• Wei Mao, Jianjun Zhou, Mengsu Zeng, Yuqin Ding, Lijie Qu, Caizhong Chen, Xiaoqiang Ding, Yaqiong Wang, and Caixia Fu.
• Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Medical Imaging, Shanghai, P.R. China.
• J Magn Reson Imaging. 2018 May 1; 47 (5): 1251-1259.

BackgroundBecause chronic kidney disease (CKD) is a worldwide problem, accurate pathological and functional evaluation is required for planning treatment and follow-up. Intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) can assess both capillary perfusion and tissue diffusion and may be helpful in evaluating renal function and pathology.PurposeTo evaluate functional and pathological alterations in CKD by applying IVIM-DWI.Study TypeProspective study.SubjectsIn all, 72 CKD patients who required renal biopsy and 20 healthy volunteers.Field Strength1.5T.AssessmentAll subjects underwent IVIM-DWI of the kidneys, and image analysis was performed by two radiologists. The mean values of true diffusion coefficient (D), pseudo diffusion coefficient (D*), and perfusion fraction (f) were acquired from renal parenchyma. Correlation between IVIM-DWI parameters and estimated glomerular filtration rate (eGFR), as well as pathological damage, were assessed.Statistical TestsOne-way analysis of variance (ANOVA), paired sample t-test and Spearman correlation analysis.ResultsThe paired sample t-test revealed that IVIM-DWI parameters were significantly lower in medulla than cortex for both patients and controls (P < 0.01). Regardless of whether eGFR was reduced, ANOVA revealed that f values of renal parenchyma were significantly lower in patients than controls (P < 0.05). Spearman correlation analysis revealed that there were positive correlations between eGFR and D (cortex, r = 0.466, P < 0.001; medulla, r = 0.491, P < 0.001), and between eGFR and f (cortex, r = 0.713, P < 0.001; medulla, r = 0.512, P < 0.001). Negative correlations were found between f and glomerular injury (cortex, r = -0.773, P < 0.001; medulla, r = -0.629, P < 0.001), and between f and tubulointerstitial lesion (cortex, r = -0.728, P < 0.001; medulla, r = -0.547, P < 0.001).Data ConclusionIVIM-DWI might be feasible for noninvasive evaluation of renal function and pathology of CKD, especially in detection of renal insufficiency at an early stage.Level Of Evidence1 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2018;47:1251-1259.© 2017 International Society for Magnetic Resonance in Medicine.

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