Renal ectopic fat deposition and hemodynamics in type 2 diabetes mellitus assessment with magnetic resonance imaging

Fig. 1. Main inclusion and exclusion criteria for the study participants. T2DM, type 2 diabetes mellitus; eGFR, estimated glomerular filtration rate; DKD, diabetic kidney disease

Fig. 2. RBF and PDFF values of cortex and medulla and perirenal fat thickness were measured in the central slice of renal hilum. A Two ROIs were selected per kidney in the renal cortex (yellow circle) and medulla (red circle) upper, middle, and lower poles on the schematic map; B Six ROIs were manually placed per kidney cortex (yellow circle) and medulla (red circle) on the RBF map. C Six ROIs were selected per kidney in the renal cortex (yellow circle) and medulla (red circle) on the fat fraction map. D Perirenal fat thickness was calculated by the distance from the anterior margin of the quadratus lumborum muscle to the dorsal margin of the kidney

Fig. 3. Comparison of RBF and PDFF values of cortex, medulla, and perirenal fat thickness. A–C A 62-year-old woman with healthy kidneys, where the mean renal RBF were 167.09 mL/100 g/min (Cortex) and 42.37 mL/100 g/min (Medulla), the renal parenchyma PDFF were 0.78% (Cortex) and 0.81% (Medulla) and the thickness of perirenal fat is 6.13 mm. D–F A 58-year-old woman with T2DM, where the mean renal RBF were 152.78 mL/100 g/min (Cortex) and 32.58 mL/100 g/min (Medulla), the renal parenchyma PDFF were 1.15% (Cortex) and 1.19% (Medulla) and the thickness of perirenal fat is 9.59 mm. G–I a 67-year-old man with stage 2 DKD, where the mean renal RBF were 139.63 mL/100 g/min (Cortex) and 28.56 mL/100 g/min (Medulla), the renal parenchyma PDFF were 1.58% (Cortex) and 1.51% (Medulla) and the thickness of perirenal fat is15.98 mm. J–L a 62-year-old man with stage 4 DKD, where the mean renal RBF were134.86 mL/100 g/min (Cortex) and 26.56 mL/100 g/min (Medulla), the renal parenchyma PDFF were 1.69% (Cortex) and1.68% (Medulla), and the thickness of perirenal fat is 22.35 mm. A, D, G, I = RBF color images; B, E, H, K = RBF maps; C, F, I, L = fat fraction maps. Higher renal cortical perfusion and lower…

Fig. 4. ROC curve for discriminating HC from T2DM (A), T2DM from DKD (B), and DKD stage I–II from DKD stage III–IV (C). ASL and IDEAL-IQ demonstrate strong diagnostic accuracy in assessing the severity of renal damage in patients with T2DM. The specific diagnostic capabilities are as follows: discriminating T2DM from DKD > discriminating HC from T2DM > discriminating DKD I–II from DKD III–IV. HC, healthy control; T2DM, type 2 diabetes mellitus; DKD, diabetic kidney disease