功能磁共振弥散加权成像与弥散张量成像在肾移植术后的应用探讨  

The application of functional magnetic resonance diffusion weighted imaging and diffusion tensor imaging in kidney transplantation

作　　者：李恩源 杨延皓 陈浩[1] 孙黎[1] 陶俊[1] 韩志坚[1] 谭若芸 张玉东[2] 居小兵[1] 顾民[1] Li Enyuan1, Yang Yanhao1, Chen Hao1, Sun Li1, Tao Jun1, Han Zhijian1, Tan Ruoyun1, Zhang Yudong2, Ju Xiaobing1, Gu Min1(1Department of Urology,2Department of Radiology,the First Affiliated Hospital of NMU,Nanjing 210029, China)

机构地区：[1]南京医科大学第一附属医院泌尿外科,江苏南京210029 [2]南京医科大学第一附属医院放射科,江苏南京210029

出　　处：《南京医科大学学报（自然科学版）》2018年第9期1280-1285,1303,共7页Journal of Nanjing Medical University(Natural Sciences)

基　　金：江苏省卫生厅面上项目(H201606);吴阶平医学基金(320675013116);南京医科大学校基金(NY200025)

摘　　要：目的:通过比较肾移植术后发生肾功能延迟恢复(delayed graft function,DGF)与未发生DGF患者术后1个月的功能磁共振弥散加权成像(diffusion weighted imaging,DWI)和弥散张量成像(diffusion tensor imaging,DTI)所对应参数的差异,并分析这些参数与移植肾肾功能指标的相关性,进而评价功能磁共振在肾移植术后的应用价值。方法:回顾南京医科大学第一附属医院2015年9月—2017年5月的肾移植病例,共选取23例DGF患者和26例非DGF患者。运用独立样本t检验分别比较这两组患者移植肾DWI与DTI对应的参数表观弥散系数(apparent diffusion coefficient,ADC)和部分各向异性(fractional anisotropy,FA)值的差异;运用Pearson相关分析分别将ADC值和FA值与移植肾估计肾小球滤过率(estimated glomerular filtration rate,e GFR)和血清肌酐值进行相关性分析,分别绘制髓质ADC、FA值诊断移植肾e GFR>60 m L/min的受试者工作特征(receiver operating characteristic,ROC)曲线。结果:肾移植术后1个月,DGF组与非DGF组移植肾皮质和髓质FA值均具有统计学差异(P<0.05)。术后1个月的移植肾髓质ADC值和FA值均与当时的e GFR呈正相关(P<0.05);术后1个月的移植肾皮质ADC值与术后6个月血清肌酐值呈负相关(P<0.05)。移植肾髓质FA值诊断移植肾e GFR>60 m L/min的ROC曲线下面积(area under the curve,AUC)为0.799,95%置信区间(confidence interval,CI)为0.671~0.928(P<0.001);移植肾髓质ADC诊断移植肾e GFR>60 m L/min的ROC曲线AUC为0.796,95%CI为0.670~0.922(P<0.001)。结论:功能磁共振DWI和DTI具有对移植肾的功能学和形态学评估价值。Objective： To evaluate the application of functional MRI in renal transplantation by comparing the parameters of diffusion weighted imaging（DWI ） and diffusion tensor imaging （DTI） between patients who suffered from delayed graft function （DGF） after transplantation and patients who not, and by analyzing the correlation between parameters of functional MRI and renal allograft function. Methods：Patients who underwent kidney transplant in our center from September 2015 to May 2017 were retrospectively reviewed, and 23 DGF patients and 26 normal graft function controls were enrolled in the study. Comparisons of apparent diffusion coefficient （ADC）and fractional anisotropy （FA） values of renal allograft were both made between DGF patients and controls one month after transplant; And correlations of ADC and FA values one month after transplant were made between estimated glomerular filtration rate （eGFR）and serum creatinine value of one and six months after transplant respectively. Differences of ADC and FA value between DGF patients and controls were compared by student＇ s t test ; Relationships between MRI parameters and eGFR and serum creatinine were analyzed respectively using Pearson correlation test. Receiver operating characteristic （ROC） curve of medullar ADC and FA value were both created for prediction of eGFR〉60 mL/min. Results： Differences of cortical and medullar FA value were found between DGF group and control group （P 〈 0.05）. Positive correlation between medullar FA and eGFR was observed one month after transplantation, as well as medullar ADC and eGFR （P 〈 0.05）. A negative correlation was found between cortical ADC of one month after transplantation and serum creatinine level at 6 months＇ post-transplant period （P 〈 0.05）. For prediction of eGFR 〉60 mL/min, the ROC curve of medullar ADC and FA showed the area under the curve （AUC）of 0.796 and 0.799 respectively, and 95% confidence interval （CI）of 0.670-0.922 and 0.671-0.928 respecti

关 键 词：功能磁共振 弥散加权成像 弥散张量成像 肾功能延迟恢复 肾移植 

分 类 号：R692[医药卫生—泌尿科学]