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Diffusion kurtosis imaging as an imaging biomarker for predicting prognosis in chronic kidney disease patients.

BACKGROUND
Renal fibrosis is the strongest prognosis predictor of end-stage renal disease (ESRD) in chronic kidney disease (CKD). Diffusion kurtosis imaging (DKI) is a promising method of magnetic resonance imaging (MRI) successfully used to assess renal fibrosis in IgA nephropathy. This study first evaluated the long-term prognostic value of DKI in CKD patients.


METHODS
Forty-two patients with CKD were prospectively enrolled, and underwent DKI on a clinical 3 T MR scanner. We excluded patients with comorbidities that could affect the volume or the components of the kidney. DKI parameters, including mean kurtosis (K), mean diffusivity (D) and apparent diffusion coefficient (ADC) of kidney cortex were obtained by region-of-interest measurement. We followed up these patients for a median of 43 months and investigated the correlations between each DKI parameter and overall renal prognosis.


RESULTS
Both K and ADC values were correlated well with the eGFR on recruitment and the eGFR of the last visit in follow-up (p＜0.001). K and ADC values were also well associated with the eGFR slopes in CKD patients, both with the first-last time point slope (p = 0.011 and p＜0.001, respectively) and with the regression slope (p = 0.010 and p＜0.001, respectively). Cox proportional hazard regression indicated that lower eGFR and ADC values independently predicted eGFR loss of more than 30% and ESRD. The receiver operating characteristic analysis showed that K and ADC values were predictable for renal prognosis, and ADC displayed better capabilities for both ESRD (AUC 0.936, sensitivity 92.31%, specificity 82.76%) and the composite endpoint (eGFR loss>30% or ESRD) (AUC 0.881, sensitivity 66.67%, specificity 96.3%).


CONCLUSIONS
Renal ADC values obtained from DKI showed significant predictive value for the prognosis of CKD patients, which could be a promising noninvasive technique in follow-up.