Validation of multiparametric MRI by histopathology after nephrectomy: a case study

Objectives

Renal multiparametric MRI (mpMRI) is a promising tool to monitor renal allograft health to enable timely treatment of chronic allograft nephropathy. This study aims to validate mpMRI by whole-kidney histology following transplantectomy.

Materials and methods

A patient with kidney transplant failure underwent mpMRI prior to transplantectomy. The mpMRI included blood oxygenation level-dependent (BOLD) MRI, T₁ and T₂ mapping, diffusion-weighted imaging (DWI), 2D phase contrast (2DPC) and arterial spin labeling (ASL). Parenchymal mpMRI measures were compared to normative values obtained in 19 healthy controls. Differences were expressed in standard deviations (SD) of normative values. The mpMRI measures were compared qualitatively to histology.

Results

The mpMRI showed a heterogeneous parenchyma consistent with extensive interstitial hemorrhage on histology. A global increase in T₁ (+ 3.0 SD) and restricted diffusivity (− 3.6 SD) were consistent with inflammation and fibrosis. Decreased T₂ (− 1.8 SD) indicated fibrosis or hemorrhage. ASL showed diminished cortical perfusion (− 2.9 SD) with patent proximal arteries. 2DPC revealed a 69% decrease in renal perfusion. Histological evaluation showed a dense inflammatory infiltrate and fibrotic changes, consistent with mpMRI results. Most interlobular arteries were obliterated while proximal arteries were patent, consistent with ASL findings.

Discussion

mpMRI findings correlated well with histology both globally as well as locally.