Prospective Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Radiol. Aug 28, 2018; 10(8): 83-90
Published online Aug 28, 2018. doi: 10.4329/wjr.v10.i8.83
In vivo evaluation of early renal damage in type 2 diabetic patients on 3.0 T MR diffusion tensor imaging
Yu-Ting Wang, Xiong Yan, Hong Pu, Long-Lin Yin
Yu-Ting Wang, Xiong Yan, Hong Pu, Long-Lin Yin, Department of Radiology, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu 611731, Sichuan Province, China
Author contributions: Wang YT designed the main ideas and wrote the paper; Yan X, Pu H and Yin LL helped collect relevant data.
Supported by the Fundamental Research Funds for the Central Universities, University of Electronic Science and Technology of China, No. ZYGX2015J125.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the Sichuan Provincial People’s Hospital.
Conflict-of-interest statement: The authors declare no conflicts of interests.
Open-Access: This article is an open-access article, which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Yu-Ting Wang, MD, Department of Radiology, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu 611731, Sichuan Province, China. wangyuting_330@163.com
Telephone: +86-28-87394725
Received: May 3, 2018
Peer-review started: May 4, 2018
First decision: June 6, 2018
Revised: June 26, 2018
Accepted: July 10, 2018
Article in press: July 10, 2018
Published online: August 28, 2018
ARTICLE HIGHLIGHTS
Research background

Diabetic nephropathy (DN) remains one of the most common causes of morbidity and mortality in patients with type 2 diabetes worldwide. Early diagnosis of DN facilitates timely treatment, and therefore, improving patient outcomes. Although microalbuminuria (MAU) level is currently the primary standard for the diagnosis of DN, it may lag behind DN progression and has limited sensitivity.

Research motivation

Diffusion tensor imaging (DTI) quantifies the directional nature of water diffusion and is especially suited for specifically oriented organs such as the kidney. DTI parameter changes were reported in several renal pathologic conditions presenting itself as a potential biomarker of renal damage.

Research objectives

The main objective of this study was to explore the possibility of using renal DTI to detect early renal damage in patients with type 2 diabetes.

Research methods

This prospective study included 26 diabetic patients (12 with MAU, and 14 with normoalbuminuria) and 14 healthy volunteers. Renal DTI on 3.0 T MR was performed and estimated glomerular filtration rate (eGFR) was recorded for each subject. Mean cortical and medullary fractional anisotropy (FA) values were separately calculated by placing multiple representative regions of interest. Mean FA values were statistically compared among groups, and correlations between FA values and eGFR were evaluated. The high-field MR offered high signal-to-noise ratio and the multiple sampling of renal parenchyma ensured the representativeness of the underlying pathological changes.

Research results

The results showed that both cortical and medullary FA were significantly reduced in diabetic patients compared to healthy controls. Cortical FA was significant lower in diabetic patients with NAU than healthy controls, indicating that the renal damage reflected by the FA changes occurred even earlier than the clinical detection of MAU. Both cortical FA and medullary FA correlated with eGFR, indicating that both renal cortex and medulla could be involved in the pathogenesis of DN.

Research conclusions

In conclusion, both cortical and medullary FA could potentially exhibit early renal damage in type 2 diabetic patients, and therefore help to differentiate diabetic kidneys from healthy controls even before the clinical detection of MAU.

Research perspectives

Based on these findings, renal DTI could be developed as an early biomarker in addition to the current examinations in the clinical practice. Further experimental or clinical studies with pathological results can be designed to reveal the specific underlying mechanism of FA reduction in DN.