ArticleAnnals of medicine2026
Navigating the diagnostic 'gray zone': prospective evaluation of an integrated MRI-Biomarker model for renal allograft triage.
Article in Annals of medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundA critical dilemma in post-transplant surveillance is determining when minor functional changes (subtle serum creatinine fluctuations or slow renal function decline) or ambiguous ultrasound findings (including mildly elevated resistive index or cortical echogenicity) warrant invasive biopsy and treatment modification. We aimed to develop a non-invasive integrated tool combining advanced diffusion MRI with functional biomarkers to stratify patients within this diagnostic gray zone. MATERIALS AND
methodsIn this prospective study, 120 renal transplant recipients underwent multi-b-value diffusion-weighted imaging at 3.0 T within 48 h prior to an allograft biopsy. Quantitative parameters of six diffusion MRI models were extracted from renal cortex and medulla. Clinical indicators, including serum HCO
resultsThe cortical distributed diffusion coefficient (DDC) and serum HCO
conclusionThis integrated multiparametric protocol provides promising preliminary decision support for renal allograft surveillance. By noninvasively identifying the potential presence of actionable active pathology, this preliminary model may help optimize biopsy referrals and stratify patients who potentially require treatment modification. However, given the single-centre design, external validation is required before clinical implementation.
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