Abstract: FR-PO427

Magnetic Resonance Imaging Allows a Novel Non-Invasive Functional and Pathophysiologic Assessment of CKD in Diabetic Nephropathy

Session Information

Category: Diabetic Kidney Disease

  • 602 Diabetic Kidney Disease: Clinical

Authors

  • Makvandi, Kianoush, Sahlgrenska University Hospital, Gothenburg, Sweden
  • Hulthe, Johannes, Antaros Medical, Molndal, Sweden
  • Baid-Agrawal, Seema, Sahlgrenska University Hospital, Gothenburg, Sweden
  • Jensen, Gert, Sahlgrenska University Hospital, Gothenburg, Sweden
  • Hockings, Paul, Antaros Medical, Molndal, Sweden
  • Unnerstall, Tim, Sahlgrenska University Hospital, Gothenburg, Sweden
  • Leonhardt, Henrik, Sahlgrenska University Hospital, Gothenburg, Sweden
  • Jarl, Lisa, Antaros Medical, Molndal, Sweden
  • Frödén löwenmark, Anna, Antaros Medical, Molndal, Sweden
  • Englund, Camilla, Antaros Medical, Molndal, Sweden
  • Francis, Susan, Sir Peter Mansfield Imaging Centre, Nottingham, United Kingdom
Background

Magnetic resonance imaging (MRI) has great potential to non-invasively assess functional and morphologic changes in the kidney that may improve diagnosis, prognosis and treatment in patients with chronic kidney disease (CKD). We investigated in diabetic nephropathy (DN) patients if non-contrast MRI using multiple techniques could differentiate a) CKD3-4 stages from healthy controls and b) CKD3 from CKD4 stages.

Methods

An interim analysis of the ongoing study evaluated 18 CKD4, 10 CKD3 patients with DN staged using measured GFR and 20 age- and gender-matched healthy controls. The MRI session included following techniques: R2* for assessment of renal hypoxia, apparent diffusion coefficient (ADC) for fibrosis, arterial spin labelling (ASL) for cortical perfusion, renal artery blood flow (peak velocity maximum and minimum, mean arterial flow [MAF], renal artery resistive index [RARI), PC perfusion (MAF/kidney volume), and kidney volume corrected for body surface area (BSA).

Results

Several of these parameters (highlighted in the table) were highly sensitive and specific to differentiate healthy vs CKD3-4 and CKD3 vs CKD4. By multivariate analysis, the combination of mean arterial flow and R2* medulla showed a strong predictive ability to separate healthy from CKD patients.

Conclusion

A comprehensive non-contrast MRI protocol was developed, which as a single non-invasive tool could improve our understanding of the function and underlying pathophysiology of CKD including DN, obviating potential user-dependent errors and risky use of contrast agents. Longitudinal follow-up will assess whether these findings can identify patients at risk for progression of CKD.

 CKD3-4 vs HealthyCKD3 vs CKD4
VariableAUCSensitivitySpecificityCut-offAUCSensitivitySpecificityCut-off
R2* medulla (s-1)0.800.670.8025.60.570.650.6024.8
ADC cortex (mm2s-1x10-3)0.730.680.782.350.840.780.802.32
ASL perfusion cortex (ml/100g/min)0.910.930.901610.640.650.7060.0
Peak velocity max (cm/s)0.700.710.8048.70.810.670.8044.5
Peak velocity min (cm/s)0.960.930.9012.60.910.940.808.35
RARI0.960.960.850.730.680.610.800.84
Mean arterial flow (ml/s)0.970.890.906.650.880.780.904.98
PC Perfusion (ml/100g/min)0.930.930.853800.850.890.90328
Kidney volume (ml) corrected for BSA0.810.750.7560.40.510.500.5051.9
Multivariable (mean arterial flow; R2* medulla)0.991.000.957.55;26.9NANANANA

Funding

  • Commercial Support