Advances in pediatric kidney diffusion tensor imaging: diagnostic and functional applications

Abstract Diffusion tensor imaging (DTI) offers a non-invasive window into kidney microstructure by measuring directional water diffusion. In pediatric populations, where early detection of kidney dysfunction is crucial, DTI shows promise for evaluating structural integrity, diagnosing conditions, and monitoring chronic diseases such as autosomal recessive polycystic kidney disease (ARPKD). This review briefly presents the principles of renal DTI, key acquisition techniques, and important nuances in applying this modality to kidney evaluation. We provide an overview of representative post-acquisition processing pipelines for diffusion tensor generation, tractography, and quantitative analysis. We then summarize current applications of DTI in assessing kidney structure, including its use in select diseases, with focused emphasis on pediatric conditions such as ureteropelvic junction obstruction (UPJO), polycystic kidney disease, and pediatric kidney transplantation. Applications for other renal disorders are also reviewed. Finally, we outline current challenges related to standardization and highlight future research directions needed to refine methodology and further establish the clinical utility of renal DTI.