In vivo evaluation of renal function using diffusion weighted imaging and diffusion tensor imaging in type 2 diabetics with normoalbuminuria versus microalbuminuria

Abstract

This work aims to estimate the value of diffusion weighted imaging (DWI) and diffusion tensor imaging (DTI) in detecting early-stage kidney injury in type 2 diabetic patients with normoalbuminuria (NAU) versus microalbuminuria (MAU) prospectively. A total of 30 T2DM patients with normal kidney function were recruited and assigned to the NAU group (n = 14) or MAU group (n = 16) according to 8 h overnight urinary albuminuria excretion rate (AER) results. A contemporary cohort of health check-up recipients were included as controls (n = 12). DWI and DTI scans were performed on bilateral kidney using SE single-shot EPI, and apparent diffusion coefficient (ADC) and fractional anisotropy (FA) of the renal parenchyma was determined from ADC and FA maps of the three groups. ADC and FA values were compared among the three groups. According to DWI with a b value of 400 s/mm², the MAU and NAU groups showed significantly lowered mean ADC values compared with the healthy controls (P<0.01). The mean ADC in the MAU group [(2.22±0.07)×10^–3 mm²/s] was slightly lower than that of the NAU group [(2.31±0.22)×10^–3 mm²/s], but this difference was not statistically significant (P>0.05). The FA value in the MAU group was higher than that in the control group (0.45±0.07 vs. 0.39±0.03, P = 0.004) but did not differ from that in the NAU group (0.42±0.03) (P>0.05). ADC and FA values may be more sensitive than urine AER in reflecting early-stage kidney injury and, hence, may facilitate earlier detection and quantitative evaluation of kidney injury in T2DM patients. Combined evaluation of ADC and FA values may provide a better quantitative approach for identifying diabetic nephropathy at early disease stages.

Keywords

type 2 diabetes mellitus / microalbuminuria / diffusion weighted imaging / diffusion tensor imaging / early-stage kidney injury

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Acknowledgements

This study was jointly supported by Doctoral Start-up Project of Guangdong Natural Science Foundation (No. 7301662). The authors thank Dr. Guangqiao Zeng (State Key Laboratory of Respiratory Disease, Guangzhou Medical University) for his assistance in medical writing. Dr. Zeng declares he has no conflicts of interest therein.

Compliance with ethics guidelines

Xiaoyan Chen, Wenxia Xiao, Xinchun Li, Jianxun He, Xiaochun Huang, and Yuyu Tan declare that they have no conflict of interest. All procedures followed in this study were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000 (5). Informed consent was obtained from all patients prior to inclusion in the study.

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2014 Higher Education Press and Springer-Verlag Berlin Heidelberg