This preprint is under consideration at BMC Nephrology. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research Article
Prediction value of IVIM Combining with BOLD-MRI in Diabetic Kidney Disease: A Prospective Cohort Study
Wenjian Wang
Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences
Corresponding Author
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background Noninvasive evaluation of hypoxia and fibrosis in kidney simultaneously by functional magnetic resonance imaging (MRI) to predict the prognosis of patients in prospective diabetic kidney disease (DKD) cohort has not been reported. We aim to assess the prediction value of blood oxygen level-dependent (BOLD) MRI and intravoxel incoherent motion (IVIM) diffusion-weighted image (DWI) in the prognosis of DKD.
Methods 77 patients with diabetes mellitus (67 with DKD) were enrolled in this prospective cohort study in single center. BOLD-MRI and IVIM-DWI were used to assess renal hypoxia and fibrosis. A well-validated, reproducible method called twelve-layer concentric objects (TLCO) was applied to quantify the R2* values of BOLD (corresponds to oxygenation) and D values of IVIM (corresponds to fibrosis) derived from MRI. All patients received standard medical care according to guideline during study and followed up for 24.8 ± 12.6 months. The primary end points were serum creatinine (Scr) increasing > 30%, ERSD, or death.
Results Our data demonstrated that medullary R2* value (MR2*) was significantly higher and cortical D value (CD) was markedly lower in DKD than those of diabetic controls, and strongly correlated with estimated glomerular filtration rate. Both the higher MR2* (log-rank test, P < 0.001) and the lower CD (log-rank test, P < 0.001) predicted a worse outcome of DKD. The corresponding areas under the curve (AUC) were 0.80 [95% confidence interval (CI) 0.69–0.89] and 0.77 (95% CI 0.64–0.89) respectively. Importantly, combination of MR2* and CD exhibited a more significant efficiency (AUC 0.85, 95% CI 0.74–0.95) than each of them respectively in predicting the outcomes of DKD.
Conclusions Integrating BOLD-MRI and IVIM-DWI quantified by TLCO was more efficient than each single of them in assessment of renal outcomes; thus, could be a noninvasive tool to predict the prognosis of DKD.
Trial registration The study protocol was registered at the Chinese Clinical Trial Registry Center (NO: ChiCTR-RRC-17012687; date of registration: 16/09/2017).
Keywords
blood oxygen level-dependent (BOLD), diabetic kidney disease (DKD), intravoxel incoherent motion (IVIM), outcomes, twelve-layer concentric objects (TLCO)
Figure 1
Figure 2
Figure 3
Figure 4
This is a list of supplementary files associated with this preprint. Click to download.
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Revision
Version 1
Posted 23 Dec, 2020
No community comments so far
Editorial decision: Major revision
On 15 Jan, 2021
Review #4 received
Received 09 Jan, 2021
Review #1 received
Received 09 Jan, 2021
Review #3 received
Received 09 Jan, 2021
Review #2 received
Received 09 Jan, 2021
Reviewer #6 agreed
On 24 Dec, 2020
Reviewer #3 agreed
On 24 Dec, 2020
Reviewer #5 agreed
On 24 Dec, 2020
Reviewer #1 agreed
On 24 Dec, 2020
Reviewer #4 agreed
On 24 Dec, 2020
Reviewer #2 agreed
On 24 Dec, 2020
Reviewers invited
Invitations sent on 22 Dec, 2020
Editor assigned
On 22 Dec, 2020
Editor invited
On 21 Dec, 2020
Submission checks complete
On 21 Dec, 2020
First submitted
On 05 Dec, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Urology & Nephrology
Learn more about our company.
This preprint is under consideration at BMC Nephrology. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research Article
Prediction value of IVIM Combining with BOLD-MRI in Diabetic Kidney Disease: A Prospective Cohort Study
Wenjian Wang
Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences
Corresponding Author
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Revision
Version 1
Posted 23 Dec, 2020
No community comments so far
Editorial decision: Major revision
On 15 Jan, 2021
Review #4 received
Received 09 Jan, 2021
Review #1 received
Received 09 Jan, 2021
Review #3 received
Received 09 Jan, 2021
Review #2 received
Received 09 Jan, 2021
Reviewer #6 agreed
On 24 Dec, 2020
Reviewer #3 agreed
On 24 Dec, 2020
Reviewer #5 agreed
On 24 Dec, 2020
Reviewer #1 agreed
On 24 Dec, 2020
Reviewer #4 agreed
On 24 Dec, 2020
Reviewer #2 agreed
On 24 Dec, 2020
Reviewers invited
Invitations sent on 22 Dec, 2020
Editor assigned
On 22 Dec, 2020
Editor invited
On 21 Dec, 2020
Submission checks complete
On 21 Dec, 2020
First submitted
On 05 Dec, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Urology & Nephrology
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background Noninvasive evaluation of hypoxia and fibrosis in kidney simultaneously by functional magnetic resonance imaging (MRI) to predict the prognosis of patients in prospective diabetic kidney disease (DKD) cohort has not been reported. We aim to assess the prediction value of blood oxygen level-dependent (BOLD) MRI and intravoxel incoherent motion (IVIM) diffusion-weighted image (DWI) in the prognosis of DKD.
Methods 77 patients with diabetes mellitus (67 with DKD) were enrolled in this prospective cohort study in single center. BOLD-MRI and IVIM-DWI were used to assess renal hypoxia and fibrosis. A well-validated, reproducible method called twelve-layer concentric objects (TLCO) was applied to quantify the R2* values of BOLD (corresponds to oxygenation) and D values of IVIM (corresponds to fibrosis) derived from MRI. All patients received standard medical care according to guideline during study and followed up for 24.8 ± 12.6 months. The primary end points were serum creatinine (Scr) increasing > 30%, ERSD, or death.
Results Our data demonstrated that medullary R2* value (MR2*) was significantly higher and cortical D value (CD) was markedly lower in DKD than those of diabetic controls, and strongly correlated with estimated glomerular filtration rate. Both the higher MR2* (log-rank test, P < 0.001) and the lower CD (log-rank test, P < 0.001) predicted a worse outcome of DKD. The corresponding areas under the curve (AUC) were 0.80 [95% confidence interval (CI) 0.69–0.89] and 0.77 (95% CI 0.64–0.89) respectively. Importantly, combination of MR2* and CD exhibited a more significant efficiency (AUC 0.85, 95% CI 0.74–0.95) than each of them respectively in predicting the outcomes of DKD.
Conclusions Integrating BOLD-MRI and IVIM-DWI quantified by TLCO was more efficient than each single of them in assessment of renal outcomes; thus, could be a noninvasive tool to predict the prognosis of DKD.
Trial registration The study protocol was registered at the Chinese Clinical Trial Registry Center (NO: ChiCTR-RRC-17012687; date of registration: 16/09/2017).
Figure 1
Figure 2
Figure 3
Figure 4