Kidney Transplant: Functional Assessment with Diffusion-Tensor MR Imaging at 3T

Purpose: To evaluate the feasibility of diffusion-tensor (DT) imaging at 3 T for functional assessment of transplanted kidneys. Materials and Methods: This study was approved by the local ethics committee; written informed consent was obtained. Between August 2009 and October 2010, 40 renal transplant recipients were prospectively included in this study and examined with a clinical 3-T magnetic resonance (MR) imager. An echo-planar DT imaging sequence was performed in coronal orientation by using five b values (0, 200, 400, 600, 800 sec/mm(2)) and 20 diffusion directions. The fractional anisotropy (FA) and apparent diffusion coefficient (ADC) were determined for the cortex and medulla of the transplanted kidney. Relationships between FA, ADC, and allograft function, determined by the estimated glomerular filtration rate (eGFR), were assessed by using Pearson correlation coefficient. ADC and FA were compared between patients with good or moderate allograft function (group A; eGFR > 30 mL/min/1.73 m(2)) and patients with impaired function (group B; eGFR. 30 mL/min/1.73 m2) by using a student t test. P < .05 indicated a statistically significant difference. Results: Mean FA of the renal medulla and cortex was significantly higher in group A (0.39 +/- 0.06 and 0.17 +/- 0.4) compared with group B (0.27 +/- 0.05 and 0.14 +/- 0.03) (P < .001 and P = .009, respectively). Mean ADCs of renal cortex and medulla were significantly higher in group A than in group B (P = .007 and P = .01, respectively). In group B, mean medullary FA was significantly lower in patients whose renal function did not recover (0.22 +/- 0.02) compared with those with stable allograft function at 6 months (0.29 +/- 0.05, P < .001). There was significant correlation between eGFR and medullary FA (r = 0.65, P,.001), cortical ADC (r = 0.43, P = .003), and medullary ADC (r = 0.35, P = .01). Conclusion: DT imaging is a promising noninvasive technique for functional assessment of renal allografts. FA values in the renal medulla exhibit a good correlation with renal function. (R) RSNA, 2012