Differentiation Henoch-Schönlein purpura nephritis from Henoch-Schönlein purpura in children using multiparametric quantitative MR imaging

Differentiation Henoch-Schönlein purpura nephritis from Henoch-Schönlein purpura in children using multiparametric quantitative MR imaging | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Differentiation Henoch-Schönlein purpura nephritis from Henoch-Schönlein purpura in children using multiparametric quantitative MR imaging Hang Su, Gang Zhang, Jingjing Wu, Wei Xing, Yufu Hu, Zhiwei Shen, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7860417/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 6 You are reading this latest preprint version Abstract Backgroud At present, there is a lack of accurate and non-invasive clinical methods for differentiating Henoch-Schonlein purpura nephritis (HSPN) from Henoch-Schonlein purpura (HSP) in pediatric patients. In this study, we aim to differentiate HSPN from HSP using kidney intravoxel incoherent motion diffusion imaging (IVIM-DWI) and T1/T2* mapping. Methods This prospective study included nine children, diagnosed with Henoch-Schonlein purpura nephritis (HSPN) confirmed by pathological examination, eight children with Henoch-Schonlein purpura (HSP) and eight healthy volunteers. Renal multi-b-value DWI images acquired with breath-triggering, and T2* mapping and T1 mapping with breath-holding were performed to detect the diffusion values and T1/T2* relaxation time in the left renal cortex. The inter-group differences of MRI parameters were compared. Twenty-four hours urine protein (UTP) and the proportion of crescents were collected in HSPN group, and their association with MR indexes was assessed. The diagnostic efficacy in distinguishing between HSPN and HSP were also evaluated. Results The levels of renal cortical the pure diffusion coefficient (D) were lower in the HSPN group compared to those in both the control group (P < 0.01) and the HSP group (P < 0.05). The T2* values in the HSPN group were significantly higher than those in the HSP group (P < 0.05). Moreover, a correlation was found between the values of renal cortical T2* and UTP in the HSPN group. The AUC area of the combined T2* and D values is 0.86 in the differentiation between HSP and HSPN is 0.79 with a specificity of 87.50%. Conclusions The application of renal cortical T2* values and D values is beneficial in distinguishing between HSPN and HSP kidneys. Kidney Diffusion Magnetic Resonance Imaging Child Diagnosis Differential Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Background Henoch-Schonlein purpura nephritis (HSPN), also referred to as Immunoglobulin A vasculitis nephritis (IgAVN), is the most common secondary glomerular disease in children [ 1 ] . It has a gradual an increase in prevalence, with approximately 20% of HSPN patients eventually developing typical nephrotic syndrome [ 2 ] . If treatment is delayed, there is a risk that the condition may progress to chronic kidney disease or end-stage renal disease [ 3 ] . Henoch-Schonlein purpura (HSP) is a pathological condition characterized by the inflammatory response of small blood vessels. One of the important symptoms associated with HSP is HSPN [ 4 ] . The prompt identification of HSPN plays an important role in accurately evaluating the prognosis and implementing customized therapeutic interventions. Biochemical and pathological markers, such as proteinuria, immune complex deposition and crescent formation, may serve as prognostic risk factors and crucial indicators for intervention and treatment [ 5 – 6 ] . However, laboratory tests are prone to being influenced by various physiological and pathological conditions, thereby resulting in outcomes that may lack precision and specificity. Additionally, renal biopsy is an intervention that has related invasiveness and offers potential risks of complications, including postoperative pain (2%-4%), hematuria (3%-18%), and bleeding (1%-7%) [ 7 – 9 ] . Therefore, this problem may hinder effective clinical screening and evaluation method for identify HSPN and HSP in a clinical environment [ 10 ] . The MRI is a non-ionizing and multi-parameter imaging method that is capable of reveal providing comprehensive information about both the anatomical structures and functional changes in the kidney. Renal MRI imaging has been used in the diagnosis and assessment of the effectiveness of acute and chronic renal diseases [ 11 ] , including transplanted kidney [ 12 ] , renal tumor [ 13 ], and renal artery stenosis [ 14 ] . Advanced diffusion model imaging techniques based on MR diffusion imaging, such as intravoxel incoherent motion (IVIM) and diffusion kurtosis imaging (DKI), show potential in identifying the diffusion rate or diffusion kurtosis of water molecules in kidney. This approach could offer indirect information relating changes in tissue microstructure, facilitating the investigation of the pathophysiological condition of the disease at the cellular and molecular levels [ 15 ] . Several studies have been published regarding the application of IVIM and DKI in the study of renal IgAN. Liang P [ 21 ] et al. had found that elevated renal cortical MK values and reduced D and ADC values in IgAN patients in comparison to a control group of healthy volunteers using DKI. The decreased ADC in IgAN was also validated by Lang ST et al [ 9 ] . Blood oxygen level dependent (BOLD) MRI is a noninvasive method for evaluating the oxygen levels in renal tissue in vivo [ 16 ] . With BOLD imaging, renal oxygenation levels could be indirectly assessed by identifying the non-uniform transverse relaxation time (T2*) caused by the paramagnetic influence of deoxyhemoglobin [ 17 – 18 ] , and the accuracy of the results was confirmed by invasive probe measurements [ 19 ] . Nishino T et al. found that BOLD-MRI combined with low-dose oxygen administration could been as a non-invasive method to evaluate the activity of HSPN [ 22 ] . Therefore, we hypothesized that children with HSPN may also show abnormal alterations in water molecule distribution and BOLD signals. However, the accuracy and reliability of previous findings might be subject to limits related to the techniques used for data collection and post-processing methods. DWI imaging with freely breathing was used in most of renal IVIM and DKI studies, which may not effectively reduce the influence of respiratory motion on the results. The inconsistency of bilateral kidney results and the presence of fluctuations in BOLD results can be attributed to the interference caused by surrounding tissue motion and renal biopsy [ 23 – 24 ] . Meanwhile, the studies acquired bilateral renal axial images with limited spatial resolution, which might hinder the accurate boundary of the extensive renal cortical data. To our knowledge, there has few studies of application of IVIM, DKI and BOLD MR imaging in the early stages of HSPN. The main aim of this study was to differentiation between HSP and HSPN with a high-resolution coronal renal diffusion images based on a zoom DWI sequence with respiratory trigger acquisition. Meanwhile, breath-hold coronal renal T2* mapping and T1 mapping maps as well as B0 mapping maps had acquired to improve the accuracy of renal advanced diffusion and BOLD measurements and the precision of outlining the renal cortical region of interest. Additionally, we investigated the potential association between the MRI indicators and biochemical and pathological indices, such as 24-hour proteinuria and crescent proportion in the HSPN group. Methods Patients The prospective study was granted approval from the local ethics committee (approvement number: 2022HL-437-01), and all participants provided informed consent. The study included a total of 30 participants, consisting of 10 pediatric patients with HSPN, 10 with HSP, and 10 healthy volunteers at our hospital from January 2022 to September 2022. The participants were divided into three groups: the HSPN group, the HSP group, and the control group. The inclusion criteria for the HSP group were follows: 1. meeting the diagnostic criteria of HSP as outlined in reference [ 25 ] ; 2. Having normal results in a routine urinary examination; 3. Having a disease duration of no more than 8 weeks; 4. The renal MR images without obvious motion artifact. The inclusion criteria for the HSPN group were as follows: 1. The presence of hematuria and/or proteinuria for a duration of six months in HSP; 2. 24h urine protein exceeding 500mg; 3. The disease duration not more than 8 weeks; 4. Successful completion of renal magnetic resonance imaging scan without obvious motion artifact. The exclusion of two healthy volunteers, two children in the HSP group, and one child in the HSPN group was necessary as they were unable to inability to cooperate effectively with breath holding during MR examination. Finally, 9 cases in the HSPN group were acquired. Within the HSPN group, 7 children underwent renal puncture biopsy in order to measure the proportion of crescents, indicating the presence of glomerular tract proliferative glomerulonephritis with IgA deposition. Meanwhile, 24h proteinuria data were obtained from HSPN patients as shown in Table 1 . Table 1 Clinical data of patients at baseline Control (n=8) HSP (n=8) HSPN (n=9) Male/female 6/2 7/1 6/3 Age (years) 12.38 ± 2.39 10.86 ± 2.95 11 ± 2.83 Serum creatinine (µmol/L) -- 43.83 ± 13.21 37.53 ± 11.75 Proteinuria (mg/24h) -- -- 3164.83 ± 2456.37 Crescent proportion (%) -- -- 17.70 ± 10.49 HSP: Henoch-Schonlein purpura; HSPN: Henoch-Schonlein purpura nephritis. MR imaging MRI examination were performed on a 3T MRI (Ingenia CX, Philips Healthcare, The Netherlands) with a 16-channel body coil. The study employed respiratory gating and finger pulse electrocardiogram (ECG) gating techniques to monitor the respiratory and ECG waveforms of the participants. After scanning anatomical images using conventional renal transverse and coronal T2 weighted Multi-Vane XD (MVXD) scans, bilateral coronal renal B0 maps, respiratory-triggered left-sided renal coronal small-field IVIM, breath-hold bilateral renal T1 mapping and breath-hold bilateral T2* mapping scans were performed, respectively. The scan parameters are shown in Table 2 . Table 2 MR scan parameters of different sequences Sequence Imaging mode FOV (mm) Thickness (mm) Gap (mm) Slice number Matrix TR/TE (ms) Number of excitations b-values (s/mm2) SENSE MultiVane (%) Flip angle Coronal T2-weighted imaging 2D- turbo spin echo (TSE) 350×350 3 0.3 20 176×176 1522/118 1 -- 2 400 -- Axial T2-weighted imaging 2D-TSE 320×320 3.5 0.35 25 160×160 1838 / 113 1 -- 2 340 -- Coronal B0 map 3D-fast field echo (FFE) 400×400 12 -6 8 68×68 30/3.1 2 -- No -- 60 Zoom-Coronal IVIM single-shot EPI with respiratory trigger 152×76 4 0 10 152×76 4000/85 1, average 2 when b = 1000 0, 10, 30, 50, 100, 250, 500, 800 and 1000 No -- -- Coronal T1 mapping balanced-FFE sequence with a single breath hold T1 MOdified Look-Locker Inversion recovery (MOLLI) acquisition, 300×300 8 1 1 152 × 150 2.3/1.05 1 -- 2 -- 20 Coronal T2* mapping multishot FFE sequence with breath-holding 300×300 5 1 1 96×72 60/ 4.6, 9.2, 13.8, 18.4, 23 1 -- 2 -- 27 IVIM: intravoxel incoherent motion; FOV: field of view; TSE: Turbo spin echo; FFE: fast field echo; EPI: echo planar imaging; MOLLI: MOdified Look-Locker Inversion recovery; TR: repetition time; TE: echo time; SENSE: SENSitivity Encoding. Data post-processing and measurement Scanned raw images were transferred to an ISP workstation (version 9, Philips Healthcare, The Netherlands). The IVIM maps are analyzed using Advanced Diffusion Processing (ADA) to analyze the different b-value raw data and remove b-value maps with high interference by respiratory motion. Automatic rigid alignment in ISP to reduce motion interference. The biexponential model is used to automatically generate D-plots, D*-plots, and F-plots, while K-plots are acquired by the simple IVIM + kurtosis model in ISP workstation. The biexponential model is given by S b =S 0 [(1-f)e − bD +f*e − bD* ], and the simple IVIM + kurtosis model is given by S b =S 0 [(1-f)e (−bD+b^2*D^2*K/6) + f*δ(b)]. The renal cortical region of interest (ROI) was manually outlined based on a black-and-white inversed DWI with a b value of 100. The ROI was copied to D-map, D*-map, F-map and K-map, and the corresponding the mean of D-value, D*-value, F-value and K-value were recorded (Fig. 1 ). The T1 mapping and T2* mapping was reconstructed directly by the scanner. The T1 mapping map was utilized to manually outline the region of interest (ROI) corresponding to the left renal cortical area, with care to avoid any potential confounding factors such as B0 inhomogeneity or visible artifacts. The ROI was attached to the T2* mapping maps, from which the T1 and T2* values of the cortex were acquired, respectively (Fig. 1 ). Pathological biopsy and HE staining All patients with HSPN were confirmed by pathological biopsy. Renal cortical tissue samples were obtained by puncture of the right kidney under the guidance of B-ultrasound. 2–3 kidney samples were obtained and HE staining was performed. The crescent body is observed under the light mirror and the proportion of the crescent body is calculated. Crescent body ratio is the number of glomerulus with crescent body in pathological picture divided by the number of all glomerulus. Statistical analysis The grouped data were first displayed using box plots, and the outliers marked with * were removed according to the displayed results (SPSS 25.0, IBM, U.S.). Then the Kolmogorov-Smirnov method and Levene's method were applied to test the normality and chi-square test of the grouped data, and the measures that conformed to the normal distribution were described by the mean ± standard deviation. Independent samples t-test was used to compare the group differences in D values, D* values, K values, T1 and T2 values. P < 0.05 was defined as a statistically significant difference. Spearman correlation analysis was used to analyze possible correlations among the above MRI indices and biochemical pathology indices (24h ptoteinuria and crescent proportion). Correlation coefficients were obtained using scatter plots and linear regression methods. Diagnostic efficacy and thresholds for differentiation between HSPN and HSP, as well as between control and HSPN were obtained using ROC curves analysis (MedCalc, 19, MedCalc Software Ltd, Belgium). Results Comparison of MRI parameters between different groups Multiparametric Quantitative MR images, including D map, D* map, F map and K map of left kidney as well as T1 mapping, T2* mapping and B0 mapping of bilateral lateral kidney were acquired in the control group, HSP group and HSPN group (Fig. 2 , 3 ). The reduced D values in HSPN group were found ( P < 0.01) compared with those in the control group. Meanwhile, there are a reduced D values in HSPN group than those in the HSP group (P = 0.04). An elevated T2* value in in HSPN group than those in the HSP group (P = 0.04). K, D*, f and T1 values were not significantly different between the three group. These results are shown in Table 3 . Table 3 Comparisons of renal cortical MRI parameters among the three groups Control (n = 8) HSP (n = 8) HSPN (n = 9) P a P b P c P D(×10 − 3 mm 2 /s) 2.68 ± 0.23 2.42 ± 0.25 2.08 ± 0.21 0.05 < 0.01 0.04 K 0.57 ± 0.07 0.55 ± 0.15 0.51 ± 0.16 0.81 0.44 0.64 D*(×10 − 3 mm 2 /s) 60.94 ± 50.23 22.68 ± 17.67 39.24 ± 36.46 0.06 0.22 0.41 f 0.10 ± 0.04 0.10 ± 0.05 0.10 ± 0.04 0.82 0.99 0.56 T2* (ms) 55.73 ± 11.20 53.15 ± 12.05 64.00 ± 5.17 0.69 0.08 0.04 T1(ms) 1568.33 ± 93.59 1521.22 ± 82.82 1520.46 ± 77.95 0.34 0.32 0.99 a P represents control vs HSP; b P represents control vs HSPN༛ c P represents HSP vs HSPN HSP: Henoch-Schonlein purpura; HSPN: Henoch-Schonlein purpura nephritis; D: pure diffusion coefficient; K: Kurtosis; D*: fast diffusion coefficient; f: the ratio of capillary volume to total volume in the body. Pathological results Crescent bodies were present in the HE stained sections of all patients in the HSPN group, and the pathological images of typical crescent bodies in two patients with HSPN were shown, as shown in Fig. 4 . Correlation between MRI parameter values and correlation with biochemical pathological indices The results showed a positive correlation between T2* values and 24-hour urine protein in the HSPN group ( r = 0.79, P = 0.024) and no significant correlation with crescentic proportion ( P = 0.913) (Fig. 5 a). Other MR indices did not correlate with biochemical pathology. Cortical D values were positively correlated with cortical K values for all subjects ( r = 0.66, P = 0.001). These results are present in Fig. 5 b. Diagnostic performance of MRI parameters We applied ROC curve analysis to assess the diagnostic performance of MRI parameters in differentiating HSPN from HSP. Regarding the differentiation between the control and HSPN groups, the T2*+D value had the highest AUC value of 0.86 with 95% confidence interval of 0.584 to 0.980, sensitivity of 75% and specificity of 100%. the threshold value of T2* was 62.8 ms and the threshold value of D value was 2.28. Regarding the differentiation between the HSP and HSPN groups, the T2*+D value had the highest AUC value of 0.79 with 95% confidence interval of 0.498 to 0.956, sensitivity of 66.67% and specificity of 87.50%. the threshold for T2* was 61.9 ms and the threshold for D value was 2.06. These results are present in Fig. 6 . Discussion This study demonstrates the efficacy of multimodal MRI in the evaluation of renal injury among pediatric patients with HSPN. Significant differences were observed in the renal cortical D values and T2* values between the control versus HSPN and HSP versus HSPN groups. The combination of D values and T2* values showed a notable level of diagnostic efficacy in identification of HSPN and the differentiation between HSP and HSPN. Additionally, a significant positive correlation was observed between T2* values and UTP (r = 0.79, P < 0.05), as well as a positive correlation between cortical D values and cortical K values in all subjects (r = 0.66, P 0.05). However, the D value demonstrate a significant reduction within the HSPN group when compared to both the control and HSP groups (P < 0.05). It is suggested that IVIM-DWI can be used to evaluate renal injury in HSPN, which is consistent with the results of previous studies [ 9 , 21 ] . The D value of IVIM quantitative parameters provides an indication of the diffusion of water molecules within and outside the cellular environment. The process of water molecule diffusion is influenced by several factors, including intercellular space, cell structure and surrounding diffusion medium. The decrease in renal cortical D values in HSPN can be attributed to the predominance of glomerular thylakoid proliferative lesions and the immunopathology characterized by the diffuse or segmental distribution of IgA in the thylakoid and parathylakoid regions, along with the deposition of multiple immune complexes [ 25 ] . The primary features of HSPN pathology include the deposition of IgA1, infiltration of complement factor and neutrophils, and vascular inflammation [ 20 ] . The deposition of IgA1 has the potential to influence the diffusion of water molecules, while inflammation can lead to the occurrence of regional blood oxygen abnormalities. The limited diffusion of water molecules in the kidney may be attributed to the deposition of immune complexes and varying degrees of thylakoid hyperplasia. As a result, the D value in the HSPN group was observed to be lower compared to the HSP group. K values are indicators of deviations from the Gaussian distribution. Previous research has demonstrated that the K values of tissues reflect the interaction between water molecules and cell membranes as well as intracellular compounds [ 26 ] . Moreover, it has been observed that the complexity of the microstructural environment positively correlates with the magnitude of the K value [ 27 ] . The findings of the current study revealed a statistically significant correlation (P 0.05), which conflicts with the findings of a previous study [ 28 ] . This may potentially be attributed to the inclusion of predominantly abnormal renal function patients in the study sample. These patients endured a decline in renal function, leading to glomerulosclerosis, cell proliferation, and interstitial fibrosis. Consequently, the renal parenchymal structure became more intricate, resulting in a deviation of water molecule diffusion from the Gaussian distribution [ 29 ] . In contrast, the duration of HSPN observed in this study was limited to a period of 8 weeks, representing the early stage of the disease. The pathological manifestations primarily consisted of thylakoid hyperplasia and crescent formation, without significant alterations in the microstructure of the renal parenchyma. In this study, BOLD MRI was performed for children with control, HSP and HSPN, and the results showed that T2* values were significantly higher in the HSPN group compared with the HSP group ( P < 0.05), indicating that the kidneys of children with HSPN maintain a certain degree of high partial pressure of oxygen, and the results were similar to previous studies [ 22 ] . There is no difference of T2* between the control group and HSPN group, which is consistent with previous research [ 9 ] . Although elevated R2* were found in the study of Chronic Kidney Disease (CKD) [ 23 ] , the pathogenesis and onset time of HSPN are different from CKD. It was found that in the acute phase glomeruli are lost due to inflammation and the remaining glomeruli become hyperperfused, which results in the inability to distribute oxygen to the downstream tubules, and the energy depletion of tubular sodium channels is one of the main causes of renal oxygen consumption [ 31 ] . Meanwhile, this study found a positive correlation between T2* values and 24h proteinuria ( P < 0.05), indicating that T2* values increased with the increase of renal injury in HSPN, suggesting that T2* values are expected to be an MRI index for assessing the severity of renal injury in HSPN, which deserves in-depth study. T1 mapping has now been used to assess chronic kidney disease [ 32 ] , and studies have shown that T1 values are prolonged in patients with chronic kidney disease compared to control [ 33 ], and tissue fibrosis leads to an increase in T1 values [ 34 ] . The T1 values in the HSPN group in this study were lower than those in the HSP and control groups, and the difference was not statistically significant, but a similar trend was observed. The non-significant difference considered may be related to the small number of cases included or the large variation in the degree and type of lesions due to histological factors. This observation requires further study. Limitations of this study: 1. the sample size of this study was small and no clinical typing of HSPN was performed, and the sample size will be expanded in the next stage for more in-depth study; 2. The location of MRI detection did not coincide with the biopsy site, and we believe the bias was relatively small because HSPN is a diffuse disease that may affect the entire kidney and avoiding the punctured kidney may reduce the interference of renal puncture in the study. 3. Although we used respiration-triggered DWI acquisition, it was found in some subjects that respiration also causes small shifts in different b-value images, resulting in some variation in the quantitative values of diffusion images between different levels. Later we will try to use motion correction to further improve the reliability of the results. Conclusions In conclusion, this study provides preliminary evidence that multimodal MRI is useful for noninvasive assessment of renal injury in children with HSPN. In particular, D and T2* values can be good parameters for differentiating between HSPN and HSP kidneys. Declarations Data availability The datasets used and analysed during the current study are available from the corresponding author on reasonable request. Acknowledgements We would like to express our gratitude to all the patients involved in this study. Funding This work has supported by the National Natural Science Foundation of China under Grant [82305309 and 82374519], Natural Science Foundation of Henan Province [232300421309 and 242300421297] and National Traditional Chinese Medicine Inheritance and Innovation Center Scientific Research Project of Henan Provincial Health Commission [2023ZXZX1158]. Author information #Hang Su and Gang Zhang contributed equally as co-first authors. Authors and Affiliations Department of Pediatrics, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China Hang Su, Jingjing Wu, Yuying Sun, Xia Zhang & Xianqing Ren College of Pediatrics, Henan University of Chinese Medicine, Zhengzhou, China Hang Su, Jingjing Wu, Yuying Sun, Xia Zhang & Xianqing Ren The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China Gang Zhang, Wei Xing & Yufu Hu Philips Healthcare, Beijing, China Zhiwei Shen Contributions HS, JJW, WX, YFH and ZWS were in charge of data acquisition, analysis and interpretation. HS was responsible for manuscript drafting. GZ and XQR critically reviewed and revised the manuscript and supervised the study. HS, GZ, XZ and XQR made a contribution to study conception and design. All authors contributed to the manuscript preparation, read and approved the final text. Corresponding authors Correspondence toXianqing Ren Ethics statement The study has been performed in accordance with the Declaration of Helsinki, and was approved by the local ethics committee of The First Affiliated Hospital of Henan University of CM (2022HL-437-01). Informed consent was obtained from all participants and their parents/guardians. Consent for publication Not applicable. Competing interests The authors declare no competing interests. References Nie S, He WJ, Huang T, Liu DK, Wang GB, Geng J, et al. The Specteum of Biopsy-proven glomerular diseases among children in China: A national, Cross-Sectional Survey. Cli J Am Soc Nephrol. 2018;13(7):1047–54. Calvo-Rfo V, Hernandez JL, Ortiz-Sanjuan F, Loricera J, Palmou-Fontana N, González-Vela MC, et al. Relapses in patients with Henoch-Schonlein purpura: Analysis of 417 patients from a single center. Medicine. 2016;95(28):e4217. Fan LR, Yan HM, Zhen XF, Wu XM, Hao J, Hou LY et al. Safety and Efficacy Evaluation of Treatment of Regular Glucocorticuid Combined with Cyclophosphamide Pulse in Chlidren Suffered from Moderately Severe Henoch-Schonlein Purpura Nephrotic Proteinuria. Evid Based Complement Alternat Med. 2020; 2020:3920735. Jiang MY, Li W, Xu XP, Zhou JQ, Jiang H. Role of p300 in the pathogenesis of henoch-schonlein purpura nephritis and as a new target of glucocorticoid therapy in mice. Chin Med J(Engl). 2019;132(16):1942–50. Kvedar JC, Fogel AL, Elenko E, Zohar D. Digital medicine , s march on chronic disease. Nat Biotechnol. 2016;34(3):239–46. Chotas W, IIyas M, Tolaymat A. A child with arthritis, skin rash, abdominal pain and nephritis: searching beyond Henoch-Schonlein purpura nephritis-Answers. Pediatr Nephrol. 2019;34(2):245–7. Roccatello D, Sciascia S, Rossi D, Naretto C, Bazzan M, Solfietti L et al. Outpatient percutaneous native renal biopsy: safety profile in a large monocentric cohort. BMJ Open 2017,7: e015243. Lees LS, McQuarrie EP, Mordi N, Geddes CC, Fox JG, Mackinnon B. Risk factors for bleeding complications after nephrologist-performed native renal biopsy. Clin Kidney J. 2017;10(4):573–7. Lang ST, Guo J, Bruns A, Dürr M, Braun J, Hamm B, et al. Multiparametric Quantitative MRI for the Detection of IgA Nephropathy Using Tomoelastography, DWI, and BOLD Imaging. Invest Radiol. 2019;54(10):669–74. Klinkhammer BM, Lammers T, Mottaghy FM, Kiessling F, Floege J, Boor P. Non-invasive molecular imaging of kidney diseases. Nat Rev Nephrol. 2021;17(10):688–703. Ding J, Chen J, Jiang Z, Zhou H, Di J, Xing W. Assessment of renal dusfunction with diffusion-weighted imaging: comparing intra-voxel incoherent motion (IVIM) with a mono-seponential model. Acta Radiol. 2016;57(4):507–12. Rheinheimer S, Schneider F, Stieltjes B, Morath C, Zeier M, Kauczor HU, et al. IVIM-DWI of transplanted kidneys: reduced diffusion and perfusion dependent on cold ischemia time. Eur J Radiol. 2012;81(9):e951–6. Byron G, Sigmund EE, Huang WC, Babb JS, Parikh NS, Stoffel D, et al. Subtype differentiation of renal tumors using voxel-based histogram analysis of intravoxel incoherent motion parameters. Invest Radiol. 2015;50(3):144–52. Kim JW, Lee CH, Yoo KH, Je BK, Kiefer B, Park YS, et al. Intravoxel incoherent motion magnetic resonance imaging to predict vesicoureteral reflux in children with urinary tract infection. Eur Radiol. 2016;26(6):1670–7. Franca M, Mart-Bonmatil L, Alberich-BayarriA, Oliveira P, Guimaraes S, Oliveira J, et al. Evaluation of fibrosis and inflammation in diffuse liver disease using intravoxel incoherent motion diffusion-weighted MR imaging. Abdom Radiol (NY). 2017;42(2):468–77. Li C, Liu H, Li X, Zhou L, Wang R, Zhang Y. Application of BOLD-MRI in the classification of renal function in chronic kidney disease. Abdom Radiol (NY). 2019;44(2):604–11. Thacker JM, Li LP, Li W, Zhou Y, Sprague SM, Prasad PV. Renal blood oxygenation level-dependent magnetic resonance imaging: a sensitive and objective analysis. Invest Radiol. 2015;50(12):821–7. Liang P, Chen Y, Li S, Xu C, Yuan G, Hu D, et al. Noninvasive assessment of kidney dysfunction in children by using blood oxygenation level-dependent MRI and intravoxel incoherent motion diffusion-weighted imaging. Insights Imaging. 2021;12(1):146. Zhang JL, Morrel G, Rusinek H, Warner L, Vivier PH, Cheung AK et al. Measurement of renal tissue oxygenation with blood oxygen level-dependent MRI and oxygen transit modeling. Am J Physiol Ren Physiol 2014,306(6):579–87. Heineke MH, Ballering AV, Jamin A, Ben Mkaddem S, Monteiro RC, Van Egmond M. New insights in the pathogenesis of immunoglobulin A vasculitis (Henoch-Schönlein purpura). Autoimmun Rev. 2017;16(12):1246–53. Liang P, Li S, Yuan G, He K, Li A, Hu D, et al. Noninvasive assessment of clinical and pathological characteristics of patients with IgA nephropathy by diffusion kurtosis imaging. Insights Imaging. 2022;13(1):18. Nishino T, Takahashi K, Ono S, Mimaki M. Fluctuation of R2* values in blood oxygenation level-dependent MRI during acute and remission phases of IgA vasculitis with nephritis in children. Jpn J Radiol. 2022;40(8):840–6. Chen F, Yan H, Yang F, Cheng L, Zhang S, Li S, et al. Evaluation of Renal Tissue Oxygenation Using Blood Oxygen Level-Dependent Magnetic Resonance Imaging in Chronic Kidney Disease. Kidney Blood Press Res. 2021;46(4):441–51. Kalis IM, Pilutti D, Krafft AJ, Hennig J, Bock M. Prospective MR image alignment between breath-holds: Application to renal BOLD MRI. Magn Reson Med. 2017;77(4):1573–82. Ozen S, Pistorio A, Iusan SM, Bakkaloglu A, Herlin T, Brik R, et al. EULAR/PRINTO/PRES criteria for Henoch-Schönlein purpura, childhood polyarteritis nodosa, childhood Wegener granulomatosis and childhood Takayasu arteritis: Ankara 2008. Part II: Final classification criteria. Ann Rheum Dis. 2010;69(5):798–806. Sukowska K, Palczewski P, Furmanczyk-Zawiska A, Perkowska-Ptasińska A, Wójcik D, Szeszkowski W, et al. Diffusion weighted magnetic resonance imaging in the assessment of renal function and parechymal changes in chronic kidney disease: a preliminary study. Ann Transpl. 2020;25:e920232. Feng YZ, Chen XQ, Yu J, Liu XL, Cheng ZY, Ren WW, et al. Intravoxel incoherent motion (IVIM) at 3.0 T: evaluation of early renal function changes in type 2 diabetic patients. Abdom Radiol(NY). 2018;43:2764–73. Chotas W, IIyas M, Tolaymat A. A child with arthritis, skin rash, abdominal pain and nephritis: searching beyond Henoch-Schonlein purpura nephritis-Answers[J]. Pediatr Nephrol. 2019;34(2):245–7. Wang WT, Yang L, Yang ZX, Hu XX, Ding Y, Yan X, et al. Assessment of microvascular invasion of hepatocellular carcinoma with diffusion kurtosis imaging. Radiology. 2018;286(2):571–80. Zheng Z, Wang Y, Yan T, Jia J, Li D, Wei L, et al. Detection of renal hypoxia configuration in patients with lupus nephritis: a primary study using blood oxygen level-dependent MR imaging. Abdom Radiol (NY). 2021;46(5):2032–44. Milani B, Ansaloni A, Sousa-Guimaraes S, Vakilzadeh N, Piskunowicz M, Vogt B, et al. Reduction of cortical oxygenation in chronic kidney disease: evidence obtained with a new analysis method of blood oxygenation level-dependent magnetic resonance imaging. Nephrol Dial Transpl. 2017;32(12):2097–105. Graham-Brown MP, Singh A, Wormleighton J, Brunskill NJ, McCann GP, Barratt J, et al. Association between native T1 mapping of the kidney and renal fibrosis in patients with IgA nephropathy. BMC Nephrol. 2019;20(1):256. Gills KA, McComb C, Patel RK, Stevens KK, Schneider MP, Radjenovic A, et al. Non-contrast renal magnetic resonance imaging to perfusion and Corticomedullary differentiation in health and chronic kidney disease. Nephron. 2016;133(3):183–92. Cox EF, Buchanan CE, Bradley CR, Prestwich B, Mahmoud H, Taal M, et al. Multiparametic renal magnetic resonance imaging: validation, interventions, and alterations in chronic kidney disease. Front Physiol. 2017;8:696. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviewers agreed at journal 16 Dec, 2025 Reviewers invited by journal 07 Dec, 2025 Editor invited by journal 10 Nov, 2025 Editor assigned by journal 23 Oct, 2025 Submission checks completed at journal 23 Oct, 2025 First submitted to journal 23 Oct, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7860417","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":556576605,"identity":"4489f3c8-a814-4866-a81b-d6682fa155b8","order_by":0,"name":"Hang Su","email":"","orcid":"","institution":"The First Affiliated Hospital of Henan University of Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Hang","middleName":"","lastName":"Su","suffix":""},{"id":556576606,"identity":"cbd48071-bb0e-4c64-b460-3a76d8f4fdb4","order_by":1,"name":"Gang Zhang","email":"","orcid":"","institution":"The First Affiliated Hospital of 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10:00:24","extension":"html","order_by":25,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":119754,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7860417/v1/7556606d11ba84ba59e684a8.html"},{"id":97966785,"identity":"d87c383f-df00-4d55-a4db-b777cb902ec6","added_by":"auto","created_at":"2025-12-11 10:00:23","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":890986,"visible":true,"origin":"","legend":"\u003cp\u003eROI location. In a black-and-white inversed DWI with a b value of 100 and T1 mapping, the contrast of kidney cortex and medulla are clear. The area of interest (ROI) in the cortex is delineated manually, and the top of the kidney is avoided due to the uniformity of B0.\u003c/p\u003e","description":"","filename":"figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-7860417/v1/ade270caeaca35fdf38e392d.png"},{"id":97966787,"identity":"1d4323b6-0955-4850-840d-5225135d116e","added_by":"auto","created_at":"2025-12-11 10:00:24","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":783287,"visible":true,"origin":"","legend":"\u003cp\u003eRepresentative small-field high-resolution DWI maps and diffusion results (D, K, D* and f) of the left kidney in a healthy volunteer, an HSP patient and a HSPN patient. In the first column, the zoom DWI images was fused on the T2W images. A significantly lower renal cortical value left kidney D map and K map is shown in the HSPN patient.\u003c/p\u003e","description":"","filename":"figure2.png","url":"https://assets-eu.researchsquare.com/files/rs-7860417/v1/912d1523135465bc6d0a0112.png"},{"id":98423363,"identity":"f4133d46-31f7-4d45-bc9f-94c3294178e1","added_by":"auto","created_at":"2025-12-17 16:32:08","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":702816,"visible":true,"origin":"","legend":"\u003cp\u003eRepresentative T1mapping, T2* mapping and B0 mapping of bilateral kidney in a healthy volunteer, a HSP patient and a HSPN patient. Increased T2* signal is seen in the HSPN group compared to the healthy control.\u003c/p\u003e","description":"","filename":"figure3.png","url":"https://assets-eu.researchsquare.com/files/rs-7860417/v1/88997b0bdc7bea6946c8cb6d.png"},{"id":97966791,"identity":"a8f016c4-5025-4883-bd3f-f873c6419239","added_by":"auto","created_at":"2025-12-11 10:00:24","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":619140,"visible":true,"origin":"","legend":"\u003cp\u003eIn 2 patients with HSPN, HE staining showed crescent bodies as indicated by arrow in the glomeruli at different magnifications. (A, ×100; B, ×200)\u003c/p\u003e","description":"","filename":"figure4.png","url":"https://assets-eu.researchsquare.com/files/rs-7860417/v1/58de160fe18829aadae1fcf8.png"},{"id":98423111,"identity":"b8bdfa73-8040-407c-baa7-fb39bab045bf","added_by":"auto","created_at":"2025-12-17 16:31:51","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":86796,"visible":true,"origin":"","legend":"\u003cp\u003eCorrelation between T2* values and 24h proteinuria in the HSPN group (A), and correlation between cortical D values and K values for all subjects (B).\u003c/p\u003e","description":"","filename":"figure5.png","url":"https://assets-eu.researchsquare.com/files/rs-7860417/v1/a1cc22804c591b0797c7eea9.png"},{"id":98423014,"identity":"06f9acf5-2b5e-4757-a123-72cdbbda90c3","added_by":"auto","created_at":"2025-12-17 16:31:44","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":94448,"visible":true,"origin":"","legend":"\u003cp\u003eROC curves. A, ROC curve of the renal cortical D value, T2* value and their combined value in different HSPN from healthy controls (A) and HSPN from HSP (B).\u003c/p\u003e","description":"","filename":"figure6.png","url":"https://assets-eu.researchsquare.com/files/rs-7860417/v1/987b38c8ad9c37101b69fe66.png"},{"id":98774912,"identity":"90a3df04-86d0-4891-af92-46cd64589ad8","added_by":"auto","created_at":"2025-12-22 12:16:44","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":3974781,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7860417/v1/f056b860-6d41-400d-a223-ca33d9d1cf10.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Differentiation Henoch-Schönlein purpura nephritis from Henoch-Schönlein purpura in children using multiparametric quantitative MR imaging","fulltext":[{"header":"Background","content":"\u003cp\u003eHenoch-Schonlein purpura nephritis (HSPN), also referred to as Immunoglobulin A vasculitis nephritis (IgAVN), is the most common secondary glomerular disease in children \u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e. It has a gradual an increase in prevalence, with approximately 20% of HSPN patients eventually developing typical nephrotic syndrome \u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e. If treatment is delayed, there is a risk that the condition may progress to chronic kidney disease or end-stage renal disease \u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e. Henoch-Schonlein purpura (HSP) is a pathological condition characterized by the inflammatory response of small blood vessels. One of the important symptoms associated with HSP is HSPN \u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e. The prompt identification of HSPN plays an important role in accurately evaluating the prognosis and implementing customized therapeutic interventions.\u003c/p\u003e\u003cp\u003eBiochemical and pathological markers, such as proteinuria, immune complex deposition and crescent formation, may serve as prognostic risk factors and crucial indicators for intervention and treatment \u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e. However, laboratory tests are prone to being influenced by various physiological and pathological conditions, thereby resulting in outcomes that may lack precision and specificity. Additionally, renal biopsy is an intervention that has related invasiveness and offers potential risks of complications, including postoperative pain (2%-4%), hematuria (3%-18%), and bleeding (1%-7%) \u003csup\u003e[\u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e. Therefore, this problem may hinder effective clinical screening and evaluation method for identify HSPN and HSP in a clinical environment \u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eThe MRI is a non-ionizing and multi-parameter imaging method that is capable of reveal providing comprehensive information about both the anatomical structures and functional changes in the kidney. Renal MRI imaging has been used in the diagnosis and assessment of the effectiveness of acute and chronic renal diseases \u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e, including transplanted kidney \u003csup\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e, renal tumor \u003csup\u003e[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e],\u003c/sup\u003e and renal artery stenosis \u003csup\u003e[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003e. Advanced diffusion model imaging techniques based on MR diffusion imaging, such as intravoxel incoherent motion (IVIM) and diffusion kurtosis imaging (DKI), show potential in identifying the diffusion rate or diffusion kurtosis of water molecules in kidney. This approach could offer indirect information relating changes in tissue microstructure, facilitating the investigation of the pathophysiological condition of the disease at the cellular and molecular levels \u003csup\u003e[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/sup\u003e. Several studies have been published regarding the application of IVIM and DKI in the study of renal IgAN. Liang P \u003csup\u003e[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/sup\u003e et al. had found that elevated renal cortical MK values and reduced D and ADC values in IgAN patients in comparison to a control group of healthy volunteers using DKI. The decreased ADC in IgAN was also validated by Lang ST et al \u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eBlood oxygen level dependent (BOLD) MRI is a noninvasive method for evaluating the oxygen levels in renal tissue in vivo \u003csup\u003e[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/sup\u003e. With BOLD imaging, renal oxygenation levels could be indirectly assessed by identifying the non-uniform transverse relaxation time (T2*) caused by the paramagnetic influence of deoxyhemoglobin \u003csup\u003e[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/sup\u003e, and the accuracy of the results was confirmed by invasive probe measurements \u003csup\u003e[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/sup\u003e. Nishino T et al. found that BOLD-MRI combined with low-dose oxygen administration could been as a non-invasive method to evaluate the activity of HSPN \u003csup\u003e[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]\u003c/sup\u003e. Therefore, we hypothesized that children with HSPN may also show abnormal alterations in water molecule distribution and BOLD signals.\u003c/p\u003e\u003cp\u003eHowever, the accuracy and reliability of previous findings might be subject to limits related to the techniques used for data collection and post-processing methods. DWI imaging with freely breathing was used in most of renal IVIM and DKI studies, which may not effectively reduce the influence of respiratory motion on the results. The inconsistency of bilateral kidney results and the presence of fluctuations in BOLD results can be attributed to the interference caused by surrounding tissue motion and renal biopsy \u003csup\u003e[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]\u003c/sup\u003e. Meanwhile, the studies acquired bilateral renal axial images with limited spatial resolution, which might hinder the accurate boundary of the extensive renal cortical data. To our knowledge, there has few studies of application of IVIM, DKI and BOLD MR imaging in the early stages of HSPN.\u003c/p\u003e\u003cp\u003eThe main aim of this study was to differentiation between HSP and HSPN with a high-resolution coronal renal diffusion images based on a zoom DWI sequence with respiratory trigger acquisition. Meanwhile, breath-hold coronal renal T2* mapping and T1 mapping maps as well as B0 mapping maps had acquired to improve the accuracy of renal advanced diffusion and BOLD measurements and the precision of outlining the renal cortical region of interest. Additionally, we investigated the potential association between the MRI indicators and biochemical and pathological indices, such as 24-hour proteinuria and crescent proportion in the HSPN group.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003ePatients\u003c/h2\u003e\u003cp\u003e The prospective study was granted approval from the local ethics committee (approvement number: 2022HL-437-01), and all participants provided informed consent. The study included a total of 30 participants, consisting of 10 pediatric patients with HSPN, 10 with HSP, and 10 healthy volunteers at our hospital from January 2022 to September 2022. The participants were divided into three groups: the HSPN group, the HSP group, and the control group. The inclusion criteria for the HSP group were follows: 1. meeting the diagnostic criteria of HSP as outlined in reference \u003csup\u003e[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]\u003c/sup\u003e; 2. Having normal results in a routine urinary examination; 3. Having a disease duration of no more than 8 weeks; 4. The renal MR images without obvious motion artifact. The inclusion criteria for the HSPN group were as follows: 1. The presence of hematuria and/or proteinuria for a duration of six months in HSP; 2. 24h urine protein exceeding 500mg; 3. The disease duration not more than 8 weeks; 4. Successful completion of renal magnetic resonance imaging scan without obvious motion artifact.\u003c/p\u003e\u003cp\u003eThe exclusion of two healthy volunteers, two children in the HSP group, and one child in the HSPN group was necessary as they were unable to inability to cooperate effectively with breath holding during MR examination. Finally, 9 cases in the HSPN group were acquired. Within the HSPN group, 7 children underwent renal puncture biopsy in order to measure the proportion of crescents, indicating the presence of glomerular tract proliferative glomerulonephritis with IgA deposition. Meanwhile, 24h proteinuria data were obtained from HSPN patients as shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eClinical data of patients at baseline\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eControl (n=8)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eHSP (n=8)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eHSPN (n=9)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale/female\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6/2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7/1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6/3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge (years)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12.38\u0026thinsp;\u0026plusmn;\u0026thinsp;2.39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10.86\u0026thinsp;\u0026plusmn;\u0026thinsp;2.95\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e11\u0026thinsp;\u0026plusmn;\u0026thinsp;2.83\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSerum creatinine (\u0026micro;mol/L)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e--\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e43.83\u0026thinsp;\u0026plusmn;\u0026thinsp;13.21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e37.53\u0026thinsp;\u0026plusmn;\u0026thinsp;11.75\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eProteinuria (mg/24h)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e--\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e--\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3164.83\u0026thinsp;\u0026plusmn;\u0026thinsp;2456.37\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCrescent proportion (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e--\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e--\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e17.70\u0026thinsp;\u0026plusmn;\u0026thinsp;10.49\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003eHSP: Henoch-Schonlein purpura; HSPN: Henoch-Schonlein purpura nephritis.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eMR imaging\u003c/h3\u003e\n\u003cp\u003eMRI examination were performed on a 3T MRI (Ingenia CX, Philips Healthcare, The Netherlands) with a 16-channel body coil. The study employed respiratory gating and finger pulse electrocardiogram (ECG) gating techniques to monitor the respiratory and ECG waveforms of the participants. After scanning anatomical images using conventional renal transverse and coronal T2 weighted Multi-Vane XD (MVXD) scans, bilateral coronal renal B0 maps, respiratory-triggered left-sided renal coronal small-field IVIM, breath-hold bilateral renal T1 mapping and breath-hold bilateral T2* mapping scans were performed, respectively. The scan parameters are shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eMR scan parameters of different sequences\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"13\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026times;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026times;\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c13\" colnum=\"13\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSequence\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eImaging mode\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFOV (mm)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eThickness\u003c/p\u003e\u003cp\u003e(mm)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eGap\u003c/p\u003e\u003cp\u003e(mm)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eSlice number\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eMatrix\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eTR/TE\u003c/p\u003e\u003cp\u003e(ms)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u003cp\u003eNumber of excitations\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c10\"\u003e\u003cp\u003eb-values\u003c/p\u003e\u003cp\u003e(s/mm2)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c11\"\u003e\u003cp\u003eSENSE\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c12\"\u003e\u003cp\u003eMultiVane (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c13\"\u003e\u003cp\u003eFlip angle\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCoronal T2-weighted imaging\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2D- turbo spin echo (TSE)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026times;\" colname=\"c3\"\u003e\u003cp\u003e350\u0026times;350\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026times;\" colname=\"c7\"\u003e\u003cp\u003e176\u0026times;176\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1522/118\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e--\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e400\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e--\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAxial T2-weighted imaging\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2D-TSE\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026times;\" colname=\"c3\"\u003e\u003cp\u003e320\u0026times;320\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026times;\" colname=\"c7\"\u003e\u003cp\u003e160\u0026times;160\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1838 / 113\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e--\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e340\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e--\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCoronal B0 map\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3D-fast field echo (FFE)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026times;\" colname=\"c3\"\u003e\u003cp\u003e400\u0026times;400\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026times;\" colname=\"c7\"\u003e\u003cp\u003e68\u0026times;68\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e30/3.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e--\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e--\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e60\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eZoom-Coronal IVIM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003esingle-shot EPI with respiratory trigger\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026times;\" colname=\"c3\"\u003e\u003cp\u003e152\u0026times;76\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026times;\" colname=\"c7\"\u003e\u003cp\u003e152\u0026times;76\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e4000/85\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e1, average 2 when b\u0026thinsp;=\u0026thinsp;1000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0, 10, 30, 50, 100, 250, 500, 800 and 1000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e--\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e--\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCoronal T1 mapping\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ebalanced-FFE sequence with a single breath hold T1 MOdified Look-Locker Inversion recovery (MOLLI) acquisition,\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026times;\" colname=\"c3\"\u003e\u003cp\u003e300\u0026times;300\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026times;\" colname=\"c7\"\u003e\u003cp\u003e152 \u0026times; 150\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e2.3/1.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e--\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e--\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCoronal T2* mapping\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003emultishot FFE sequence with breath-holding\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026times;\" colname=\"c3\"\u003e\u003cp\u003e300\u0026times;300\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026times;\" colname=\"c7\"\u003e\u003cp\u003e96\u0026times;72\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e60/ 4.6, 9.2, 13.8, 18.4, 23\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e--\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e--\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e27\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"13\"\u003eIVIM: intravoxel incoherent motion; FOV: field of view; TSE: Turbo spin echo; FFE: fast field echo; EPI: echo planar imaging; MOLLI: MOdified Look-Locker Inversion recovery; TR: repetition time; TE: echo time; SENSE: SENSitivity Encoding.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\n\u003ch3\u003eData post-processing and measurement\u003c/h3\u003e\n\u003cp\u003eScanned raw images were transferred to an ISP workstation (version 9, Philips Healthcare, The Netherlands). The IVIM maps are analyzed using Advanced Diffusion Processing (ADA) to analyze the different b-value raw data and remove b-value maps with high interference by respiratory motion. Automatic rigid alignment in ISP to reduce motion interference. The biexponential model is used to automatically generate D-plots, D*-plots, and F-plots, while K-plots are acquired by the simple IVIM\u0026thinsp;+\u0026thinsp;kurtosis model in ISP workstation. The biexponential model is given by S\u003csub\u003eb\u003c/sub\u003e=S\u003csub\u003e0\u003c/sub\u003e[(1-f)e\u003csup\u003e\u0026minus;\u0026thinsp;bD\u003c/sup\u003e+f*e\u003csup\u003e\u0026minus;\u0026thinsp;bD*\u003c/sup\u003e], and the simple IVIM\u0026thinsp;+\u0026thinsp;kurtosis model is given by S\u003csub\u003eb\u003c/sub\u003e=S\u003csub\u003e0\u003c/sub\u003e[(1-f)e\u003csup\u003e(\u0026minus;bD+b^2*D^2*K/6)\u003c/sup\u003e\u0026thinsp;+\u0026thinsp;f*δ(b)].\u003c/p\u003e\u003cp\u003eThe renal cortical region of interest (ROI) was manually outlined based on a black-and-white inversed DWI with a b value of 100. The ROI was copied to D-map, D*-map, F-map and K-map, and the corresponding the mean of D-value, D*-value, F-value and K-value were recorded (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eThe T1 mapping and T2* mapping was reconstructed directly by the scanner. The T1 mapping map was utilized to manually outline the region of interest (ROI) corresponding to the left renal cortical area, with care to avoid any potential confounding factors such as B0 inhomogeneity or visible artifacts. The ROI was attached to the T2* mapping maps, from which the T1 and T2* values of the cortex were acquired, respectively (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\n\u003ch3\u003ePathological biopsy and HE staining\u003c/h3\u003e\n\u003cp\u003eAll patients with HSPN were confirmed by pathological biopsy. Renal cortical tissue samples were obtained by puncture of the right kidney under the guidance of B-ultrasound. 2\u0026ndash;3 kidney samples were obtained and HE staining was performed. The crescent body is observed under the light mirror and the proportion of the crescent body is calculated. Crescent body ratio is the number of glomerulus with crescent body in pathological picture divided by the number of all glomerulus.\u003c/p\u003e\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003eStatistical analysis\u003c/h2\u003e\u003cp\u003e The grouped data were first displayed using box plots, and the outliers marked with * were removed according to the displayed results (SPSS 25.0, IBM, U.S.). Then the Kolmogorov-Smirnov method and Levene's method were applied to test the normality and chi-square test of the grouped data, and the measures that conformed to the normal distribution were described by the mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation. Independent samples t-test was used to compare the group differences in D values, D* values, K values, T1 and T2 values. \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was defined as a statistically significant difference. Spearman correlation analysis was used to analyze possible correlations among the above MRI indices and biochemical pathology indices (24h ptoteinuria and crescent proportion). Correlation coefficients were obtained using scatter plots and linear regression methods. Diagnostic efficacy and thresholds for differentiation between HSPN and HSP, as well as between control and HSPN were obtained using ROC curves analysis (MedCalc, 19, MedCalc Software Ltd, Belgium).\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\u003ch2\u003eComparison of MRI parameters between different groups\u003c/h2\u003e\u003cp\u003eMultiparametric Quantitative MR images, including D map, D* map, F map and K map of left kidney as well as T1 mapping, T2* mapping and B0 mapping of bilateral lateral kidney were acquired in the control group, HSP group and HSPN group (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, \u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). The reduced D values in HSPN group were found (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01) compared with those in the control group. Meanwhile, there are a reduced D values in HSPN group than those in the HSP group (P\u0026thinsp;=\u0026thinsp;0.04). An elevated T2* value in in HSPN group than those in the HSP group (P\u0026thinsp;=\u0026thinsp;0.04). K, D*, f and T1 values were not significantly different between the three group. These results are shown in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComparisons of renal cortical MRI parameters among the three groups\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eControl\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;8)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eHSP\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;8)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eHSPN\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;9)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003csup\u003e\u003cem\u003ea\u003c/em\u003e\u003c/sup\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003csup\u003e\u003cem\u003eb\u003c/em\u003e\u003c/sup\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003csup\u003e\u003cem\u003ec\u003c/em\u003e\u003c/sup\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eD(\u0026times;10\u003csup\u003e\u0026minus;\u0026thinsp;3\u003c/sup\u003emm\u003csup\u003e2\u003c/sup\u003e/s)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e2.68\u0026thinsp;\u0026plusmn;\u0026thinsp;0.23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e2.42\u0026thinsp;\u0026plusmn;\u0026thinsp;0.25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e2.08\u0026thinsp;\u0026plusmn;\u0026thinsp;0.21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.01\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e0.04\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eK\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e0.57\u0026thinsp;\u0026plusmn;\u0026thinsp;0.07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e0.55\u0026thinsp;\u0026plusmn;\u0026thinsp;0.15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e0.51\u0026thinsp;\u0026plusmn;\u0026thinsp;0.16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.81\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.64\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eD*(\u0026times;10\u003csup\u003e\u0026minus;\u0026thinsp;3\u003c/sup\u003emm\u003csup\u003e2\u003c/sup\u003e/s)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e60.94\u0026thinsp;\u0026plusmn;\u0026thinsp;50.23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e22.68\u0026thinsp;\u0026plusmn;\u0026thinsp;17.67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e39.24\u0026thinsp;\u0026plusmn;\u0026thinsp;36.46\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.41\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e0.10\u0026thinsp;\u0026plusmn;\u0026thinsp;0.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e0.10\u0026thinsp;\u0026plusmn;\u0026thinsp;0.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e0.10\u0026thinsp;\u0026plusmn;\u0026thinsp;0.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.82\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.99\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.56\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eT2* (ms)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e55.73\u0026thinsp;\u0026plusmn;\u0026thinsp;11.20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e53.15\u0026thinsp;\u0026plusmn;\u0026thinsp;12.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e64.00\u0026thinsp;\u0026plusmn;\u0026thinsp;5.17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e0.04\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eT1(ms)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e1568.33\u0026thinsp;\u0026plusmn;\u0026thinsp;93.59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e1521.22\u0026thinsp;\u0026plusmn;\u0026thinsp;82.82\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e1520.46\u0026thinsp;\u0026plusmn;\u0026thinsp;77.95\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.99\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"7\"\u003e\u003csup\u003e\u003cem\u003ea\u003c/em\u003e\u003c/sup\u003e\u003cem\u003eP\u003c/em\u003e represents control vs HSP;\u003csup\u003e\u003cem\u003eb\u003c/em\u003e\u003c/sup\u003e\u003cem\u003eP\u003c/em\u003e represents control vs HSPN༛\u003csup\u003e\u003cem\u003ec\u003c/em\u003e\u003c/sup\u003e\u003cem\u003eP\u003c/em\u003e represents HSP vs HSPN\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"7\"\u003eHSP: Henoch-Schonlein purpura; HSPN: Henoch-Schonlein purpura nephritis; D: pure diffusion coefficient; K: Kurtosis; D*: fast diffusion coefficient; f: the ratio of capillary volume to total volume in the body.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003ePathological results\u003c/h3\u003e\n\u003cp\u003eCrescent bodies were present in the HE stained sections of all patients in the HSPN group, and the pathological images of typical crescent bodies in two patients with HSPN were shown, as shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eCorrelation between MRI parameter values and correlation with biochemical pathological indices\u003c/h2\u003e\u003cp\u003eThe results showed a positive correlation between T2* values and 24-hour urine protein in the HSPN group (\u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.79, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.024) and no significant correlation with crescentic proportion (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.913) (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003ea). Other MR indices did not correlate with biochemical pathology. Cortical D values were positively correlated with cortical K values for all subjects (\u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.66, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.001). These results are present in Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003eb.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003eDiagnostic performance of MRI parameters\u003c/h2\u003e\u003cp\u003eWe applied ROC curve analysis to assess the diagnostic performance of MRI parameters in differentiating HSPN from HSP. Regarding the differentiation between the control and HSPN groups, the T2*+D value had the highest AUC value of 0.86 with 95% confidence interval of 0.584 to 0.980, sensitivity of 75% and specificity of 100%. the threshold value of T2* was 62.8 ms and the threshold value of D value was 2.28. Regarding the differentiation between the HSP and HSPN groups, the T2*+D value had the highest AUC value of 0.79 with 95% confidence interval of 0.498 to 0.956, sensitivity of 66.67% and specificity of 87.50%. the threshold for T2* was 61.9 ms and the threshold for D value was 2.06. These results are present in Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e6\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study demonstrates the efficacy of multimodal MRI in the evaluation of renal injury among pediatric patients with HSPN. Significant differences were observed in the renal cortical D values and T2* values between the control versus HSPN and HSP versus HSPN groups. The combination of D values and T2* values showed a notable level of diagnostic efficacy in identification of HSPN and the differentiation between HSP and HSPN. Additionally, a significant positive correlation was observed between T2* values and UTP (r\u0026thinsp;=\u0026thinsp;0.79, P\u0026thinsp;\u0026lt;\u0026thinsp;0.05), as well as a positive correlation between cortical D values and cortical K values in all subjects (r\u0026thinsp;=\u0026thinsp;0.66, P\u0026thinsp;\u0026lt;\u0026thinsp;0.01).\u003c/p\u003e\u003cp\u003eThe finding of this study revealed a reduction in the D value among the HSP group in comparison to the control group, although the difference was not statistically significant (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05). However, the D value demonstrate a significant reduction within the HSPN group when compared to both the control and HSP groups (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). It is suggested that IVIM-DWI can be used to evaluate renal injury in HSPN, which is consistent with the results of previous studies \u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/sup\u003e. The D value of IVIM quantitative parameters provides an indication of the diffusion of water molecules within and outside the cellular environment. The process of water molecule diffusion is influenced by several factors, including intercellular space, cell structure and surrounding diffusion medium. The decrease in renal cortical D values in HSPN can be attributed to the predominance of glomerular thylakoid proliferative lesions and the immunopathology characterized by the diffuse or segmental distribution of IgA in the thylakoid and parathylakoid regions, along with the deposition of multiple immune complexes \u003csup\u003e[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eThe primary features of HSPN pathology include the deposition of IgA1, infiltration of complement factor and neutrophils, and vascular inflammation \u003csup\u003e[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/sup\u003e. The deposition of IgA1 has the potential to influence the diffusion of water molecules, while inflammation can lead to the occurrence of regional blood oxygen abnormalities. The limited diffusion of water molecules in the kidney may be attributed to the deposition of immune complexes and varying degrees of thylakoid hyperplasia. As a result, the D value in the HSPN group was observed to be lower compared to the HSP group. K values are indicators of deviations from the Gaussian distribution. Previous research has demonstrated that the K values of tissues reflect the interaction between water molecules and cell membranes as well as intracellular compounds \u003csup\u003e[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]\u003c/sup\u003e. Moreover, it has been observed that the complexity of the microstructural environment positively correlates with the magnitude of the K value \u003csup\u003e[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eThe findings of the current study revealed a statistically significant correlation (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Moreover, no substantial differences in K values was observed between the HSPN group and the two other groups (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05), which conflicts with the findings of a previous study \u003csup\u003e[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]\u003c/sup\u003e. This may potentially be attributed to the inclusion of predominantly abnormal renal function patients in the study sample. These patients endured a decline in renal function, leading to glomerulosclerosis, cell proliferation, and interstitial fibrosis. Consequently, the renal parenchymal structure became more intricate, resulting in a deviation of water molecule diffusion from the Gaussian distribution \u003csup\u003e[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]\u003c/sup\u003e. In contrast, the duration of HSPN observed in this study was limited to a period of 8 weeks, representing the early stage of the disease. The pathological manifestations primarily consisted of thylakoid hyperplasia and crescent formation, without significant alterations in the microstructure of the renal parenchyma.\u003c/p\u003e\u003cp\u003eIn this study, BOLD MRI was performed for children with control, HSP and HSPN, and the results showed that T2* values were significantly higher in the HSPN group compared with the HSP group (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05), indicating that the kidneys of children with HSPN maintain a certain degree of high partial pressure of oxygen, and the results were similar to previous studies \u003csup\u003e[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]\u003c/sup\u003e. There is no difference of T2* between the control group and HSPN group, which is consistent with previous research \u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e. Although elevated R2* were found in the study of Chronic Kidney Disease (CKD)\u003csup\u003e[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]\u003c/sup\u003e, the pathogenesis and onset time of HSPN are different from CKD. It was found that in the acute phase glomeruli are lost due to inflammation and the remaining glomeruli become hyperperfused, which results in the inability to distribute oxygen to the downstream tubules, and the energy depletion of tubular sodium channels is one of the main causes of renal oxygen consumption \u003csup\u003e[\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eMeanwhile, this study found a positive correlation between T2* values and 24h proteinuria (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05), indicating that T2* values increased with the increase of renal injury in HSPN, suggesting that T2* values are expected to be an MRI index for assessing the severity of renal injury in HSPN, which deserves in-depth study. T1 mapping has now been used to assess chronic kidney disease \u003csup\u003e[\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]\u003c/sup\u003e, and studies have shown that T1 values are prolonged in patients with chronic kidney disease compared to control \u003csup\u003e[\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e],\u003c/sup\u003e and tissue fibrosis leads to an increase in T1 values \u003csup\u003e[\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]\u003c/sup\u003e. The T1 values in the HSPN group in this study were lower than those in the HSP and control groups, and the difference was not statistically significant, but a similar trend was observed. The non-significant difference considered may be related to the small number of cases included or the large variation in the degree and type of lesions due to histological factors. This observation requires further study.\u003c/p\u003e\u003cp\u003eLimitations of this study: 1. the sample size of this study was small and no clinical typing of HSPN was performed, and the sample size will be expanded in the next stage for more in-depth study; 2. The location of MRI detection did not coincide with the biopsy site, and we believe the bias was relatively small because HSPN is a diffuse disease that may affect the entire kidney and avoiding the punctured kidney may reduce the interference of renal puncture in the study. 3. Although we used respiration-triggered DWI acquisition, it was found in some subjects that respiration also causes small shifts in different b-value images, resulting in some variation in the quantitative values of diffusion images between different levels. Later we will try to use motion correction to further improve the reliability of the results.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eIn conclusion, this study provides preliminary evidence that multimodal MRI is useful for noninvasive assessment of renal injury in children with HSPN. In particular, D and T2* values can be good parameters for differentiating between HSPN and HSP kidneys.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to express our gratitude to all the patients involved in this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work has supported by the National Natural Science Foundation of China under Grant [82305309 and 82374519], Natural Science Foundation of Henan Province [232300421309 and 242300421297] and National Traditional Chinese Medicine Inheritance and Innovation Center Scientific Research Project of Henan Provincial Health Commission [2023ZXZX1158].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e#Hang Su and Gang Zhang contributed equally as co-first authors.\u003c/p\u003e\n\u003cp\u003eAuthors and Affiliations\u003c/p\u003e\n\u003cp\u003eDepartment of Pediatrics, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China\u003c/p\u003e\n\u003cp\u003eHang Su, Jingjing Wu, Yuying Sun, Xia Zhang \u0026amp; Xianqing Ren\u003c/p\u003e\n\u003cp\u003eCollege of Pediatrics, Henan University of Chinese Medicine, Zhengzhou, China\u003c/p\u003e\n\u003cp\u003eHang Su, Jingjing Wu, Yuying Sun, Xia Zhang \u0026amp; Xianqing Ren\u003c/p\u003e\n\u003cp\u003eThe First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China\u003c/p\u003e\n\u003cp\u003eGang Zhang, Wei Xing \u0026amp; Yufu Hu\u003c/p\u003e\n\u003cp\u003ePhilips Healthcare, Beijing, China\u003c/p\u003e\n\u003cp\u003eZhiwei Shen\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eContributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHS, JJW, WX, YFH and ZWS were in charge of data acquisition, analysis and interpretation. HS was responsible for manuscript drafting. GZ and XQR critically reviewed and revised the manuscript and supervised the study. HS, GZ, XZ and XQR made a contribution to study conception and design. All authors contributed to the manuscript preparation, read and approved the final text.\u003c/p\u003e\n\u003cp\u003eCorresponding authors\u003c/p\u003e\n\u003cp\u003eCorrespondence toXianqing Ren\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study has been performed in accordance with the Declaration of Helsinki, and was approved by the local ethics committee of The First Affiliated Hospital of Henan University of CM (2022HL-437-01). Informed consent was obtained from all participants and their parents/guardians.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eNie S, He WJ, Huang T, Liu DK, Wang GB, Geng J, et al. The Specteum of Biopsy-proven glomerular diseases among children in China: A national, Cross-Sectional Survey. Cli J Am Soc Nephrol. 2018;13(7):1047\u0026ndash;54.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCalvo-Rfo V, Hernandez JL, Ortiz-Sanjuan F, Loricera J, Palmou-Fontana N, Gonz\u0026aacute;lez-Vela MC, et al. Relapses in patients with Henoch-Schonlein purpura: Analysis of 417 patients from a single center. Medicine. 2016;95(28):e4217.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFan LR, Yan HM, Zhen XF, Wu XM, Hao J, Hou LY et al. Safety and Efficacy Evaluation of Treatment of Regular Glucocorticuid Combined with Cyclophosphamide Pulse in Chlidren Suffered from Moderately Severe Henoch-Schonlein Purpura Nephrotic Proteinuria. Evid Based Complement Alternat Med. 2020; 2020:3920735.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJiang MY, Li W, Xu XP, Zhou JQ, Jiang H. Role of p300 in the pathogenesis of henoch-schonlein purpura nephritis and as a new target of glucocorticoid therapy in mice. Chin Med J(Engl). 2019;132(16):1942\u0026ndash;50.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKvedar JC, Fogel AL, Elenko E, Zohar D. Digital medicine\u003csup\u003e,\u003c/sup\u003es march on chronic disease. Nat Biotechnol. 2016;34(3):239\u0026ndash;46.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChotas W, IIyas M, Tolaymat A. A child with arthritis, skin rash, abdominal pain and nephritis: searching beyond Henoch-Schonlein purpura nephritis-Answers. Pediatr Nephrol. 2019;34(2):245\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRoccatello D, Sciascia S, Rossi D, Naretto C, Bazzan M, Solfietti L et al. Outpatient percutaneous native renal biopsy: safety profile in a large monocentric cohort. BMJ Open 2017,7: e015243.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLees LS, McQuarrie EP, Mordi N, Geddes CC, Fox JG, Mackinnon B. Risk factors for bleeding complications after nephrologist-performed native renal biopsy. Clin Kidney J. 2017;10(4):573\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLang ST, Guo J, Bruns A, D\u0026uuml;rr M, Braun J, Hamm B, et al. Multiparametric Quantitative MRI for the Detection of IgA Nephropathy Using Tomoelastography, DWI, and BOLD Imaging. Invest Radiol. 2019;54(10):669\u0026ndash;74.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKlinkhammer BM, Lammers T, Mottaghy FM, Kiessling F, Floege J, Boor P. Non-invasive molecular imaging of kidney diseases. Nat Rev Nephrol. 2021;17(10):688\u0026ndash;703.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDing J, Chen J, Jiang Z, Zhou H, Di J, Xing W. Assessment of renal dusfunction with diffusion-weighted imaging: comparing intra-voxel incoherent motion (IVIM) with a mono-seponential model. Acta Radiol. 2016;57(4):507\u0026ndash;12.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRheinheimer S, Schneider F, Stieltjes B, Morath C, Zeier M, Kauczor HU, et al. IVIM-DWI of transplanted kidneys: reduced diffusion and perfusion dependent on cold ischemia time. Eur J Radiol. 2012;81(9):e951\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eByron G, Sigmund EE, Huang WC, Babb JS, Parikh NS, Stoffel D, et al. Subtype differentiation of renal tumors using voxel-based histogram analysis of intravoxel incoherent motion parameters. Invest Radiol. 2015;50(3):144\u0026ndash;52.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKim JW, Lee CH, Yoo KH, Je BK, Kiefer B, Park YS, et al. Intravoxel incoherent motion magnetic resonance imaging to predict vesicoureteral reflux in children with urinary tract infection. Eur Radiol. 2016;26(6):1670\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFranca M, Mart-Bonmatil L, Alberich-BayarriA, Oliveira P, Guimaraes S, Oliveira J, et al. Evaluation of fibrosis and inflammation in diffuse liver disease using intravoxel incoherent motion diffusion-weighted MR imaging. Abdom Radiol (NY). 2017;42(2):468\u0026ndash;77.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLi C, Liu H, Li X, Zhou L, Wang R, Zhang Y. Application of BOLD-MRI in the classification of renal function in chronic kidney disease. Abdom Radiol (NY). 2019;44(2):604\u0026ndash;11.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eThacker JM, Li LP, Li W, Zhou Y, Sprague SM, Prasad PV. Renal blood oxygenation level-dependent magnetic resonance imaging: a sensitive and objective analysis. Invest Radiol. 2015;50(12):821\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLiang P, Chen Y, Li S, Xu C, Yuan G, Hu D, et al. Noninvasive assessment of kidney dysfunction in children by using blood oxygenation level-dependent MRI and intravoxel incoherent motion diffusion-weighted imaging. Insights Imaging. 2021;12(1):146.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZhang JL, Morrel G, Rusinek H, Warner L, Vivier PH, Cheung AK et al. Measurement of renal tissue oxygenation with blood oxygen level-dependent MRI and oxygen transit modeling. Am J Physiol Ren Physiol 2014,306(6):579\u0026ndash;87.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHeineke MH, Ballering AV, Jamin A, Ben Mkaddem S, Monteiro RC, Van Egmond M. New insights in the pathogenesis of immunoglobulin A vasculitis (Henoch-Sch\u0026ouml;nlein purpura). Autoimmun Rev. 2017;16(12):1246\u0026ndash;53.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLiang P, Li S, Yuan G, He K, Li A, Hu D, et al. Noninvasive assessment of clinical and pathological characteristics of patients with IgA nephropathy by diffusion kurtosis imaging. Insights Imaging. 2022;13(1):18.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNishino T, Takahashi K, Ono S, Mimaki M. Fluctuation of R2* values in blood oxygenation level-dependent MRI during acute and remission phases of IgA vasculitis with nephritis in children. Jpn J Radiol. 2022;40(8):840\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChen F, Yan H, Yang F, Cheng L, Zhang S, Li S, et al. Evaluation of Renal Tissue Oxygenation Using Blood Oxygen Level-Dependent Magnetic Resonance Imaging in Chronic Kidney Disease. Kidney Blood Press Res. 2021;46(4):441\u0026ndash;51.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKalis IM, Pilutti D, Krafft AJ, Hennig J, Bock M. Prospective MR image alignment between breath-holds: Application to renal BOLD MRI. Magn Reson Med. 2017;77(4):1573\u0026ndash;82.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOzen S, Pistorio A, Iusan SM, Bakkaloglu A, Herlin T, Brik R, et al. EULAR/PRINTO/PRES criteria for Henoch-Sch\u0026ouml;nlein purpura, childhood polyarteritis nodosa, childhood Wegener granulomatosis and childhood Takayasu arteritis: Ankara 2008. Part II: Final classification criteria. Ann Rheum Dis. 2010;69(5):798\u0026ndash;806.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSukowska K, Palczewski P, Furmanczyk-Zawiska A, Perkowska-Ptasińska A, W\u0026oacute;jcik D, Szeszkowski W, et al. Diffusion weighted magnetic resonance imaging in the assessment of renal function and parechymal changes in chronic kidney disease: a preliminary study. Ann Transpl. 2020;25:e920232.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFeng YZ, Chen XQ, Yu J, Liu XL, Cheng ZY, Ren WW, et al. Intravoxel incoherent motion (IVIM) at 3.0 T: evaluation of early renal function changes in type 2 diabetic patients. Abdom Radiol(NY). 2018;43:2764\u0026ndash;73.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChotas W, IIyas M, Tolaymat A. A child with arthritis, skin rash, abdominal pain and nephritis: searching beyond Henoch-Schonlein purpura nephritis-Answers[J]. Pediatr Nephrol. 2019;34(2):245\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWang WT, Yang L, Yang ZX, Hu XX, Ding Y, Yan X, et al. Assessment of microvascular invasion of hepatocellular carcinoma with diffusion kurtosis imaging. Radiology. 2018;286(2):571\u0026ndash;80.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZheng Z, Wang Y, Yan T, Jia J, Li D, Wei L, et al. Detection of renal hypoxia configuration in patients with lupus nephritis: a primary study using blood oxygen level-dependent MR imaging. Abdom Radiol (NY). 2021;46(5):2032\u0026ndash;44.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMilani B, Ansaloni A, Sousa-Guimaraes S, Vakilzadeh N, Piskunowicz M, Vogt B, et al. Reduction of cortical oxygenation in chronic kidney disease: evidence obtained with a new analysis method of blood oxygenation level-dependent magnetic resonance imaging. Nephrol Dial Transpl. 2017;32(12):2097\u0026ndash;105.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGraham-Brown MP, Singh A, Wormleighton J, Brunskill NJ, McCann GP, Barratt J, et al. Association between native T1 mapping of the kidney and renal fibrosis in patients with IgA nephropathy. BMC Nephrol. 2019;20(1):256.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGills KA, McComb C, Patel RK, Stevens KK, Schneider MP, Radjenovic A, et al. Non-contrast renal magnetic resonance imaging to perfusion and Corticomedullary differentiation in health and chronic kidney disease. Nephron. 2016;133(3):183\u0026ndash;92.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCox EF, Buchanan CE, Bradley CR, Prestwich B, Mahmoud H, Taal M, et al. Multiparametic renal magnetic resonance imaging: validation, interventions, and alterations in chronic kidney disease. Front Physiol. 2017;8:696.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-imaging","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmim","sideBox":"Learn more about [BMC Medical Imaging](http://bmcmedimaging.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmim/default.aspx","title":"BMC Medical Imaging","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Kidney, Diffusion Magnetic Resonance Imaging, Child, Diagnosis, Differential","lastPublishedDoi":"10.21203/rs.3.rs-7860417/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7860417/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackgroud\u003c/h2\u003e\u003cp\u003eAt present, there is a lack of accurate and non-invasive clinical methods for differentiating Henoch-Schonlein purpura nephritis (HSPN) from Henoch-Schonlein purpura (HSP) in pediatric patients. In this study, we aim to differentiate HSPN from HSP using kidney intravoxel incoherent motion diffusion imaging (IVIM-DWI) and T1/T2* mapping.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eThis prospective study included nine children, diagnosed with Henoch-Schonlein purpura nephritis (HSPN) confirmed by pathological examination, eight children with Henoch-Schonlein purpura (HSP) and eight healthy volunteers. Renal multi-b-value DWI images acquired with breath-triggering, and T2* mapping and T1 mapping with breath-holding were performed to detect the diffusion values and T1/T2* relaxation time in the left renal cortex. The inter-group differences of MRI parameters were compared. Twenty-four hours urine protein (UTP) and the proportion of crescents were collected in HSPN group, and their association with MR indexes was assessed. The diagnostic efficacy in distinguishing between HSPN and HSP were also evaluated.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eThe levels of renal cortical the pure diffusion coefficient (D) were lower in the HSPN group compared to those in both the control group (P\u0026thinsp;\u0026lt;\u0026thinsp;0.01) and the HSP group (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The T2* values in the HSPN group were significantly higher than those in the HSP group (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Moreover, a correlation was found between the values of renal cortical T2* and UTP in the HSPN group. The AUC area of the combined T2* and D values is 0.86 in the differentiation between HSP and HSPN is 0.79 with a specificity of 87.50%.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eThe application of renal cortical T2* values and D values is beneficial in distinguishing between HSPN and HSP kidneys.\u003c/p\u003e","manuscriptTitle":"Differentiation Henoch-Schönlein purpura nephritis from Henoch-Schönlein purpura in children using multiparametric quantitative MR imaging","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-11 10:00:14","doi":"10.21203/rs.3.rs-7860417/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"36471946635948613745035761814731486220","date":"2025-12-16T15:44:07+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-12-07T14:19:47+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-11-10T17:32:30+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-10-24T02:34:45+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-10-23T04:09:31+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Imaging","date":"2025-10-23T04:06:33+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-imaging","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmim","sideBox":"Learn more about [BMC Medical Imaging](http://bmcmedimaging.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmim/default.aspx","title":"BMC Medical Imaging","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"5c00cd36-1472-4f79-adc4-8af310f167e2","owner":[],"postedDate":"December 11th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-12-11T10:00:15+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-11 10:00:14","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7860417","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7860417","identity":"rs-7860417","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}