Evaluation Of Hemodynamics Between Renal And Splenic Arteries In Type2 Diabetes Mellitus(T2DM) Patients With 4D Flow MRI

Objective:Microcirculation changes can occur in patients with type 2 diabetes at an early stage,leading to abnormal abdominal hemodynamic changes.This study aims to use the emerging 4D FLOW sequence of magnetic resonance to more comprehensively and accurately assess the state of renal and splenic blood flow in patients with type 2 diabetes and its hemodynamic change trend,so as to promptly guide clinical early treatment and intervention of complications.Methods:A total of 30 T2DM patients diagnosed were recruited into the study at Zhongda Hospital of Southeast University from March 2019 to May 2020.Notably,9out of 30 T2DM patients were diagnosed as DN according to Mogensen classification（UAE>20μg/min in the resting state）.And in the meantime,30 healthy subjects with matching gender and age were recruited.All the subjects underwent the 4D Flow MRI examination in Philips Ingenia 3.0T scanner.The hemodynamic parameters such as net volume of the blood flow through the contour in one cardiac cycle(Flow_cyc,ml/s),average velocity(V_avg,cm/s),resistance index of the vessel（RI）were obtained,respectively.There are three parts of the study:a)validate the reproducibility of the measurement of hemodynamic parameters of the arteries of concern using 4D Flow MRI;b)investigate the differences hemodynamic parameters between DM patients and healthy volunteers;3)evaluate the performance of 4D Flow MRI in the detection and diagnosis of DM/DN.Results:The processing of the 4D Flow data and the measurement of the hemodynamic parameters showed good inter-observer/intra-observer reproducibility,Inter-class correlation coefficient（ICC）values are both higher than 0.90.In T2DM patients,the flow of the left renal artery in one cardiac cycle was significantly lower than that of the healthy control group(Flow_cyc 0.088±0.029 vs.0.105±0.028,P=0.032),and the vascular resistance index RI was significantly higher than that of the healthy control group（0.65±0.006 vs.0.61±0.06,P=0.015）.In the right renal artery of T2DM patients,the flow in one cardiac cycle was significantly lower than that of the healthy control group(Flow_cyc 0.66±0.07 vs.0.57±0.07,P=0.031),and the vascular resistance index RI was significantly higher than that of the healthy control group（0.094±0.028 vs.0.114±0.032,P<0.001）;In the splenic artery,the vascular resistance of T2DM patients was significantly higher than that of the healthy control group（0.64±0.078 vs.0.57±0.065,P=0.002）.The blood supply of bilateral renal arteries was balanced between the two groups of subjects（T2DM group:0.079±0.08,healthy control group:0.086±0.07,P=0.758）.The vascular resistance RI of the right renal artery showed the best performance in detecting T2DM,with an AUC value of0.81（sensitivity 0.78,specificity 0.77,cut-off value 0.61）.In the diagnostic performance evaluation of DN,the left renal artery Flow_cyc AUC value was 0.89（sensitivity 0.89,specificity 0.78,cut-off value 0.079）,showing the most excellent diagnostic performance.Conclusions:4D Flow MRI can non-invasively and comprehensively evaluate the state of renal and splenic blood flow and its hemodynamic change trend in patients with T2DM.Related parameters may potentially guide clinical decision-making in time and provide early treatment and intervention for T2DM complications.