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• Clinical Article •
Application of ASL in renal function injury and staging of T2DM
LIU Jian  WU Yu  XU Min  ZHANG Xunlan  CHEN Hengzhi  WANG Rongpin  ZENG Xianchun 

Cite this article as: LIU J, WU Y, XU M, et al. Application of ASL in renal function injury and staging of T2DM[J]. Chin J Magn Reson Imaging, 2023, 14(11): 90-96. DOI:10.12015/issn.1674-8034.2023.11.015.


[Abstract] Objective To explore the correlation and clinical value of arterial spin labeling (ASL) in quantitatively evaluating renal blood flow (RBF) and renal injury in patients with type 2 diabetes mellitus (T2DM).Materials and Methods Prospective recruitment of T2DM patients with varying degrees of renal function impairment was conducted. The patients were grouped based on the presence or absence of proteinuria and the estimated glomerular filtration rate (eGFR). Group A included T2DM patients without proteinuria, group B consisted of patients with proteinuria and eGFR≥60 mL/(min·1.73 m²), representing diabetic kidney disease (DKD) stages Ⅰ-Ⅱ, and group C comprised patients with 15 mL/(min·1.73 m²)≤eGFR＜60 mL/(min·1.73 m²), representing DKD stages Ⅲ-Ⅳ. Healthy volunteers were included as a control group. Dual-kidney routine MRI scans and ASL scans were performed to obtain RBF values in the cortical region of both kidneys. Additionally, biochemical indicators such as renal function and urine analysis were collected. Statistical analysis was conducted to compare the differences in cortical RBF values among the groups and assess the correlation, sensitivity, and optimal diagnostic thresholds of the relevant indicators.Results No significant difference in cortical RBF values was found between the left and right kidneys (all P＞0.05). There was a significant overall difference in cortical RBF values among the four groups (all P＜0.001). Compared to the control group (174.28±23.89) mL/(100 g·min), group A exhibited a decrease to (159.66±28.54) mL/(100 g·min), group B decrease to (142.16±19.49) mL/(100 g·min), and group C showed the lowest value at (122.55±18.59) mL/(100 g·min). The reductions in RBF values for groups A, B, and C were 8%, 18%, and 30%, respectively. Group C had a significant decrease in cortical RBF values compared to groups A and B (both P＜0.05), with reductions of 23% and 14%, respectively. Group B also had a significant decrease compared to group A (P＜0.05), with a reduction of 11%. Cortical RBF values showed a negative correlation with serum creatinine (Scr) levels (r=-0.429, P＜0.001) and a positive correlation with eGFR (r=0.377, P＜0.001). The area under the curve (AUC) values of cortical RBF in distinguishing healthy volunteers from T2DM were 0.651 (95% CI: 0.520-0.768), distinguishing T2DM from DKD were 0.734 (95% CI: 0.619-0.829), and distinguishing early-stage DKD from mid-to-late-stage DKD was 0.760 (95% CI: 0.580-0.891).Conclusions ASL imaging provides a noninvasive quantitative evaluation of RBF changes and can effectively assess the progression of T2DM based on decreased RBF. It holds promise as an effective imaging method for noninvasively evaluating renal function damage in patients with T2DM.
[Keywords] diabetes mellitus, type 2；diabetic kidney disease；renal blood flow；magnetic resonance imaging；arterial spin labeling

LIU Jian   WU Yu   XU Min   ZHANG Xunlan   CHEN Hengzhi   WANG Rongpin   ZENG Xianchun*  

Department of Medical Imaging, Guizhou Provincial People's Hospital, Guiyang 550002, China

Corresponding author: ZENG X C, E-mail: zengxianchun04@foxmail.com

Conflicts of interest   None.

ACKNOWLEDGMENTS National Natural Science Foundation of China (No. 82060314).
Received  2023-04-30
Accepted  2023-08-09
DOI: 10.12015/issn.1674-8034.2023.11.015
Cite this article as: LIU J, WU Y, XU M, et al. Application of ASL in renal function injury and staging of T2DM[J]. Chin J Magn Reson Imaging, 2023, 14(11): 90-96. DOI:10.12015/issn.1674-8034.2023.11.015.

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