| Purpose:To investigate whether magnetic resonance arterial spin labeling(ASL)and intravoxel incoherent motion(IVIM-DWI)can detect early renal function changes in patients with type 2 diabetes mellitus(T2DM).Methods:Forty-three patients with T2DM from the Department of Endocrinology,Shanxi Provincial People’s Hospital from November 2021 to November 2022 were selected and divided into T2DM group(ACR<30 mg/g,27 patients)and early diabetic nephropathy group(30≤ACR≤300 mg/g,16 patients)according to the albumin/creatinine ratio(ACR),and 16 healthy volunteers matched for age and gender were also included as the control group.ASL and IVIM-DWI scans were performed on all subjects using a GE Discovery MR750 3.0T superconducting MR scanner.Renal blood flow(RBF value),perfusion fraction(f value),pseudodiffusion(D*value),and apparent diffusion coefficient(ADC value),pure molecular diffusion(D value)were measured in the bilateral renal cortex and renal medulla of the three groups respectively.Using two-sample t-test,one-way analysis of variance and non-parametric test to compare the differences in the clinical data of the three groups,and using two-sample t-test and non-parametric Wilcoxon test to compare the differences in the clinical data of the two groups.Using Kruskal-Wallis H test and one-way analysis of variance to compare differences in renal functional magnetic resonance imaging parameters between the three groups,and Tukey-M1 test or Steel Dwass test was used for pairwise comparisons.Using Spearman correlation analysis and Pearson correlation analysis to compare the correlation between renal functional magnetic resonance imaging parameters and clinically relevant parameters(ACR)and the correlation between renal functional magnetic resonance imaging parameters.Receiver operating characteristic(ROC)curves and binary logistic regression were used to analyze the diagnostic value of renal ASL and IVIM-DWI parameters for early renal function changes in T2DM patients.P<0.05 represents a statistically significant difference.Results:(1)There were significant differences in RBF values in renal cortex and ADC,D,and f values in renal cortex and renal medulla among healthy controls,T2DM groups,and early diabetic nephropathy groups(P<0.05).Pairwise comparisons showed that compared with the healthy control group,the RBF value(P<0.01),f value(P<0.001)in the cortex and D value(P<0.001)and f value(P<0.001)in the medulla were significantly reduced in the T2DM group;the RBF value(P<0.001),D value(P<0.01),f value(P<0.001)in the cortex and ADC value(P<0.05),D value(P<0.001),and f value(P<0.001)in the medulla were significantly reduced in the early diabetic nephropathy group.Compared with the T2DM group,the RBF value(P<0.05),f value(P<0.001),ADC value(P<0.01),D value(P<0.05)in the cortex and ADC value(P<0.01),D value(P<0.001),and f value(P<0.001)in the medulla were significantly reduced in the early diabetic nephropathy group,and the differences were statistically significant.(2)In the correlation analysis,there was more than moderate negative correlation between ADC value of renal cortex and f value of renal cortex and medulla and ACR(_>-0.4,P<0.01),and weak negative correlation between RBF value,D value of renal cortex and ADC value and D value of renal medulla and ACR(_>-0.2,P<0.05).Renal cortical RBF value and f value are significantly positively correlated(_=0.575,P<0.001).(3)RBF value,f value of renal cortex and D value and f value of renal medulla had higher differential diagnostic efficacy for healthy control group and T2DM group,healthy control group and early diabetic nephropathy group,T2DM group and early diabetic nephropathy group;ADC value,D value of renal cortex and ADC value of renal medulla had higher differential diagnostic efficacy for healthy control group and early diabetic nephropathy group,T2DM group and early diabetic nephropathy group.Conclusion:ASL and IVIM-DWI can reflect the changes of renal microcirculatory perfusion and microstructure in patients with T2DM at the early stage,and can be used to evaluate the early renal function injury in patients with T2DM. |
