Prediction value of IVIM Combining with BOLD-MRI in Diabetic Kidney Disease: A Prospective Cohort Study

Abstract Background Noninvasive evaluation of hypoxia and fibrosis in kidney simultaneously by functional magnetic resonance imaging (MRI) to predict the prognosis of patients in prospective diabetic kidney disease (DKD) cohort has not been reported. We aim to assess the prediction value of blood oxygen level-dependent (BOLD) MRI and intravoxel incoherent motion (IVIM) diffusion-weighted image (DWI) in the prognosis of DKD.Methods 77 patients with diabetes mellitus (67 with DKD) were enrolled in this prospective cohort study in single center. BOLD-MRI and IVIM-DWI were used to assess renal hypoxia and fibrosis. A well-validated, reproducible method called twelve-layer concentric objects (TLCO) was applied to quantify the R2* values of BOLD (corresponds to oxygenation) and D values of IVIM (corresponds to fibrosis) derived from MRI. All patients received standard medical care according to guideline during study and followed up for 24.8 ± 12.6 months. The primary end points were serum creatinine (Scr) increasing > 30%, ERSD, or death.Results Our data demonstrated that medullary R2* value (MR2*) was significantly higher and cortical D value (CD) was markedly lower in DKD than those of diabetic controls, and strongly correlated with estimated glomerular filtration rate. Both the higher MR2* (log-rank test, P < 0.001) and the lower CD (log-rank test, P < 0.001) predicted a worse outcome of DKD. The corresponding areas under the curve (AUC) were 0.80 [95% confidence interval (CI) 0.69–0.89] and 0.77 (95% CI 0.64–0.89) respectively. Importantly, combination of MR2* and CD exhibited a more significant efficiency (AUC 0.85, 95% CI 0.74–0.95) than each of them respectively in predicting the outcomes of DKD.Conclusions Integrating BOLD-MRI and IVIM-DWI quantified by TLCO was more efficient than each single of them in assessment of renal outcomes; thus, could be a noninvasive tool to predict the prognosis of DKD.Trial registration The study protocol was registered at the Chinese Clinical Trial Registry Center (NO: ChiCTR-RRC-17012687; date of registration: 16/09/2017).