DTI对鉴别移植肾急性排异反应及急性肾小管坏死的价值初探  

Diffusion tensor imaging for differentiating acute rejection from acute tubular necrosis in kidney allografts dysfunction-apre-liminary study

作　　者：李琼[1,2] 任涛[1] 陈丽华[3] 黄黎香[3] 沈文[3] 

机构地区：[1]天津医科大学一中心临床学院,天津300192 [2]天津市中心妇产科医院超声科,天津300052 [3]天津市第一中心医院放射科,天津300192

出　　处：《放射学实践》2015年第5期531-535,共5页Radiologic Practice

摘　　要：目的：探讨扩散张量成像（DTI）鉴别移植肾急性排异反应（AR）、急性肾小管坏死（ATN）和功能正常移植肾的可行性,以期探寻无创、敏感的评价移植肾功能的方法。方法：选取2012年5月-2013年12月行异体肾移植术后2～3周的患者42例纳入本研究,所有受试者均行常规MR及脂肪抑制平面回波斜冠状面DTI检查（在6个非共线性方向上施加扩散敏感梯度场,b值为0、300s/mm2）。患者分为三组,即移植肾功能正常组、AR组及ATN组,其中AR组与ATN组均经病理穿刺证实。分别测量并计算各组移植肾皮质、髓质的ADC值及FA值,采用单因素方差分析比较移植肾各组间皮质、髓质ADC值及FA值的差异。结果：AR组皮质ADC值小于功能正常组（t=-3.517,P=0.001）及ATN组（t=-2.875,P=0.007）,差异均具有统计学意义;AR组髓质ADC值小于功能正常组（t=-5.121,P=0.000）及ATN组（t=-2.912,P=0.006）,差异均具有统计学意义;移植肾功能正常组与ATN组间皮质、髓质ADC值差异均无统计学意义（P〉0.05）;三组之间皮、髓质FA值差异均无统计学意义（P〉0.05）。结论：DTI能无创、有效鉴别移植肾AR与ATN,其中皮、髓质ADC值可作为鉴别诊断指标。Objective：To assess the feasibility of using diffusion tensor imaging （DTI） to differentiate acute rejection （AR） ,acute tubular necrosis （ATN） and kidney allografts with normal function, and to explore a sensitive, noninvasive strategy for evaluating renal allograft function. Methods：Between May 2012 and December 2013,42 renal allograft recipients 2-4 weeks after transplantation were included in this study and examined using a fat saturated echo planar DTI sequence （diffusion directions= 6,b=0,300s/mm2） in oblique coronal orientation at a 3.0 Tesla magnetic resonance （MR） imager. All patients were divided into three groups： normal renal function group,acute rejection group and acute tubular necrosis group,and the latter two groups were confirmed by pathological biopsy. Mean apparent diffusion coefficient （ADC） and mean fractional anisotropy （FA） and R2 values were determined separately for the cortex and the medulla and compared among the three groups by using one way ANOVA test. Results： Mean ADC value in the cortex of AR group was significantly lower than those in normal renal function group （t=-3. 517, P=0. 001） and ATN group （t=-2. 875, P=0. 007）. Mean ADC value in the medulla in AR group was lower than those in normal renal function group （t=-5. 121 ,P=0. 000） and ATN group （t=-2. 912,P=0. 006）. There were no significant differences of mean ADC values in the cortex and medulla between normal renal function group and ATN group （P〉0.05） ;There were no significant differences of mean FA value in the cortex and medulla among all the three groups （P〉0.05）. Conclusion DTI can differentiate between transplanted renal AR and ATN noninvasively,and mean ADC value in the cortex and medulla can be used as a criterion for differential diagnosis.

关 键 词：扩散张量成像 磁共振成像 肾移植 肾小管坏死 急性 

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