糖尿病性肾病:磁共振扩散加权成像b值优化及在分期中的应用价值  

Diabetic nephropathy:b value optimization of MR diffusion-weighted-imaging and applying value in the nephrotic stage

作　　者：郭永榜[1] 殷洁[1] 张晓亚[1] 郭青榜 向旭[1] 周勇[1] 张颖雪 GUO Yongbang;YIN Jie;ZHANG Xiaoya;GUO Qingbang;XIANG Xu;ZHOU Yong;ZHANG Yingxue(Department of Magnetic Resonance Imaging,Nanyang Central Hospital,Nanyang 473000,P.R.China;Department of VIP Clinic,Nanyang Central Hospital,Nanyang 473000,P.R.China)

机构地区：[1]河南省南阳市中心医院磁共振室,河南南阳473000 [2]河南省南阳市中心医院特需科,河南南阳473000

出　　处：《医学影像学杂志》2021年第9期1561-1564,共4页Journal of Medical Imaging

摘　　要：目的探讨3.0T MRI多b值DWI技术对糖尿病肾病(DN)分期诊断的最优b值及诊断效能。方法选取临床确诊的55例糖尿病肾病患者(包括DN早期组34例和中晚期组21例)和60例健康志愿者(正常对照组)作为观察对象。采用3.0T MRI对肾脏进行DWI扫描,b值选取0、50、100、300、500、800 s/mm^(2),定量测量各组肾脏皮质及髓质ADC值并进行统计学分析,观察各组肾脏皮髓质ADC值的差异,以ROC曲线评价ADC值的鉴别诊断价值。结果各b值下正常对照组、DN早期组和DN中晚期组的皮质及髓质ADC值均依次减低(P<0.05),当b值取800 s/mm^(2)时,三组间两两比较差异最显著(P<0.01)。b值取800 s/mm^(2),鉴别正常对照组和DN早期组时,髓质ADC值的诊断效能高于皮质,敏感度为71.7%,特异度为69.1%;鉴别DN早期组与DN中晚期组时,皮质ADC值的诊断效能高于髓质,敏感度为92.5%,特异度为42.6%,两者的最佳诊断阈值均为1.905。结论b值取800 s/mm^(2)是DN分期诊断的最优b值;肾脏皮髓质ADC值对糖尿病肾病的分期鉴别具有一定的诊断效能。Objective To investigate the performance of 3.0T diffusion-weighted MRI with optimized b value for the diagnosis and stage of diabetic nephropathy.Methods Fifty-five patients with diabetic nephropathy(34 cases with early stage DN,21 cases with intermediate/end stage DN)and 60 healthy volunteers were included into the study.Imaging exam was performed on 3.0T DW-MRI with b value of 0,50,100,300,500 and 800 s/mm^(2).The ADC on renal cortex and medulla between early-stage DN,intermediate/end-stage DN and normal group were quantitatively measured and statistically analyzed with a ROC curve.Results The cortical and medullary ADC in the three groups decreased successively when b value was increased(P<0.05).The ADC measured at b value 800 s/mm^(2)resulted in the best classification performance between the three groups(P<0.01).Using this setting of b-value,the performance of medulla ADC was higher than that of cortex ADC for differentiating early-stage DN from normal group,with a sensitivity of 71.7%and a specificity of 69.1%.However,the cortical ADC was superior to medulla ADC for the differentiation between early-stage DN and intermediate/end-stage DN group,with a sensitivity of 92.5%and a specificity of 42.6%,and the optimal diagnostic threshold was 1.905.Conclusion The b value of 800 s/mm^(2)is optimal for DW-MRI of DN.Measurement on renal dermal and medullary ADC is a promising tool for staging and classification of DN.

关 键 词：糖尿病肾病 扩散加权成像 磁共振成像 表观弥散系数 

分 类 号：R587.1[医药卫生—内分泌] R445.2[医药卫生—内科学]