磁共振弥散加权成像诊断移植肾急性排异的应用研究  

Value of diffusion-weighted MR imaging in diagnosis of acute rejection after renal transplantation

作　　者：许晶晶[1] 肖文波[2] 张雷[3] 张敏鸣[1] 

机构地区：[1]浙江大学医学院附属第二医院放射科,浙江杭州310009 [2]浙江大学医学院附属第一医院放射科,浙江杭州310003 [3]浙江省肿瘤医院放射科,浙江杭州310022

出　　处：《浙江大学学报（医学版）》2010年第2期163-167,共5页Journal of Zhejiang University(Medical Sciences)

基　　金：国家自然科学基金(30770627);浙江省科技厅重点科研社会发展项目(2006C23022);浙江省自然科学基金(Y2007431)

摘　　要：目的：评估磁共振扩散加权成像（DWI）对肾脏移植术后移植肾急性排异诊断的应用价值。方法：选取首次行肾脏移植手术的患者69名,根据临床表现及病理穿刺结果,将患者分为排异组（ADCr,n=26例）和正常功能组（ADCn,n=43例）。正常功能组在术后2-3周进行磁共振扫描,排异组在肾移植术后1个月内且肾脏穿刺活检前后5日内进行磁共振扫描。测量移植肾在不同扩散敏感梯度系数（b值=200、400、600、800、1 000 s/mm^2）时的的ADC值。两组数据比较采用t检验分析。结果：在不同b值取值时,排异组ADC值均较正常功能组有明显降低（P≤0.05）。不同b值下的ROC曲线显示,当b取800 s/mm^2时,DWI诊断肾移植后急性排异的敏感度和特异度最高。结论：DWI可无创性早期诊断移植肾急性排异。Objective： To evaluate the feasibility of MR diffusion-weighted imaging（DWI） in diagnosis of acute rejection after renal transplantation.Methods： Sixty-nine patients who underwent renal transplantation were enrolled in the study.According to the clinical features and renal biopsy,26 patients were designated in rejection group and 43 in non-rejection group.Patients in non-rejection group underwent MR DWI scan at 2 to 3 weeks after operation,and those in rejection group underwent scan at 5 d before or after renal biopsy.Then the apparent diffusion coefficient（ADC） values of transplanted kidneys were measured with high diffusion sensitivity gradient factors（b values）.Results： Patients with acute rejection had significantly lower ADC（P≤0.05） than non-rejection patients with all the different b values（b=200,400,600,800,1 000 s/mm2）.The ROC curves showed that sensitivity and specificity were best when b value was 800 s/mm2.Conclusion： DWI is a potential and reliable non-invasive method for the diagnosis of the acute rejection after renal transplantation.

关 键 词：磁共振成像/方法 肾移植/副作用 移植物排斥/诊断 肾/病理学 扩散成像 排异 

分 类 号：R699.2[医药卫生—泌尿科学] R445.2[医药卫生—外科学]