The utility of magnetic resonance imaging for noninvasive evaluation of diabetic nephropathy

Robert S Brown; Maryellen R M Sun; Isaac E Stillman; Teresa L Russell; Sylvia E Rosas; Jesse L Wei

doi:10.1093/ndt/gfz066

The utility of magnetic resonance imaging for noninvasive evaluation of diabetic nephropathy

Nephrol Dial Transplant. 2020 Jun 1;35(6):970-978. doi: 10.1093/ndt/gfz066.

Authors

Robert S Brown¹, Maryellen R M Sun², Isaac E Stillman³, Teresa L Russell⁴, Sylvia E Rosas^{5

6}, Jesse L Wei⁴

Affiliations

¹ Division of Nephrology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA.
² Department of Radiology, Lowell General Hospital, Lowell, MA, USA.
³ Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA.
⁴ Department of Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA.
⁵ Kidney and Hypertension Unit, Joslin Diabetes Center, Boston, MA, USA.
⁶ Division of Nephrology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.

Abstract

Background: Noninvasive quantitative measurement of fibrosis in chronic kidney disease (CKD) would be desirable diagnostically and therapeutically but standard radiologic imaging is too variable for clinical usage. By applying a vibratory force, tissue shear wave stiffness can be measured by magnetic resonance elastography (MRE) that may correlate with progression of kidney fibrosis. Since decreased kidney perfusion decreases tissue turgor and stiffness, we combined newly available three-dimensional MRE shear stiffness measurements with MR arterial spin labeling (ASL) kidney blood flow rates to evaluate fibrosis in diabetic nephropathy.

Methods: Thirty individuals with diabetes and Stage 0-5 CKD and 13 control individuals without CKD underwent noncontrast MRE with concurrent ASL blood flow measurements.

Results: MRE cortical shear stiffness at 90 Hz was decreased significantly below controls in all CKD stages of diabetic nephropathy. Likewise, ASL blood flow decreased progressively from 480 ± 136 mL/min/100 g of cortical tissue in controls to 302 ± 95, 229 ± 7 and 152 ± 32 mL/min/100 g in Stages 3, 4 and 5 CKD, respectively. A magnetic resonance imaging (MRI) surrogate for the measured glomerular filtration fraction [surrogate filtration fraction = estimated glomerular filtration rate (eGFR)/ASL] decreased progressively from 0.21 ± 0.07 in controls to 0.16 ± 0.04 in Stage 3 and 0.10 ± 0.02 in Stage 4-5 CKD.

Conclusions: In this pilot study, MRI with ASL blood flow rates can noninvasively measure decreasing kidney cortical tissue perfusion and, with eGFR, a decreasing surrogate filtration fraction in worsening diabetic nephropathy that appears to correlate with increasing fibrosis. Differing from the liver, MRE shear stiffness surprisingly decreases with worsening CKD, likely related to decreased tissue turgor from lower blood flow rates.

Keywords: chronic kidney disease; diabetic nephropathy; kidney fibrosis; kidney perfusion; magnetic resonance elastography.

Publication types

Evaluation Study
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Case-Control Studies
Diabetic Nephropathies / pathology*
Disease Progression
Glomerular Filtration Rate
Hemodynamics
Humans
Magnetic Resonance Imaging / methods*
Pilot Projects
Renal Insufficiency, Chronic / physiopathology*
Spin Labels*

Substances

Spin Labels

Grants and funding

U24 DK076169/DK/NIDDK NIH HHS/United States