Early detection of subclinical pathology in patients with stable kidney graft function by arterial spin labeling
- 1 May 2021
- journal article
- research article
- Published by Springer Science and Business Media LLC in European Radiology
- Vol. 31 (5), 2687-2695
- https://doi.org/10.1007/s00330-020-07369-5
Abstract
Objectives To evaluate the utility of arterial spin labeling (ASL) for the identification of kidney allografts with underlying pathologies, particularly those with stable graft function. Methods A total of 75 patients, including 18 stable grafts with normal histology (normal group), 21 stable grafts with biopsy-proven pathology (subclinical pathology group), and 36 with unstable graft function (unstable graft group), were prospectively examined by ASL magnetic resonance imaging. Receiver operating characteristic curves were generated to calculate the area under the curve (AUC), sensitivity, and specificity. Results Patient demographics among the 3 groups were comparable. Compared with the normal group, kidney allograft cortical ASL values decreased in the subclinical pathology group and the unstable graft group (204.7 +/- 44.9 ml/min/100 g vs 152.5 +/- 38.9 ml/min/100 g vs 92.3 +/- 37.4 ml/min/100 g, p < 0.001). The AUC, sensitivity, and specificity for discriminating allografts with pathologic changes from normal allografts were 0.92 (95% CI, 0.83-0.97), 71.9%, and 100% respectively by cortical ASL and 0.82 (95% CI, 0.72-0.90), 54.4%, and 100% respectively by serum creatinine. The cortical ASL identified allografts with subclinical pathology among patients with stable graft function with an AUC of 0.80 (95% CI, 0.64-0.91), sensitivity of 57.1%, and specificity of 88.9%. Combined use of proteinuria and cortical ASL could improve the sensitivity and specificity to 76.2% and 100% respectively for distinguishing the subclinical pathology group from the normal group. Conclusions Cortical ASL is useful for the identification of allografts with underlying pathologies. More importantly, ASL showed promise as a non-invasive tool for the clinical translation of identifying kidney allografts with subclinical pathology.This publication has 36 references indexed in Scilit:
- Acute Kidney Injury: Arterial Spin Labeling to Monitor Renal Perfusion Impairment in Mice—Comparison with Histopathologic Results and Renal FunctionRadiology, 2014
- Functional evaluation of transplanted kidneys using arterial spin labeling MRIJournal of Magnetic Resonance Imaging, 2013
- Correlation of histopathologic and dynamic tissue perfusion measurement findings in transplanted kidneysBMC Nephrology, 2013
- Functional MRI of the kidneysJournal of Magnetic Resonance Imaging, 2013
- Evolution and Clinical Pathologic Correlations of De Novo Donor-Specific HLA Antibody Post Kidney TransplantAmerican Journal of Transplantation, 2012
- Arterial spin labeling MRI for assessment of perfusion in native and transplanted kidneysMagnetic Resonance Imaging, 2011
- Measurement of kidney perfusion by magnetic resonance imaging: comparison of MRI with arterial spin labeling to para-aminohippuric acid plasma clearance in male subjects with metabolic syndromeNephrology Dialysis Transplantation, 2009
- Subclinical Rejection Associated with Chronic Allograft Nephropathy in Protocol Biopsies as a Risk Factor for Late Graft LossAmerican Journal of Transplantation, 2006
- The renal medullary microcirculationFrontiers in Bioscience-Landmark, 2000