Comparison of IVIM and BOLD MR imaging in Functional Evaluation of Diabetic nephropathy
Lihua Chen1, Tao Ren1, Yu Zhang2, Chenglong Wen1, and Wen Shen1

1Tianjin First Center Hospital, Tianjin, China, People's Republic of, 2Philips healthcare, Beijing, China, People's Republic of


To detect the changes of kidney diseases, magnetic resonance imaging(MRI) as a noninvasive approach has been proved to be more suitable for detecting and monitoring diabetic nephropathy(DN). Intravoxel incoherent motion (IVIM) and blood oxygenation level dependent (BOLD) MR imaging have been confirmed their high potential in detecting changes of renal function in patients with chronic renal diseases and transplanted kidneys. We compared the parameters of IVIM and BOLD in patients with DN and heathy controls. The results demonstrated the capacity of IVIM and BOLD for reflecting renal perfusion, diffusion and oxygenation changes in patients with DN.


Diabetes nephropathy(DN), after the earliest clinical evidence of microalbuminuria is detected, is followed by renal function deteriorating slowly and progression to end-stage renal disease. Histopathological changes, including thickening of the glomerular basement membrane, nodular and diffuse glomerular sclerosis, tubular damage, and interstitial fibrosis, are earlier than clinical abnormality, and can be evaluated only by kidney biopsy. However, further studies are needed to help distinguish between tubular and vascular changes and to better understand these changes. Magnetic resonance (MR) imaging as a noninvasive approach is more suitable for detecting and monitoring diabetic nephropathy than biopsy. Intravoxel incoherent motion (IVIM) and blood oxygenation level dependent (BOLD) MR imaging have been confirmed their high potential in detecting changes of renal function in patients with chronic renal diseases and transplanted kidneys. BOLD imaging has been reported that medullary R2* values changes in patients with diabetic nephropathy may be caused by oxygenation consumption in diabetes1,2. Combined IVIM and BOLD MR imaging can simultaneously observe the perfusion, diffusion and oxygenation of cortex and medullar in diabetes nephropathy. The purpose of the presented study was to assess the capacity for detecting the changes of diabetic nephropathy using IVIM and BOLD.


Four patients with type 2 diabetes (mean age 45.0±3.6 years) and 11 healthy controls (mean age 24.1±6.7 years)were involved and examined using a 3.0 T MR scanner (Ingenia, Philips Healthcare, Best, the Netherlands). All four patients with chronic kidney disease due to diabetic nephropathy showed increasing 24 hours proteinuria. Coronal-oblique IVIM was obtained with following parameters: voxel size = 0.9×0.9×4.0 mm3, TE/TR=52/500ms, and 11 b values of 0, 10, 20, 30, 50, 75, 100, 200, 300, 500, and 700 s/mm2 on 3 gradient directions. To separate the perfusion and diffusion, a bi-exponential fitting was used to calculate the perfusion fraction(f), pseudo-diffusion coefficient (D*) and diffusion coefficient(D). BOLD-MRI using multiple T2*-weighted gradient echo sequence, was acquired in coronal-oblique plane with 6 slices with 5mm thickness as well as following parameters: TR=117ms; TE=2.3-39.1ms, echo time spacing=9.2ms; flip angle=35°; matrix=220×220. The medullary and cortical R2*values were quantified with BOLD. Three sections nearest to the renal hilum were selected for region of interest (ROI) analysis. For each selected section, three ellipsoid ROIs of approximately 10-15 pixels were placed in the medulla, and a ROI of 80-120 pixels was manually delineated to cover the renal cortex. The ROIs of the left and right kidney were averaged for each subject for the cortex and medulla after excluding significant left and right differences. These parameters were compared between patients and healthy controls by using Student’s t-tests in SPSS 17.0 software (SPSS Inc., Chicago, IL, USA) and P <0.05 indicated significant difference.

Results and Discussion

Table 1 shows the mean values of MRI parameters between healthy controls and patients with diabetes nephropathy. The results displayed that the mean values of cortical D and f, medullar D of patients with DN were lower than the ones of healthy controls. The mean values of cortical and medullar R2* of patient group slightly increased compared to healthy controls’, which was consistent with previous study3. The results may indicate that these changes, including decreased perfusion of cortex, decreased diffusion of both cortex and medullar combined increased oxygenation consumption may coexist in patients with DN. No significant differences of D* values of both cortex and medullar were found between the two groups. Figure 1 shows image examples of D, f and T2* of kidneys in a healthy volunteer and a patient with DN.


IVIM and BOLD were able to reflect perfusion, diffusion and oxygenation information in healthy controls and patients with diabetes nephropathy, and may be used for monitoring renal function noninvasively.


No acknowledgement found.


[1]Wang ZJ, Kumar R, Banerjee S, Hsu CY. Blood oxygen level-dependent (BOLD) MRI of diabetic nephropathy: preliminary experience. J Magn Reson Imaging. 2011;33(3):655-660.

[2] Neugarten J, Golestaneh L. Blood oxygenation level-dependent MRI for assessment of renal oxygenation. Int J Nephrol Renovasc Dis. 2014; 21;7:421-435.

[3]Yin WJ, Liu F, Li XM, et al. Noninvasive evaluation of renal oxygenation in diabetic nephropathy by BOLD-MRI. Eur J Radiol. 2012;81(7):1426-1431.


Figure 1 Image examples of D, f and T2* of kidneys in a patient with diabetes nephropathy(A) and a healthy volunteer(B)

Table 1 Comparison of mean values of IVIM and BOLD parametersbetween patients and healthy controls

Proc. Intl. Soc. Mag. Reson. Med. 24 (2016)