Journal of magnetic resonance imaging : JMRI · 2025
Identification of Diffusion-Relaxation Compartments Based on Correlation to Renal Pathological Scores: An Explorative Study on Lupus Nephritis.
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Hu Wentao, Liu Fang, Shen Yiwei, Yang Tianshu, Ye Shuang, Dai Yongming, Wu Dongmei, Ding Huihua, Zhou Yan
Аннотация
BACKGROUND: Renal histologic findings are beneficial in the diagnosis and treatment of lupus nephritis (LN), but require an invasive biopsy. Diffusion-relaxation correlated spectrum imaging (DR-CSI) has previously been applied to assess renal fibrosis, yet current approaches for compartment identification lack quantified standards.
PURPOSE: This exploratory study is aimed at establishing a spectrum-pathology correlation analysis for identifying possible DR-CSI compartments, and explore the diagnostic value of the compartment fractions on common pathologic features.
STUDY TYPE: Cross-sectional.
POPULATION/SUBJECTS: 66 LN patients (58 females) and 20 healthy volunteers (17 females).
FIELD STRENGTH/SEQUENCE: 3 T scanner/Axial renal DR-CSI scan with 34 contrasts (TE 55~170 ms, b-values 0~1200 s/mm2).
ASSESSMENT: Pathologic classification, activity index, and chronicity index were obtained through biopsy. The estimated glomerular filtration rate (eGFR) was assessed, representing renal function. Four compartments, short-T2 (S), restricted-diffusion (R), long-T2 (L), and pseudo-diffusion (PD), were identified. Compartment fractions F X were calculated (X: compartment label).
STATISTICAL TESTS: Spearman correlation for spectrum-pathology relationship. Student's t-test or Mann-Whitney U-test for group comparison. ROC analysis for diagnostic performance. Significance criteria: p < 0.05.
RESULTS: LN patients had significantly higher F R (12.3% ± 5.6% vs. 7.6% ± 2.3%), lower F PD (36.3% ± 9.1% vs. 29.6% ± 13.0%), lower F L (30.1% ± 12.1% vs. 24.8% ± 7.6%), and higher ADC (1.95 ± 0.19 vs. 1.78 ± 0.22 μm2/ms) than healthy volunteers. Patients with impaired renal function had significantly higher F R (11.1% ± 5.3% vs. 15.4% ± 5.2%), higher F L (27.8% ± 10.8% vs. 36.0% ± 13.5%), lower F PD (32.3% ± 12.3% vs. 23.3% ± 12.7%), and lower ADC (1.82 ± 0.19 vs. 1.69 ± 0.23 μm2/ms). Proliferative LN patients had significantly increased FL (31.8% ± 12.1% vs. 24.8% ± 11.2%) than non-proliferative ones. For identifying patients with impaired function, F R showed numerically highest AUC (0.736), sensitivity (0.842), and balanced accuracy (0.730) at optimal point for Youden index. For identifying proliferative patients, F L showed numerically highest AUC (0.679), sensitivity (0.800), and negative predictive value (0.474) among single univariate models.
DATA CONCLUSION: The compartment fractions can identify proliferative LN and impaired function, highlighting the potential of a histology-driven compartment identification strategy.
EVIDENCE LEVEL: 2.
TECHNICAL EFFICACY: Stage 2.
PURPOSE: This exploratory study is aimed at establishing a spectrum-pathology correlation analysis for identifying possible DR-CSI compartments, and explore the diagnostic value of the compartment fractions on common pathologic features.
STUDY TYPE: Cross-sectional.
POPULATION/SUBJECTS: 66 LN patients (58 females) and 20 healthy volunteers (17 females).
FIELD STRENGTH/SEQUENCE: 3 T scanner/Axial renal DR-CSI scan with 34 contrasts (TE 55~170 ms, b-values 0~1200 s/mm2).
ASSESSMENT: Pathologic classification, activity index, and chronicity index were obtained through biopsy. The estimated glomerular filtration rate (eGFR) was assessed, representing renal function. Four compartments, short-T2 (S), restricted-diffusion (R), long-T2 (L), and pseudo-diffusion (PD), were identified. Compartment fractions F X were calculated (X: compartment label).
STATISTICAL TESTS: Spearman correlation for spectrum-pathology relationship. Student's t-test or Mann-Whitney U-test for group comparison. ROC analysis for diagnostic performance. Significance criteria: p < 0.05.
RESULTS: LN patients had significantly higher F R (12.3% ± 5.6% vs. 7.6% ± 2.3%), lower F PD (36.3% ± 9.1% vs. 29.6% ± 13.0%), lower F L (30.1% ± 12.1% vs. 24.8% ± 7.6%), and higher ADC (1.95 ± 0.19 vs. 1.78 ± 0.22 μm2/ms) than healthy volunteers. Patients with impaired renal function had significantly higher F R (11.1% ± 5.3% vs. 15.4% ± 5.2%), higher F L (27.8% ± 10.8% vs. 36.0% ± 13.5%), lower F PD (32.3% ± 12.3% vs. 23.3% ± 12.7%), and lower ADC (1.82 ± 0.19 vs. 1.69 ± 0.23 μm2/ms). Proliferative LN patients had significantly increased FL (31.8% ± 12.1% vs. 24.8% ± 11.2%) than non-proliferative ones. For identifying patients with impaired function, F R showed numerically highest AUC (0.736), sensitivity (0.842), and balanced accuracy (0.730) at optimal point for Youden index. For identifying proliferative patients, F L showed numerically highest AUC (0.679), sensitivity (0.800), and negative predictive value (0.474) among single univariate models.
DATA CONCLUSION: The compartment fractions can identify proliferative LN and impaired function, highlighting the potential of a histology-driven compartment identification strategy.
EVIDENCE LEVEL: 2.
TECHNICAL EFFICACY: Stage 2.