磁共振成像信号强度对胡桃夹综合征患儿左肾淤血的诊断价值  

Diagnostic value of signal intensity of MR imaging for renal congestion in nutcracker syndrome: report of 39 children

作　　者：罗佳鑫 张高福[2,3] 李伟[1,3] 高思婕 马维 徐晔[1,3] LUO Jiaxin;ZHANG Gaofu;LI Wei;GAO Sijie;MA Wei;XU Ye(Department of Radiology,Children's Hospital of Chongqing Medical University,Chongqing,400014,China;Department of Nephrology and Immunology,Children's Hospital of Chongqing Medical University,Chongqing,400014,China;National Clinical Research Center for Child Health and Disorders,Key Laboratory of Child Development and Disorders of Ministry of Education,Chongqing Key Laboratory of Pediatrics,Children's Hospital of Chongqing Medical University,Chongqing,400014,China)

机构地区：[1]重庆医科大学附属儿童医院放射科,重庆400014 [2]重庆医科大学附属儿童医院肾脏内科与免疫学,重庆400014 [3]重庆医科大学附属儿童医院国家儿童健康与疾病临床医学研究中心,儿童发育疾病研究教育部重点实验室,儿科学重庆市重点实验室,重庆400014

出　　处：《第三军医大学学报》2021年第3期249-254,共6页Journal of Third Military Medical University

基　　金：重庆市卫生健康委员会医学科研项目(2013-2-056);重庆市技术创新与应用示范项目(CSTC2018jscx-msyX0069)。

摘　　要：目的探讨胡桃夹综合征(nutcracker syndrome,NCS)左肾淤血的磁共振成像(magnetic resonance imaging,MRI)影像识别及临床价值。方法纳入本院2018年6月至2019年3月确诊的NCS 39例患儿,其中男性23例,女性16例;年龄(11±3)岁。采用MRI平扫T_2WI序列观测双肾皮髓质信号,测量两肾髓质与皮质MRI信号强度的差值(即MC值),计算两肾MC值的差的绝对值(即BR值)。根据双肾皮髓质信号是否有差异将患儿分为淤血组(n=25)及非淤血组(n=14),收集相关临床生化资料,分析识别肾淤血的MRI特征及与生化检查指标的相关性。结果左肾淤血时T_2WI序列上显示髓质信号降低、双肾实质信号出现差异。淤血组的BR值显著高于非淤血组(P<0.001),双肾皮髓质信号差异明显;而两组患儿的血尿发生率(P=0.614)、24 h尿蛋白定量(P=0.429)、尿素氮(P=0.420)、尿肌酐(P=0.781)差异均无统计学意义。ROC曲线分析显示,当BR值>2.4时,可判定为左肾淤血,诊断价值较高(AUC=0.894);24 h尿蛋白定量(AUC=0.579)、尿素氮(AUC=0.579)和尿肌酐(AUC=0.527)判定肾淤血诊断价值较低。结论两肾MRI信号强度差可判断NCS患儿左肾有无淤血,诊断价值较常用临床生化指标高。Objective To investigate the findings of MR imaging and their clinical value in diagnosis of left renal congestion in children with nutcracker syndrome(NCS).Methods All the 39 children(23 boys and 16 girls,mean age of 11±3 years)with NCS diagnosed at our hospital from Jun 2018 to Mar 2019 were enrolled in this study.Plain scanning sequence of T2WI was performed to measure the difference in signal intensity between the renal medulla and cortex(MC value)and calculate the absolute value of the difference between the MC values of both kidneys(BR value).Then,the children were divided into congestion group(n=25)and non-congestion group(n=14)according to whether a different renal signal existed between the 2 kidneys.The correlation of MRI findings and clinical biochemical data were analyzed with aid of statistics software SPSS 21.0.Results In the patients with congested left kidney,the medullary signals were reduced at T2 WI,which rendered a distinct signal difference between the 2 kidneys.The patients from the congestion group had significantly higher BR value(P<0.001)and obvious differences in MC value than those from the non-congestion group.There were no statistical differences in the incidence rates of hematuria(P=0.614),24-hour urine protein quantification(P=0.429),and serum levels of urea nitrogen(P=0.420)and urinary creatinine(P=0.781)between the 2 groups.ROC curve analysis showed that when BR value>2.4,left renal congestion was valid,with higher diagnostic value(AUC=0.894),but 24-hour urine protein quantification(AUC=0.579)and serum levels of urea nitrogen(AUC=0.579)and urinary creatinine(AUC=0.527)had lower diagnostic values.Conclusion Inter-kidney MRI signal difference in children with NCS is a reliable sign to judge whether a congested left kidney exists;whereas clinical biochemical indices are not.

关 键 词：胡桃夹综合征 肾淤血 磁共振成像 儿童 

分 类 号：R445.2[医药卫生—影像医学与核医学] R543.6[医药卫生—诊断学]