Intravoxel incoherent motion imaging of the kidney: alterations in diffusion and perfusion in patients with renal dysfunction

Purpose

To investigate the relationship between estimated glomerular filtration rate (eGFR) and parameters calculated using intravoxel incoherent motion (IVIM) imaging of the kidneys.

Materials and Methods

We studied 365 patients, divided into 4 groups based on eGFR levels (mL/min/1.73 m²): group 1, eGFR ≥ 80(n = 80); group 2, eGFR 60–80 (n = 156); group 3, eGFR 30–60 (n = 114); and group 4 ,eGFR < 30 (n = 15). IVIM imaging was used to acquire diffusion-weighted images at 12 b values. The diffusion coefficient of pure molecular diffusion (D), the diffusion coefficient of microcirculation or perfusion (D*), and perfusion fraction (f) were compared among the groups using group 1 as control.

Results

In the renal cortex, D* values were significantly lower in groups 2, 3, and 4 than in group 1. The D value of renal cortex was significantly low in only group 3. In the renal medulla, the D* and D values were significantly lower only in groups 2 and 3, respectively.

Conclusion

As renal dysfunction progresses, renal perfusion might be reduced earlier and affected more than molecular diffusion in the renal cortex. These changes are effectively detected by IVIM MR imaging.     

Effects of gadoxetic acid on liver elasticity measurement by using magnetic resonance elastography

The purpose of this study was to evaluate the effect of gadoxetic acid (Gd-EOB-DTPA) on measurements of liver stiffness by using magnetic resonance elastography (MRE). In this study, 104 consecutive patients (mean age, 67.7±9.4 years) underwent MRE using a 1.5-T MR scanner equipped with a cylindrical passive driver that was placed across the right chest wall for delivering vibrations. Axial gradient-echo images, which were automatically converted to elastograms that represented stiffness (kPa), were acquired using a continuous sinusoidal vibration of 60 Hz. Two raters independently placed a region of interest on the right lobe of the liver on the elastograms obtained before and after Gd-EOB-DTPA was administered. Liver stiffness was measured using these two elastograms and compared using a paired t test and correlation analysis. No significant difference was observed in liver stiffness before and after Gd-EOB-DTPA was administered (Rater 1, P=.1200; Rater 2, P=.3585). The correlation coefficients were 0.986 (Rater 1) and 0.984 (Rater 2), indicating excellent correlation between the stiffness values before and after Gd-EOB-DTPA was administered. Liver stiffness measured by MRE did not differ before and after Gd-EOB-DTPA was administered.     

Staging liver fibrosis by using liver-enhancement ratio of gadoxetic acid-enhanced MR imaging: comparison with aspartate aminotransferase-to-platelet ratio index

Objective

To compare the diagnostic ability of gadoxetic acid-enhanced hepatocyte-phase MR images with aspartate aminotransferase-to-platelet ratio index (APRI) to predict liver fibrosis stage.

Materials and Methods

Our study included 100 patients who underwent gadoxetic acid-enhanced MRI and either liver biopsy or liver surgery. Liver fibrosis stage was histologically determined according to the METAVIR system: F0 (n=16), F1 (n=17), F2 (n=10), F3 (n=21) and F4 (n=36). Four measures were used as imaging-based fibrosis markers: liver-spleen contrast ratio, liver-enhancement ratio, corrected liver-enhancement ratio and spleen index. APRI represented a blood test-based fibrosis marker. The diagnostic ability of those fibrosis markers were compared through receiver-operating characteristic analysis.

Results

The area under the curve (AUC) for APRI prediction of severe fibrosis (≥F3 and F4) was significantly greater than that of corrected liver-enhancement ratio. However, corrected liver-enhancement ratio had a greater AUC for prediction of mild fibrosis (≥F1) than APRI, although the difference was insignificant.

Conclusion

Corrected liver-enhancement ratio with gadoxetic acid-enhanced MRI is correlated to the stage of liver fibrosis. APRI, however, has greater reliability for predicting severe fibrosis and cirrhosis than does the imaging-based fibrosis marker tested in this study.