Pathological assessment of chronic kidney disease with DWI: Is there an added value for diffusion kurtosis imaging?

Background Chronic kidney disease (CKD) is a worldwide health problem, precise functional and pathological assessment is beneficial to better treatment. Diffusion kurtosis imaging (DKI) can evaluate non‐Gaussian diffusion and may help to assess renal pathology and function. Purpose To assess pathological and functional alterations in CKD using DKI compared with diffusion‐weighted imaging (DWI). Study Type Prospective study. Population 70 CKD patients and 20 healthy volunteers. Field Strength 1.5 T. Assessment All participants underwent DKI, and apparent diffusion coefficient (ADC), mean diffusivity (MD), and mean kurtosis (MK) of renal parenchyma were acquired. Correlation between renal parenchymal ADC, MD, MK, and estimated glomerular filtration rate (eGFR), pathological scores were assessed. The diagnostic efficacy of ADC, MD, and MK for assessing the degree of renal pathological injury were compared. Statistical Tests ANOVA, Spearman correlation analysis, and ROC curve analysis. Results The cortical ADC, MD were significantly higher than medulla for all participants, whereas medullary MK was significantly higher than cortex ( P < 0.01). Whether eGFR reduced or not, renal parenchymal MK were significantly higher in patients than controls ( P < 0.05). Positive correlation was found between eGFR and ADC (cortex, r = 0.562; medulla, r = 0.527), and negative correlation between eGFR and MK (cortex, r = −0.786; medulla, r = −0.709) (all P < 0.001). There was positive correlation between MK and glomerular injury (cortex, r = 0.681; medulla, r = 0.652), tubulointerstitial lesion (cortex, r = 0.650; medulla, r = 0.599) (all P < 0.001). For discrimination between mild and m‐s renal injury group, the AUC values of ADC, MD, MK were cortex: 0.723, 0.655, 0.864 and medulla: 0.718, 0.581, 0.829. The AUC values of ADC, MD, MK were cortex: 0.708, 0.679, 0.770 and medulla: 0.713, 0.830, 0.780 for differentiating control group from mild renal injury group. Data Conclusion DKI is practicable for noninvasive assessment of renal pathology and function of CKD, DKI offer better diagnostic performance than DWI. Evidence Level 1 Technical Efficacy 2