Multiparametric Renal Magnetic Resonance Imaging for Prediction and Annual Monitoring of the Progression of Chronic Kidney Disease over Two Years

Background: Multiparametric renal Magnetic Resonance Imaging (MRI) provides a non-invasive method to assess kidney structure and function, but longitudinal studies are limited. Methods: A total of 22 patients with CKD category G3-4 (estimated glomerular filtration rate (eGFR) 15-59 mL/min/1.73 m(2)) were recruited. Annual 3T multiparametric renal MRI scans were performed, comprising total kidney volume (TKV), longitudinal relaxation time (T-1), apparent diffusion coefficient (ADC), Arterial Spin Labelling, and Blood Oxygen Level Dependent relaxation time (T-2*), with 15 patients completing a Year 2 scan. CKD progression over 2 years was defined as eGFR_slope >= -5 mL/min/1.73 m(2)/year. Results: At baseline, T-1 was higher (cortex p = 0.05, medulla p = 0.03) and cortex perfusion lower (p = 0.015) in participants with subsequent progression versus stable eGFR. A significant decrease in TKV and ADC and an increase in cortex T-1 occurred in progressors at Year 1 and Year 2, with a significant decrease in perfusion in progressors only at Year 2. The only decline in the stable group was a reduction in TKV. There was no significant change in cortex or medulla T-2* at Year 1 or Year 2 for progressors or stable participants. Conclusion: Lower renal cortex perfusion and higher T-1 in the cortex and medulla may predict CKD progression, while renal cortex T-1, TKV, and ADC may be useful to monitor progression. This study provides pilot data for future large-scale studies.