磁共振扩散加权成像联合血氧水平依赖成像在慢性肾脏病肾功能评价中的应用  

Application of Diffusion-weighted Imaging and Blood Oxygen Level-dependent MRI in the Evaluation of Renal Function of Chronic Kidney Disease

作　　者：李成[1,2] 罗丹丹[3] 龚良庚[3] 连珞[3] 曾磊[4] 周国盛[5] 樊烨[6] 徐高四[7] 涂卫平[7] 房向东[7] 

机构地区：[1]南昌大学 [2]九江学院附属医院肾内科 [3]南昌大学第二附属医院影像中心 [4]南昌大学第二附属医院病理科 [5]江西省宜丰县人民医院 [6]江西省修水县人民医院 [7]南昌大学第二附属医院肾内科

出　　处：《中国全科医学》2014年第12期1437-1440,1444,共5页Chinese General Practice

基　　金：江西省卫生厅科技计划资助项目(20131067)

摘　　要：目的探讨磁共振扩散加权成像联合血氧水平依赖成像在慢性肾脏病(CKD)肾功能评价中的应用。方法收集2012年2—12月在南昌大学第二附属医院肾内科就诊的CKD患者50例为CKD组,另选取同时期体检健康正常志愿者20例为对照组,分别采用磁共振扩散加权成像联合血氧水平依赖成像测量双肾皮质和髓质表观弥散系数(ADC)值和表观横向弛豫率(R2*)值。根据99Tcm-二乙基三胺五乙酸(DTPA)肾动态显像测定的肾小球滤过率(GFR)将CKD组分为CKD1期16例、CKD2期13例和CKD3期21例,分析不同分期间CKD患者ADC值和R2*值的变化。18例CKD患者行肾穿刺活检,分析其肾皮质和髓质ADC值和R2*值与病理损害积分的相关性。结果 CKD1组、CKD2组、CKD3组皮质ADC值和髓质ADC值较对照组降低(P<0.05);CKD2组、CKD3组皮质ADC值和髓质ADC值较CKD1组降低(P<0.05);CKD3组皮质ADC值和髓质ADC值较CKD2组降低(P<0.05)。CKD2组、CKD3组较对照组和CKD1组皮质R2*值升高、髓质R2*值降低(P<0.05);CKD3组较CKD2组皮质R2*值升高、髓质R2*值降低(P<0.05)。18例CKD患者皮质ADC值和髓质ADC值与病理损害积分均呈负相关(r皮=-0.814,r髓=-0.800,P<0.01)。皮质R2*值与病理损害积分无线性相关性(r=0.461,P>0.05);髓质R2*值与病理损害积分呈负相关(r=-0.659,P<0.05)。结论肾实质ADC值可无创性反映CKD肾功能水平及肾脏病理状态的改变。R2*值可以评价CKD肾脏髓质的氧代谢的改变,且对于判断CKD肾脏病理损伤的程度有一定意义。Objective To investigate the application of diffusion - weighted imaging （DWI） and blood oxygen level - dependent MRI （ BOLD MRI） in the evaluation of renal function of chronic kidney disease （CKD） . Methods A total of 50 patients with CKD who went to Department of Nephrology, the Second Affiliated Hospital of Nanchang University from February to December in 2012, were included in CKD group, 20 healthy volunteers were included in control group. The ADC and R2 ＊ values of bilateral cortex and medulla were measured by DWI and BOLD MRI among two groups. According to GFR measured by 99Tcm - DTPA scintigraphy, CKD group were divided into 3 groups： CKD1 stage group （16 cases） ; CKD2 stage group （13 cases） ; CKD3 stage group （21 cases） . The changes of ADC and R2 ＂ values among patients with different CKD stages were analyzed. A total of 18 patients received renal biopsy, the correlation between pathological lesion degree and ADC and R2 ＊ values of cortex and medulla was analysed. Results The ADC and R2 values＂ of bilateral cortex and medulla in CKD1 group, CKD2 group and CKD3 group were significantly lower than those in control group （ P 〈 0. 05 ） . The ADC and R2＊ values of bilateral cortex and medulla in CKD2 group and CKD3 group were significantly lower than those in CKD1 group （P 〈 0.05 ） . The ADC and R2＊ val- ues of bilateral cortex and medulla in CKD3 group were significantly lower than those in CKD2 group （P 〈 0.05 ） . The cortical and medullary ADC values were correlated negatively with pathological lesion degree （rcotic,l = -0. 814, rmedullary = --0. 800, P 〈 0.01 ） . The renal cortical R2 ＊ values in CKD2 group and CKD3 group were significantly higher than those in control group and CKD1 group, while the medullary R2＊ values in CKD2 group and CKD3 group were significantly lower than those in control group and CKD1 group （P 〈 0. 05 ） . The renal cortical R2＊ values in CKD3 group were significantly higher than those in CKD2 group, while

关 键 词：肾功能不全 慢性 磁共振成像 弥散 肾小球滤过率 

分 类 号：R692[医药卫生—泌尿科学]