The Egyptian Journal of Radiology and Nuclear Medicine (Jul 2025)

3T BOLD and DW magnetic resonance imaging quantitative parameters for prediction of early diabetic nephropathy

  • Omnia Ezz Eldin,
  • Yahya Bashir Ali,
  • Noha Mohamed Elkholy,
  • Yasser Mazloum,
  • Ashraf Naguib Ettaby

DOI
https://doi.org/10.1186/s43055-025-01490-5
Journal volume & issue
Vol. 56, no. 1
pp. 1 – 13

Abstract

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Abstract Background The prevalence of diabetic nephropathy (DN) has increased more than as previously known, with estimates indicating that 20–40% of diabetic individuals will develop this complication. This study aimed to assess the role of blood oxygen level dependent (BOLD) and diffusion-weighted imaging (DWI) magnetic resonance imaging (MRI) techniques as predictive tools for the early stages of diabetic nephropathy. Methods This prospective ethically approved study was conducted from December 2022 to February 2024, enrolling 40 participants. MRI protocol was performed on 3T system including coronal T1- and T2-weighted images, DWI, and BOLD sequences. R2* and ADC values of the cortex and medulla for both kidneys were analyzed by two radiologists. Statistical testing was used in comparisons for significant repeated measures, and ROC curve analysis was used to assess the diagnostic effectiveness of R2* and ADC in predicting DN. Results The studied cohort was stratified into two groups: Group I included 20 diabetic patients, subdivided into group IA comprising 11 patients with normal or mild albuminuria ( 300 mg/day), and Group II included 20 control participants. ROC curve analysis demonstrated that M-R2* and MCR were superior predictors for mild and severe DN, with optimal cutoff values of > 30.31/s for M-R2* and for MCR > 1.61 and > 1.69 for mild and severe DN prediction; respectively, exhibiting 100% sensitivity and high specificity at these thresholds. CR2* showed 90% sensitivity and 65% specificity at a cutoff of > 18.33/s for prediction of moderate to severe DN. Notably, DWI was ineffective in distinguishing between control and diabetic groups. Conclusions BOLD and DWI MRI sequences show promise in evaluating renal function in diabetic patients. BOLD-MRI, particularly through the assessment of M-R2*, demonstrates significant potential for detecting early renal function alterations by identifying hypoxic changes more sensitively than DWI and ADC parameters, which typically indicate later fibrotic changes. M-R2* and the calculated MCR can effectively differentiate diabetic patients from controls, serving as valuable biomarkers for predicting mild and moderate to severe diabetic nephropathy.

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