Susceptibility-weighted Imaging For Renal Iron Overload Assessment: A Pilot Study Ⅱ

Results 

Qualitative analysis 

The flowchart of change in SI for the renal cortex and medulla on T2WI and SWI is summarized in Fig. 2. At the 0th week (Fig. 3): in the control group, for all rabbits, the SI of the cortex was similar to that of the medulla on both T2WI and SWI, respectively; even in the iron group, for all rabbits, the SI of the cortex was similar to that of medulla on both T2WI and SWI, respectively; there was no significant change in the SI of cortex on both T2WI and SWI between the control and iron group, so did the medullary region; in the control and iron group, there was no significant change in the SI of cortex on both T2WI and SWI between the males and females, so did the medulla.

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At the 8th week (Fig. 4): in the control group, for all rabbits, the SI of the cortex was similar to that of medulla on both T2WI and SWI, respectively; in the iron group, for all rabbits, the SI of the cortex was similar to that of medulla on T2WI; however, the SI of the cortex was significantly lower than that of the medulla on SWI; there was no significant change in the SI of cortex on T2WI between the control and iron group, so did the medullary region; on SWI, the SI of cortex in the iron group was significantly lower than the control group; however, there was no significant change in the SI of the medullary region between the control and iron group; in the control and iron group, there was no significant change in the SI of cortex on both T2WI and SWI between the males and females, so did the medulla.

At the 12th week (Fig. 5): in the control group, for all rabbits, the SI of cortex was similar to that of medulla on both T2WI and SWI; in the iron group, for all rabbits, the SI of cortex was similar to that of medulla on T2WI; in the iron group, on SWI images, eight rabbits were found to have decreased SI of only cortex, and the other six rabbits had decreased SI of cortex and medulla by the same degree; there was no significant change in the SI of cortex on T2WI between the control and iron group, so did the medullary region; on SWI, the SI of cortex in the iron group was significantly lower than the control group; in the control and iron group, there was no significant change in the SI of cortex on both T2WI and SWI between the males and females, so did the medulla.

Quantitative analysis 

In the control group, there was no significant difference in the ARV of the renal cortex among the imaging evaluation done in the 0th, 8th, and 12th week (Table 2), so did the renal medulla. In the iron group: For renal cortex, there was a significant difference in the ARV among the 0th, 8th, and 12th week; the ARV of the 8th and 12th week was significantly higher than that of the 0th week; there was no significant difference in the ARV between the 8th and 12th week (Table 2). For renal medulla, there was a significant difference in the ARV among the 0th, 8th, and 12th week; the ARV of the other six rabbits that had decreased SI of cortex and medulla by the same degree in the 12th week was significantly higher than that of the 0th week, 8th week, and eight rabbits that found to have decreased SI of only cortex in the 12th week (Table 3).

Fig. 5 In the 12th week, the control group (a-d), the iron group (e-h) with only cortical SI decreased, and the iron group (i-l) with cortical and medullary SI both decreased. In the control group (a-d): the SI of the cortex was similar to that of the medulla on both T2WI (a) and SWI (b) images, respectively, and the Photomicrograph showed no blue-positive irons deposit in both renal cortex (c) and medulla (d) (Prussian blue stain, × 400). In the iron group (e-h) with only cortical SI decreased: the SI of the cortex was similar to that of the medulla on T2WI (e) images, but the SI of the cortex (yellow arrows) was significantly lower than that of the medulla (red arrows) on SWI (f) images; photomicrograph showed many blue positive irons deposit in the renal cortex (g) but no deposit in the medulla (h) (Prussian blue stain, × 400). In the iron group (i-l) with cortical and medullary SI, all decreased: the SI of the cortex was similar to that of the medulla on T2WI (i) images, and the SI of the cortex (yellow arrows) and medulla (red arrows) were both decreased on SWI (j) images. Photomicrograph showed many blue-positive iron deposits in both cortex (k) and medulla (l) (Prussian blue stain, × 400)-SI, signal intensity; SWI, susceptibility-weighted imaging; T2WI, T2-weighted image.

Between the iron and control group: For the renal cortex, there was no significant difference in the ARV in the 0th week (Table 2); in the 8th and 12th week, the ARV of the iron group was significantly higher than that of the control group, respectively (Table 2). For renal medulla, there was no significant difference in the ARV at the 0th and 8th week; in the 12th week, there was no significant difference in the ARV between eight rabbits that were found to have decreased SI of only cortex and the control group. Still, the ARV of the other six rabbits which had decreased SI of cortex and medulla by the same degree in the iron group was significantly higher than that of the control group (Table 3).

Between the cortex and medulla: In the control group at the 0th, 8th, and 12th week, there was no significant difference in the ARV between the cortex and medulla (Table 4). In the iron group at the 0th week, there was no significant difference in the ARV between the cortex and medulla; in the iron group at the 8th week, the ARV of the renal cortex was significantly higher than that of the medulla; in the iron group at the 12th week, the ARV of the renal cortex was significantly higher than that of the medulla of the eight rabbits that were found to have decreased SI of the only cortex, and there was no significant difference in the ARV between the cortex and the medulla of the other six rabbits that had decreased SI of cortex and medulla by the same degree

Between the males and females: There was no significant difference in the ARV of the cortex and medulla in the control group at the 0th, 8th, and 12th week, respectively (Table 5), so was in the iron group (Table 6).

Hematoxylin-eosin stain 

In the 12th week: in the control group, the renal cortex and medulla were demarcated, the structures of glomerular capillaries were clear, and the structures of renal tubular epithelial cells were normal; in the iron group, part of the cortex, medulla, and interstitial congestion, the renal tubular epithelial cells were edema and degeneration; brownish-yellow deposits can be seen in renal tubular epithelial cells (Prussian blue stain confirmed that hemosiderin has accumulated in the cells). 

Prussian blue stain 

At the 12th w: in the control group, none of the rabbits had blue-positive iron deposits either in the renal cortex or medulla; in the iron group, eight rabbits were found to have many Prussian blue-positive irons (which represented hemosiderin particles) deposits in the renal cortex; however, none of them had a deposit in the medulla, and the other six rabbits were found to have many Prussian blue-positive irons (which represented hemosiderin particles) deposit both in the cortex and medulla (Fig. 5).

Atomic absorption spectrophotometer evaluation 

In the 12th week: the iron content in the renal cortex that was measured by the atomic absorption spectrophotometer in the iron group was significantly higher than that of the control group; the iron content in the renal medulla of the other six rabbits that had decreased SI of cortex and medulla by the same degree in the iron group was significantly higher than that of the control group; in the control group, there was no significant difference in the iron content between the cortex and medulla; in the iron group, there was a significant difference in the iron content among the cortex, medulla of eight rabbits, and medulla of the other six rabbits (Table 7).