肾脏皮、髓质ADC在慢性肾脏病分期中的应用  

Application of ADC value of renal cortex and medulla in staging chronic kidney disease

作　　者：李琼[1] 张泉[2] 孙浩然[2] 白人驹[2] 

机构地区：[1]天津市南开医院放射科,天津300100 [2]天津医科大学总医院放射科,天津300052

出　　处：《中国医学影像技术》2012年第4期751-755,共5页Chinese Journal of Medical Imaging Technology

基　　金：天津市自然科学基金面上项目(08JCYBJC07900)

摘　　要：目的应用DWI技术探讨ADC对不同分期慢性肾脏病(CKD)的鉴别诊断价值。方法临床确诊的52例CKD患者[包括轻度损害组(23例)和中、重度损害组(29例)]及27名健康志愿者(正常对照组),均接受MR常规检查和DWI,b值分别取50、100、500、1000s/mm2,定量测量各组肾脏皮、髓质的ADC值并进行统计学分析,观察各组肾脏ADC值的差异,以ROC曲线评价ADC值的鉴别诊断价值。结果各b值下正常对照组、轻度损害组和中、重度损害组肾脏皮、髓质ADC值均依次降低(P<0.05),以皮、髓质ADC1000值在正常对照组与轻度损害组之间、轻度损害组与中、重度损害组之间的差异最显著(P均<0.001)。b值为1000s/mm2时,以肾脏髓质ADC值区分正常对照组与轻度损害组的最佳诊断阈值为1.82×10-3mm2/s,敏感度和特异度分别为69.60%、100%;以肾脏皮质ADC值区分轻度损害组与中、重度损害组的最佳诊断阈值为1.82×10-3mm2/s,敏感度和特异度分别为65.50%、82.60%。结论 DWI可以反映CKD患者肾脏皮、髓质水分子扩散运动的变化,测量肾脏皮、髓质ADC值有助于对CKD患者进行分期。Objective To explore the differential diagnostic value of ADC of renal cortex and medulla in staging chronic kidney disease （CKD） with DWI. Methods Fifty two patients with CKD （including 23 with minor CKD and 29 with moderate/severe CKD） as well as 27 healthy volunteers （normal control group） were included. All subjects received conventional MR and DWI examinations with multiple b values including 50, 100, 500 and 1000 s/ram2. The ADC values of cortex and medulla in kidney with each b value were measured respectively and analyzed. The ADC values of cortex and medulla were compared among control group, minor CKD group and moderate/severe CKD group. ROC analysis was performed to evaluate the value of ADC on differential diagnosis of CKD. Results ADC values of cortex and medulla went down in turn among normal control group, minor CKD group and moderate/severe CKD group （P〈0.05） with all b values. The most significant differences of ADC1000 values of cortex and medulla were found between normal control group and minor CKD group, as well as minor CKD group and severe CKD group （both P〈0. 001）. The cutoff value, sensitivity and specificity of medullary ADC1000 values for differentiating control group and minor CKD group were 1.82 × 10 a mm2/s, 69.60% and 100%, respectively, while those of cortical ADC values for differentiating minor CKD group and moderate/severe CKD group were 1.82 ×10^-3 mm2/s, 65.50% and 82. 60%, respectively. Conclusion Water diffusion changes of kidney in patients with CKD could be reflected by DWI. The cortical and medullary ADC values are helpful for staging CKD.

关 键 词：肾脏病 扩散磁共振成像 

分 类 号：R692[医药卫生—泌尿科学] R445.2[医药卫生—外科学]