Evaluating the added value of multiparametric functional MRI in predicting renal function response to renal artery stenting in severe atherosclerotic renal artery stenosis.

Objective: To explore the potential of Intravoxel Incoherent Motion Diffusion (IVIM) and Arterial Spin Labeling (ASL) in predicting the short-term effectiveness of post-revascularization for severe atherosclerotic renal artery stenosis.
Material and Methods: A retrospective analysis of 88 cases from October 2018 to February 2023 was conducted. Patients were divided into Responder and Non-Responder groups based on renal function outcomes at their last follow-up. Clinical data were compared between the groups, and preoperative functional MRI images were analyzed. ROIs were outlined for the affected and both kidneys. Measurements included ASL-derived renal blood flow (RBF), IVIM's pseudo-diffusion coefficient (D*), perfusion fraction (f), true diffusion coefficient (D), and the conventional apparent diffusion coefficient (ADC).Multivariate logistic regression identified independent clinical predictors of benefit, and a clinical prediction model was developed. Model performance was assessed using Receiver Operating Characteristic (ROC) curves and Decision Curve Analysis(DCA) curves.
Results: In the training cohort of 54 non-responders and 34 responders, no quantitative parameters of bilateral kidneys showed statistical significance in predicting Responders (all p > 0.05). Pre-treatment eGFR, presence of diabetes, and the D value of the affected kidney were identified as independent factors for predicting short-term treatment effectiveness. The combined clinical-functional imaging model yielded a higher AUC at 0.796 (95 % CI: 0.690-0.897). Decision curve analysis further confirmed the better net benefit of combined model.
Conclusion: Beyond clinical characteristics, functional MRI had the potential to predict response of stenting for severe atherosclerotic renal artery stenosis.
Competing Interests: Declaration of competing interest The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The authors declare no conflicts of interest. The cases for this study were approved by the ethics committee (Ethics Code: 2023105001,Peking University First Hospital) and all participants provided informed consent. The study protocol adhered to the Declaration of Helsinki and the Good Clinical Practice guidelines defined by the International Conference on Harmonization (ICH). The researchers declare no conflicts of interest. The data that support the findings of this study are available on request from the corresponding author, upon reasonable request.
(Copyright © 2025. Published by Elsevier Inc.)