增强磁共振与SPECT肾动态显像评估移植肾肾小球滤过率的对比分析  

Comparison of DCE-MRI renography, SPECT renography and endogenous creatinine clearance rate in kidney transplant recipients

作　　者：周万里[1] 陶俊[1] 张玉东[1] 韩志坚[1] 武晨江[1] 陈浩[1] 孙黎[1] 黄正楷[1] 阙宏亮 王增军[1] 谭若芸[1] 顾民[1] Zhou Wanli Tao Jun Zhang Yudong Han Zhijian Wu Chenjiang Chen Hao Sun Li Huang Zhengkai Que Hongliang Wang Zengjun Tan Ruoyun Gu Min(First Affiliated Hospital, Nanjing Medical University, Nanjing 210029, China)

机构地区：[1]南京医科大学第一附属医院,210029

出　　处：《中华器官移植杂志》2017年第5期272-276,共5页Chinese Journal of Organ Transplantation

基　　金：国家自然科学基金面上项目（81570676,81470981）;江苏省“333”工程项目（BRA2015469）;江苏省“科教兴卫”工程医学重点人才培养资助项目（RC2011055）;江苏省“六大人才高峰”资助项目（2010WSN-56,201I-WS-033）;江苏省卫生厅面上项目（H2009907）

摘　　要：目的 对比分析动态对比增强磁共振（DCE-MRI）与单光子发射计算机断层成像术（SPECT）肾动态显像测定移植肾肾小球滤过率（GFR）的准确性.方法 选取60例2015年12月至2016年7月接受肾移植手术的受者,分别采用DCE-MRI及SPECT测定其移植肾GFR,并与内生肌酐清除率（Ccr）进行对比,对两组结果行统计分析.结果 60例受者中,矫正Ccr为（60.63±24.83）ml·min-1 ·1.73 m-2,SPECT和MRI测得的矫正移植肾GFR（GFR-SPECT和GFR-MRI）分别为（65.31±17.08）和（50.44±22.78）ml·min-1·1.73 m-2.以矫正Ccr为基础值,GFR-SPECT偏倚为4.69ml·min-1 ·1.73 m-2,精度为23.76 ml·min-1 ·1.73m-2;GFR-MRI偏倚为-10.18 ml·min-1 ·1.73 m-2,精度为13.87 ml·min-1·1.73m-2.Ccr与GFR-SPECT的相关系数（r）=0.406,P＜0.01,直线回归方程为Ccr=34.169＋0.591＆#215;GFR（SPECT）;Ccr与GFR-MRI的r=0.833,P＜0.01,直线回归方程为Ccr=22.298＋0.831＆#215;GFR（MRI）;MRI所测得GFR与Ccr线性关系更为显著.GFR-SPECT和GFR-MRI的r=0.342,P＜0.01,直线回归方程为GFR（SPECT）=16.192＋0.342＆#215;GFR（MRI）,二者呈弱相关.通过Bland-Altman分析,GFR-SPECT的可信区间为95.3 ml·min-1 ·1.73 m-2,GFR-MRI的可信区间为62.3ml·min-1·1.73m-2,MRI的可信区间更窄.结论 与SPECT相比,DCE-MRI测得GFR与矫正Ccr偏倚较大,但与矫正Ccr具有更好的相关性及一致性.DCE-MRI在评估移植肾及尿路解剖结构的同时,同样能准确地评价移植肾功能.Objective To compare the accuracy of dynamic contrast-enhanced magnetic resonance （DCE-MRI） and SPECT in the measurement of glomerular filtration rate （GFR） in renal allografts.Methods Sixty renal transplant recipients were enrolled in this study.DCE-MRI and SPECT were used to measure the GFR of the transplanted kidneys,and compared with the endogenous creatinine clearance rate （Ccr）.Bias,precision,correlation and Bland-Altman agreement were calculated for each modality compared with the endogenous Ccr.Results In 60 renal transplant recipients,the corrected Ccr was （60.63 ± 24.83） ml · min-1 · 1.73 m-2.The GFR measured by SPECT was （65.31 ± 17.08） ml · min-1 · 1.73 m-2,and （50.44 ± 22.78） ml · min-1 · 1.73 m-2 by MRI,respectively.The bias of GFR-SPECT was 4.69 ml·min-1 · 1.73 m-2,and the precision was 23.76 ml·min-1 1.73 m-2.The bias of GFR-MRI was-10.18 ml·min-1 ·1.73 m-2,and the precision was 13.87 ml·min-1 · 1.73 m-2.Correlation analysis showed that GFR-MRI and the endogenous Ccr had a good correlation （r=0.833,P〈0.01）,GFR-SPECT and the endogenous Ccr had a moderate correlation （r=0.406,P〈0.01）,and GFR-MRI and GFR-MRI had a poor correlation （r=0.342,P 〈0.01）.Bland-Altman analysis showed a confidence interval of 95.3 ml·min-1 ·1.73 m-2 for GFR-SPECT and 62.3 ml· min-1 · 1.73 m-2 for GFR-MRI.Conclusion DCE-MRI can be used as confidently as SPECT to evaluate the renal function of transplanted kidneys in the same time of determining anatomical information.

关 键 词：肾移植 肾小球滤过率 磁共振 动态对比增强 核素肾动态显像 

分 类 号：R699.2[医药卫生—泌尿科学]