Perspectives on the Role of Magnetic Resonance Imaging (MRI) for Noninvasive Evaluation of Diabetic Kidney Disease

Abstract

Renal magnetic resonance imaging (MRI) techniques are currently in vogue, as they provide in vivo information on renal volume, function, metabolism, perfusion, oxygenation, and microstructural alterations, without the need for exogenous contrast media. New imaging biomarkers can be identified using these tools, which represent a major advance in the understanding and study of the different pathologies affecting the kidney. Diabetic kidney disease (DKD) is one of the most important diseases worldwide due to its high prevalence and impact on public health. However, its multifactorial etiology poses a challenge for both basic and clinical research. Therefore, the use of novel renal MRI techniques is an attractive step forward in the comprehension of DKD, both in its pathogenesis and in its detection and surveillance in the clinical practice. This review article outlines the most promising MRI techniques in the study of DKD, with the purpose of stimulating their clinical translation as possible tools for the diagnosis, follow-up, and monitoring of the clinical impacts of new DKD treatments.

Keywords: arterial spin labeling; blood oxygen-dependent level; chronic kidney disease; diabetic kidney disease; diffusion weighted imaging; fibrosis; kidney function; magnetic resonance imaging; oxygenation; perfusion.

Figure 1

Representative RBF maps in a healthy volunteer (age 66 years) (a) and an individual with diabetes and CKD (age 76 years, eGFR 46 mL/min/1.73 m²) (b). The color bar applies for both control and CKD. RBF maps of the kidneys are overlaid on the reference images (M0).

Figure 2

Representative R2* parametric maps in a healthy volunteer (age 62 years) (a) and an individual with type 1 diabetes and CKD (age 63 years, eGFR 34.7 mL/min/1.73 m²) (b). The color bar applies for both control and CKD. R2* maps of the kidneys are overlaid on the anatomic MR images (short TE images from BOLD MRI acquisition).

Figure 3

Representative ADC maps in a healthy volunteer (age 28 years) (a) and an individual with kidney transplant and CKD (age 69 years, eGFR 62 mL/min/1.73 m²) (b). The color bar applies for both control and CKD. ADC maps of the kidneys are overlaid on the diffusion image with gradient b = 0.