was proposed as a potential modality for the evaluation of renal function. 11 Diffusion tensor imaging (DTI), a widely used diffusion MRI method, can measure the anisotropy of water diffusion caused by the tissue microstructure, such as renal tubular in the medulla.…”

Section: Introductionmentioning

confidence: 99%

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Acute renal impairment characterization using diffusion magnetic resonance imaging: Validation by histology

Zhu

et al. 2019

NMR in Biomedicine

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Diffusion magnetic resonance imaging has been demonstrated to be a simple, noninvasive and accurate method for the detection of renal microstructure and microcirculation, which are closely linked to renal function. Moreover, serum endothelin‐1 (ET‐1) was also reported as a good indicator of early renal injury. The aim of this study was to evaluate the feasibility and capability of diffusion MRI and ET‐1 to detect acute kidney injury by an operation simulating high‐pressure renal pelvic perfusion, which is commonly used during ureteroscopic lithotripsy. Histological findings were used as a reference. Fourteen New Zealand rabbits in an experimental group and 14 in a control group were used in this study. Diffusion tensor imaging and intravoxel incoherent motion diffusion‐weighted imaging were acquired by a 3.0 T MRI scanner. Significant corticomedullary differences were found in the values of the apparent diffusion coefficient (ADC), pure tissue diffusion, volume fraction of pseudo‐diffusion (fp) and fractional anisotropy (FA) (P < 0.05 for all) in both preoperation and postoperation experimental groups. Compared with the control group, the values of cortical fpmean, medullary ADCmean and FAmean decreased significantly (P < 0.05) after the operation in the experimental group. Also, the change rate of medullary ADCmean in the experimental group was more pronounced than that in the control group (P = 0.018). No significant change was found in serum ET‐1 concentration after surgery in either the experimental (P = 0.80) or control (P = 0.17) groups. In the experimental group, histological changes were observed in the medulla, while no visible change was found in the cortex. This study demonstrated the feasibility of diffusion MRI to detect the changes of renal microstructure and microcirculation in acute kidney injury, with the potential to evaluate renal function. Moreover, the sensitivity of diffusion MRI to acute kidney injury appears to be superior to that of serum ET‐1.

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The Use of Diffusion Tensor Imaging in the Identification of Acute Rejection and Chronic Allograft Nephropathy After Renal Transplantation

Jiang,

Yu,

Wan

et al. 2023

Magnetic Resonance Imaging

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BackgroundIdentifying the cause of renal allograft dysfunction is important for the clinical management of kidney transplant recipients.PurposeTo evaluate the diagnostic efficiency of diffusion tensor imaging (DTI) for identifying allografts with acute rejection (AR) and chronic allograft nephropathy (CAN).Study TypeProspective.SubjectsSeventy‐seven renal transplant patients (aged 42.5 ± 9.5 years), including 29 patients with well‐functioning stable allografts (Control group), 25 patients diagnosed with acute rejection (AR group), and 23 patients diagnosed with chronic allograft nephropathy (CAN group).Field Strength/Sequence1.5 T/T2‐weighted imaging and DTI.AssessmentThe serum creatinine, proteinuria, pathologic results, and fractional anisotropy (FA) values were obtained and compared among the three groups.Statistical TestOne‐way analysis of variance; correlation analysis; independent‐sample t‐test; intraclass correlation coefficients and receiver operating characteristic curves. Statistical significance was set to a P‐value <0.05.ResultsThe AR and CAN groups presented with significantly elevated serum creatinine as compared with the Control group (191.8 ± 181.0 and 163.1 ± 115.8 μmol/L vs. 82.3 ± 20.9 μmol/L). FA decreased in AR group (cortical/medullary: 0.13 ± 0.02/0.31 ± 0.07) and CAN group (cortical/medullary: 0.11 ± 0.02/0.27 ± 0.06), compared with the Control group (cortical/medullary: 0.15 ± 0.02/0.35 ± 0.05). Cortical FA in the AR group was higher than in the CAN group. The area under the curve (AUC) for identifying AR from normal allografts was 0.756 and 0.744 by cortical FA and medullary FA, respectively. The AUC of cortical FA and medullary FA for differentiating CAN from normal allografts was 0.907 and 0.830, respectively. The AUC of cortical FA and medullary FA for distinguishing AR and CAN from normal allografts was 0.828 and 0.785, respectively. Cortical FA was able to distinguish between AR and CAN with an AUC of 0.728.Data ConclusionDTI was able to detect patients with dysfunctional allografts. Cortical FA can further distinguish between AR and CAN.Evidence Level2Technical EfficacyStage 2

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Rejection evaluation after renal transplantation using MR diffusion tensor imaging

Cited by 12 publications

References 30 publications

Renal Allograft Rejection: Noninvasive Ultrasound- and MRI-Based Diagnostics

Renal Allograft Rejection: Noninvasive Ultrasound- and MRI-Based Diagnostics

Acute renal impairment characterization using diffusion magnetic resonance imaging: Validation by histology

The Use of Diffusion Tensor Imaging in the Identification of Acute Rejection and Chronic Allograft Nephropathy After Renal Transplantation

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