The Value Of DTI And IVIM In Diabetic Kidney Disease

Objective All diabetic kidney disease(DKD) patients were scanned by diffusion tensor imaging(DTI) and intravoxel incoherent motion(IVIM). FA values, D and f values of the renal cortex and medulla were measured in DKD subgroups of patients, and which were performed correlation analysis with estimated glomerular filtration rate, and the pathogenesis of DKD and the value of DTI, IVIM in DKD staging and evaluation aspects were explored.Materials and methods We selected 46 patients with type 2 diabetes of definitive diagnosis and clinical staging in endocrinology of our hospital,who hospitalized in between September 2015 and December 2015. According to the stages of diabetic nephropathy, DKD patients were divided into DM group, DN â…¢ group and DN â…£ group. Another healthy volunteers were matched DKD patients with gender and age as control group. All the research objects were scanned by Siemens 3.0 T magnetic resonance, and renal T1 WI,T2WI,DTI and DWI images were accessed. So FA values, D and f values respectively were received through software for reprocessing.In addition, Clinical and other related data of all DKD patients were recorded. The statistical software SPSS was employed for data analysis.Results 1.FA values,D and f values were significant difference in comparison of cortex and medulla for both control group and DKD patients(P<0.01).The renal FA values of cortex were significantly lower than the medulla for both control group and DKD patients,but the renal D and f values of cortex were significantly higher than the medulla. 2. FA values,D and f values of the renal cortex and medulla were significant difference in comparison of control group and DKD patients(P<0.01), and FA values,D and f values of the renal cortex and medulla in control group were higher than DKD patients. 3. Comparison between control group and the subgroups of DKD patients: for FA values of cortex, there was no significant difference in comparison of DM group with DN â…¢ group, DN â…¢ group with DN â…£ group(P>0.05), and the result of the comparison of other groups was the opposite(P<0.05). FA values of cortex gradually reduced with the increase of stages. For FA values of medulla, there was significant difference in comparison of control group and the subgroups of DKD patients(P<0.001), and FA values of medulla gradually reduced with the increase of stages. For D,f values of the renal cortex and medulla, there was significant difference in comparison of control group and the subgroups of DKD patients(P<0.05), and D,f values of the renal cortex and medulla gradually reduced with the increase of stages. 4. The diagnosis efficiency of medulla FA values: the best cut-off of differentiating DM group from control group was 519.36, and the sensitivity and specificity were 75%, 93.7% respectively. The best cut-off of differentiating DN â…¢ group from DM group was 428.09, and the sensitivity and specificity were 81.3%,87.5% respectively. The best cut-off of differentiating DN â…£ group from DN â…¢ group was 342.44, and the sensitivity and specificity were 93.8%,57.1% respectively. 5. FA values of cortex had no correlations with e GFR(P>0.05). However, FA values of medulla had positive correlations with e GFR(P<0.01),and FA values of medulla increased gradually with increasing of the e GFR. D and f values of the renal cortex and medulla also had positive correlations with e GFR(P<0.05),and D and f values of the renal cortex and medulla increased gradually with increasing of the e GFR.Conclusions 1. DTI and IVIM can be used to explore the general rule of FA values, D and f values of the renal cortex and medulla both healthy people and DKD patients,and we found that FA values, D and f values reduced gradually with the evolvement of DKD. In a certain extent, it can explain the pathogenesis of DKD. 2. DTI and IVIM in DKD diagnosis of stages have a certain significance, especially in FA values of medulla. FA values can identify the different stages,and provid a certain reference value for DKD staging. 3. The obtained relevant parameters of DTI and IVIM correlated with e GFR in a certain degree, it revealed that DTI and IVIM can evaluate the function of the kidney.