Objective: To explore the value of DWI on transplanted renals with early acute rejection. Materials and Methods: Study protocol was approved by local ethics committee; informed consent was obtained. A total of 88 velunteers were enrolled and divided into three groups, as follows: Group A, 51 cases with healthy kidneys in situ;group B, 22 transplantation with stable renal function for at least 3 months after operating; and group C, 15 iliac allograft renals with early acute rejection from 1 week to 4 weeks after operating. T2W, T1W axial/coronal, and a transverse fat-saturated echo-planar DWI with 3 b-values(0, 100, 800 s/mm2) were performed on a 3.0 T scanner during normal breathing. EWS2.6.3 workstation was used to calculate the apparent diffusion coefficient(ADC) value of renal cortex, medulla, muscle respectively based on ADC0-800 maps. Receiver operating characteristic(ROC) curve was used to predict the kidneys with early acute rejection. Results: No statistic significances were found for gender, age, ADC0-800 of muscle among three groups(P>0.05), nor did ADC0-800 values reveal a significant difference for left and right kidneys in situ(P>0.05). It showed renal cortex mean(+/-SD) ADC0-800 values of (1.92±0.13), (1.93±0.15), (1.68±0.14)×10–3 mm2/s for group A, B and C, respectively. Group C was significantly higher than both group A and B(P<0.05); however no statistic significance was found between group A and B(P>0.05); Nor did medullary ADC0-800 values reveal a significant difference for 3 groups. While the difference between cortex and medulla was statistically significant for both groups A and B(P<0.05). With an ADC0-800 <1.76×10–3 mm2/s as diagnose critical points compared to biopsy, the sensibility was 86.7%, the specificity was 90.4%, and the accuracy was 0.942 in the prediction of the kidneys with early acute rejection. Conclusion: DWI is of important value in transplanted renals with early-stage acute rejection, it can provide reliable imaging evidence for treatment.%目的：探讨移植肾急性排斥扩散加权成像早期诊断价值。材料与方法应用3.0 T MR扩散加权成像序列(b=0、100、800 s/mm2)，分别扫描原位正常肾51例(A组)、移植正常肾22例(B组)、急性排斥反应移植肾15例(C组)志愿者，数据导入自带工作站处理获得3组肾皮质、髓质、肌肉的表观扩散系数(apparent diffusion coefficient, ADC0-800)。比较原位肾组皮髓质ADC0-800值双侧差异，两组正常肾皮质与髓质差异，3组年龄、性别间以及肌肉、肾皮质、髓质ADC0-800值差异，以活检病理为“金标准”，评价肾皮质ADC0-800值诊断移植肾急性排斥效能。结果3组间年龄、性别、肌肉ADC0-800值无统计学差异(P＞0.05)；原位肾皮髓质ADC0-800值双侧差异无统计学意义(P＞0.05)；正常肾皮质ADC0-800值高于髓质，差异有统计学意义(P＜0.05)；3组间肾皮质ADC0-800值差异有统计学意义(P＜0.05)，两两比较C组与A、B组间均有统计学差异(P＜0.05)，A组与B组间差异无统计学意义(P＞0.05)；髓质ADC值3组间无统计学差异(P＞0.05)。以病理为标准，取1.76×10–3 mm2/s为阈值，皮质ADC0-800值诊断急性排斥移植肾受试者工作特征曲线下面积为0.942，敏感度与特异性分别为86.7%和90.4%。结论磁共振扩散加权成像对移植肾急性排斥早期诊断具有较高价值。
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