Arterial spin labeling MRI is able to detect early hemodynamic changes in diabetic nephropathy

• Published in: Journal of magnetic resonance imaging Vol. 46; no. 6; pp. 1810 - 1817
• Main Authors: Mora‐Gutiérrez, José María, Garcia‐Fernandez, Nuria, Slon Roblero, M. Fernanda, Páramo, Jose A., Escalada, F. Javier, Wang, Danny JJ, Benito, Alberto, Fernández‐Seara, María A.
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01.12.2017
• Subjects: Adult; Aged; arterial spin labeling; Blood flow; Blood Flow Velocity - physiology; Change detection; Creatinine; Cystatin C; Diabetes; Diabetes mellitus; Diabetic Nephropathies - diagnostic imaging; Diabetic Nephropathies - physiopathology; Diabetic nephropathy; Epidermal growth factor receptors; Female; Flexible bodies; Glomerular filtration rate; Glomerular Filtration Rate - physiology; hemodynamic changes; Hemodynamics - physiology; Humans; Impairment; Kidney - diagnostic imaging; Kidney - physiopathology; Kidney transplantation; Labeling; Magnetic resonance imaging; Magnetic Resonance Imaging - methods; Male; Middle Aged; MRI; Nephropathy; Patients; Perfusion; Renal Circulation - physiology; Renal function; renal perfusion; Reproducibility of Results; Spin labeling; Spin Labels; Spine; renal perfusion; diabetes mellitus; MRI; hemodynamic changes; arterial spin labeling; diabetic nephropathy
• ISSN: 1053-1807; 1522-2586; 1522-2586
• DOI: 10.1002/jmri.25717

Purpose To investigate whether arterial spin labeling (ASL) MRI could detect renal hemodynamic impairment in diabetes mellitus (DM) along different stages of chronic kidney disease (CKD). Materials and Methods Three Tesla (3T) ASL‐MRI was performed to evaluate renal blood flow (RBF) in 91 subjects (46 healthy volunteers and 45 type 2 diabetic patients). Patients were classified according to their estimated glomerular filtration rate (eGFR) as group I (eGFR > 60 mL/min/1.73 m2), group II (60 ≥ eGFR>30 mL/min/1.73 m2), or group III (eGFR ≤ 30 mL/min/1.73 m2), to determine differences depending on renal function. Studies were performed at 3T using a 12‐channel flexible body array combined with the spine array coil as receiver. Results A 28% reduction in cortical RBF was seen in diabetics in comparison with healthy controls (185.79 [54.60] versus 258.83 [37.96] mL/min/100 g, P < 3 × 10−6). Differences were also seen between controls and diabetic patients despite normal eGFR and absence of overt albuminuria (RBF [mL/min/100 g]: controls=258.83 [37.96], group I=208.89 [58.83], P = 0.0018; eGFR [mL/min/1.73 m2]: controls = 95.50 [12.60], group I = 82.00 [20.76], P > 0.05; albumin‐creatinine ratio [mg/g]: controls = 3.50 [4.45], group I = 17.50 [21.20], P > 0.05). A marked decrease in RBF was noted a long with progression of diabetic nephropathy (DN) through the five stages of CKD (χ2 = 43.58; P = 1.85 × 10−9). Strong correlation (r = 0.62; P = 4 × 10−10) was obtained between RBF and GFR estimated by cystatin C. Conclusion ASL‐MRI is able to quantify early renal perfusion impairment in DM, as well as changes according to different CKD stages of DN. In addition, we demonstrated a correlation of RBF quantified by ASL and GFR estimated by cystatin C. Level of Evidence: 3 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2017;46:1810–1817.