Spectral diffusion MRI detects early fibrosis in renal allografts in a pilot clinical translational study

Motivation: The current reference standard of kidney allograft fibrosis is histopathology, which requires invasive biopsy, and fibrosis can develop silently as time for intervention is lost and irreversible kidney damage occurs. Goal(s): We evaluate non-contrast spectral diffusion, IVIM, and ADC, MRI for diagnosis and quantification of early fibrosis and function in kidney allografts. Approach: A prospective two-center study of kidney transplant recipients with either percutaneous clinically indicated biopsies or percutaneous protocol biopsies due to the presence of donor specific antibodies. Results: Spectral diffusion detected mild/moderate fibrosis, and detected fibrosis in allografts presenting with normal/stable function that ADC, eGFR, time-from-transplant, and allograft size did not. Impact: Initial experience supports clinical relevance of advanced diffusion MRI for early fibrosis development in renal transplant patients who have not shown a decrease in eGFR, allowing preventative modification in medication regimen and treatment.