*Purpose: To evaluate the feasibility and clinical application of diffusional kurtosis imaging (DKI) technique in non-invasive assessment for chronic allograft injury (CAI).

*Methods: The local ethics committee approved this study; written informed consent was obtained. Between January 2018 and October 2019, a total of 105 renal allograft recipients were recruited and divided into allograft function normal(eGFR≥60) and abnormal(eGFR<60) groups for analysis and screening of relevant DKI parameters. Then they were grouped on eGFR (mL/min/1.73m²) levels to 3 groups: group 1, eGFR≥60(n=5); group 2, eGFR 30-60 (n=69); group 3, eGFR<30 (n=31). DKI was performed on a clinical 3 T magnetic resonance imaging (MRI) system, and region-of-interest measurements were conducted to determine mean kurtosis (K), mean diffusivity (D), and apparent diffusion coefficient (ADC) of the kidney cortex and medulla. Renal biopsy specimens were performed in allograft functionabnormal group randomly.

*Results: Mean D values of the renal cortex were significantly lower in the eGFR abnormal group. And Mean D values of the renal cortex decreased gradually with the increase of creatinine, whereas there is a significant difference in the value of D values of cortex between different eGFR groups. (p<0.05). And biopsy result confirmed interstitial fibrosis and tubular atrophy (IFTA).

*Conclusions: As allograft injury progresses, the perfusion of renal might be reduced, and the molecular of the renal cortex might be influenced. The DKI quantitative parameter D of the renal cortex can non-invasively assess CAI to some extent. DKI technique is expected to be an effective, natural, and non-invasive method to detect CAI.

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