单双指数扩散加权成像直方图评价早期糖尿病肾病的价值  

The value of monoexponential and biexponential diffusion-weighted imaging based on histogram analysis in early diagnosis of diabetic kidney disease

作　　者：杨茹[1] 王逸敏[1] 邱平[2] 王少清[3] 胡富碧[1] YANG Ru;WANG Yimin;QIU Ping;WANG Shaoqing;HU Fubi(Department of Radiology,the First Affiliated Hospital of Chengdu Medical College,Chengdu 610500;Department of Endocrinology,the First Affiliated Hospital of Chengdu Medical College,Chengdu 610500;Department of Nephropathy,the First Affiliated Hospital of Chengdu Medical College,Chengdu 610500)

机构地区：[1]成都医学院第一附属医院放射科,四川成都610500 [2]成都医学院第一附属医院内分泌科,四川成都610500 [3]成都医学院第一附属医院肾病科,四川成都610500

出　　处：《实用放射学杂志》2020年第9期1438-1442,共5页Journal of Practical Radiology

基　　金：四川省卫生健康委员会科研基金资助项目(130387);成都医学院科研基金资助项目(CYZ16-19)。

摘　　要：目的探讨基于直方图分析的单指数和双指数DWI对早期糖尿病肾病(DKD)的诊断价值.方法对42例符合纳入和排除标准的早期DKD患者(病例组)及同期20例健康志愿者(对照组)行多b值(0、50、100、150、200、300、500、800 s/mm^2)DWI并利用软件生成相关定量参数图,在定量参数图上勾画ROI自动提取直方图参数(包括平均值、标准差、偏态、峰度、极差、四分位间距、25位百分位数、50位百分位数和75位百分位数).采用组内相关系数(ICC)评价测量者间及测量者内部一致性.所有直方图定量参数在2组中的差异性分析采用Mann-W hitney U或独立样本t检验;对有统计学意义的参数进一步采用ROC曲线评价其对早期DKD的诊断效能.结果2名测量者间和测量者内部的直方图参数测量一致性好(ICC:0.823~0.954).基于真实扩散系数(D)图和灌注分数(f)图的平均值、第50位百分位数和第75位百分位数在2组间差异均有统计学意义(P<0.05).ROC曲线分析显示基于D图的平均值、第50位百分位数和第75位百分位数诊断早期DKD的AUC分别为0.717、0.768和0.864,而基于f图的AUC分别为0.703、0.802和0.768.进一步比较分析显示各直方图参数的诊断效能差异无统计学意义(P>0.05).结论基于直方图分析的双指数DWI对早期DKD具有一定的诊断价值,D图和f图的平均值、第50位百分位数和第75位百分位数具有较高的诊断效能.Objective To investigate the performance of monoexponential and biexponential DWI based on histogram analysis in the diagnosis of diabetic kidney disease(DKD)at the early stage.Methods Forty-two consecutive patients with early DKD(case group)and 20 normal volunteers(control group)underwent DWI with 8 b-value(0,50,100,150,200,300,500,800 s/mm^2).Histogram metrics including mean,standard deviation,skewnessfkurtosisfrange,interquartile range(Iq range),and percentiles(25th,50th,75th)were extracted by drawing ROI on the related parametric maps.Intra-and interobserver agreement were assessed with the intraclass correlation coefficient(ICC).All histogram metrics between the two groups were compared using Mann-Whitney U or two-sample t-test.ROC curve analysis was further performed to evaluate the diagnostic performance of statistical significant parameters for the detection of early DKD.ResuIts Intra-and interobserver agreement of measurement on histogram metrics were good(ICC:0.823-0.954).The mean,percentiles(50th and 75th)of D and f maps between the groups were significant differences(all P<0.05).The AUC of the mean,50th,75th percentile of D map for diagnosing early DKD was 0.717,0.768 and 0.864 respectively.The AUC of the mean,50th,75th percentile of D map for diagnosing early DKD was 0.703,0.802 and 0.768 respectively.Differences between the AUC were not statistically significant for any pairwise comparison(P>0.05 for all comparisons).Conclusion The biexponential DWI based on histogram analysis has a certain value for diagnosing early DKD.The 50th and 75th percentile of D map and f map had high diagnostic efficiency.

关 键 词：糖尿病肾病 磁共振成像 扩散加权成像 直方图分析 

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