The value of T1 mapping combined with DWI in the early identification of renal interstitial fibrosis
Objective:To explore the value of T1 mapping combined with diffusion-weighted imaging(DWI)in the early identification of renal interstitial fibrosis(IF).Materials and Methods:A total of 38 patients with chronic kidney disease(CKD)and 20 healthy volunteers who received renal needle biopsy after evaluation by nephrologist were collected from January 2020 to December 2023 in Wuxi People's Hospital Affiliated to Nanjing Medical University.Serum creatinine(SCr)and estimated glomerular filtration rate(eGFR)were measured in all subjects.T1 mapping and DWI were performed at the same time,and T1 and ADC values of renal cortex and medulla were measured,respectively.According to the degree of interstitial damage in renal pathology,CKD patients were divided into CKD-IF0 group(7 cases)without interstitial fibrosis and IF1 group(31 cases)with mild interstitial fibrosis.Healthy volunteers were divided into control group(20 cases).Renal medullary T1 and ADC values in control group,CKD-IF0 group and IF1 group were compared.We analyzed the correlation between cutis medulla T1 and ADC values and eGFR,and further evaluated the efficacy of eGFR,cutis medulla T1 and ADC values in the diagnosis of renal interstitial fibrosis without and with mild fibrosis.Results:(1)There were no significant differences in T1 and ADC values between control group and CKD-IF0 group(P＞0.05).ADC values of cortex and medulla in control group were higher than those of IF1 group(P＜0.05),and T1 values of control group were lower than those of IF1 group(P＜0.05).The ADC values of cortex and medulla in CKD-IF0 group were higher than those in IF1 group(P＜0.05),cT1 was lower than that in IF1 group(P＜0.05),and there was no significant difference in mT1 between the two groups(P＞0.05).(2)After the control group and CKD-IF0 were combined into IF0 group,the cortex and medulla T1 value of IF0 group was significantly lower than that of IF1 group(P＜0.05),and the ADC value was significantly higher than that of IF1 group(P＜0.05).(3)cT1 was negatively correlated with eGFR(ρ=-0.476,P＜0.05),and cADC was positively correlated with eGFR(ρ=0.391,P＜0.05).There was no significant correlation between mT1 and mADC and eGFR(P＞0.05).(4)When eGFR,cT1,mT1,cADC and mADC were used separately to distinguish IF0 group and IF1 group,eGFR had the highest efficiency,with AUC of 0.861[95％confidence interval(CI):0.761-0.962],sensitivity of 80.6％,and specificity of 88.9％.When cT1 and cADC were combined,the efficiency of differentiation between IF0 group and IF1 group was further improved,with AUC of 0.912(95％CI:0.839-0.984),sensitivity of 83.9％,and specificity of 85.2％.When combined with eGFR,cT1 and cADC,the highest differential efficacy was achieved,with AUC of 0.963(95％CI:0.922-1.000),sensitivity of 87.1％and specificity of 96.3％.Conclusions:T1 mapping combined with DWI can noninvasculatively and effectively identify renal interstitial fibrosis,and is expected to assist eGFR to further improve the ability of early identification of renal tissue and structure damage.
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