表观扩散系数和肾脏体积对胎儿肾脏发育和肾脏疾病的定量评估  

Quantitative evaluation of apparent diffusion coefficient and renal volume on fetal renal development and renal disease

作　　者：陈长安 汪盈坊 蔡舒蕾 凌蕾 张鹤 朱铭[2] 张国福 Chang'an Chen;Yingfang Wang;Shulei Cai;Lei Ling;He Zhang;Ming Zhu;Guofu Zhang(Department of Radiology,Obstetrics and Gynecology Hospital of Fudan University,Shanghai 200011,China;Department of Radiology,Shanghai Children's Medical Center,Shanghai Jiaotong University School of Medicine,Shanghai 200127,China)

机构地区：[1]复旦大学附属妇产科医院放射科,上海200011 [2]上海交通大学医学院附属上海儿童医学中心放射科,上海200127

出　　处：《中华围产医学杂志》2022年第4期256-262,共7页Chinese Journal of Perinatal Medicine

基　　金：上海市自然科学基金(19ZR1407200)。

摘　　要：目的探讨表观扩散系数(apparent diffusion coefficient,ADC)和肾脏体积对胎儿肾脏发育和肾脏疾病评估的价值。方法回顾性纳入2016年1月至2020年10月在复旦大学附属妇产科医院行MRI检查的先天性肾脏和尿路畸形(congenital anomalies of kidney and urinary tract,CAKUT)胎儿84例(CAKUT组)。以同期MRI和生后随访均未见明显异常的胎儿97例作为对照组。测量2组胎儿肾脏ADC和体积。分析对照组胎儿肾脏ADC和体积与胎龄、位置(左/右侧)和胎儿性别的关系。比较对照组正常发育的肾脏与CAKUT胎儿的肾脏ADC和体积的差异。采用两独立样本t检验、配对样本t检验和线性相关分析对数据进行统计学分析。结果(1)CAKUT组中1例孕妇为双胎妊娠,共85例胎儿。84例孕妇年龄(29±4)岁,范围为21~39岁;检查时孕周(26±4)周,范围为21~34周。85例胎儿中,男性52例(61.2%),女性33例(38.8%);多囊性发育不良肾32例(37.6%),肾积水29例(34.1%),孤立肾24例(28.2%)。对照组97例均为单胎妊娠,孕妇年龄(30±5)岁,范围为19~41岁;检查时孕周(27±4)周,范围为21~34周。男性胎儿45例(46.4%),女性52例(53.6%)。(2)对照组肾脏ADC[(1.255±0.112)×10-3 mm2/s]与胎龄呈负相关(R2=0.30,P<0.01),而肾脏体积[(4747±2479)mm3]与胎龄呈正相关(R2=0.80,P<0.01)。对照组不同性别胎儿的肾脏ADC和肾脏体积差异无统计学意义。(3)多囊性发育不良肾胎儿的肾脏ADC[(1.720±0.200)×10-3 mm2/s]和体积[(8154±8337)mm3]均大于对照组(t值分别为-13.11和-3.08,P值分别为<0.001和0.004)。肾积水胎儿的肾脏ADC[(1.333±0.171)×10-3 mm2/s]大于对照组(t=-3.90,P<0.001);肾脏体积[(7201±4460)mm3]显现出大于对照组的趋势,但差异未见统计学意义。孤立肾胎儿的肾脏ADC[(1.239±0.125)×10-3 mm2/s]显现出低于对照组的趋势,体积[(5239±4244)mm3]显现出大于对照组的趋势,但差异均未见统计学意义。结论正常胎儿肾脏ADC随胎龄增加而减小,体积随胎�Objective:To explore the value of apparent diffusion coefficient(ADC)and renal volume in assessing fetal kidney development and disease.Methods:From January 2016 to October 2020,84 fetuses with congenital anomalies of the kidney and urinary tract(CAKUT)were identified with MRI(CAKUT group),and 97 fetuses with no significant abnormalities on MRI or postnatal follow-up(control group)from the Obstetrics and Gynecology Hospital of Fudan University were enrolled and analyzed retrospectively.ADC value and renal volume were measured to compare the two groups,and the relationship was analyzed between these two parameters in the control group with gestational age,location(left or right kidney),and fetal gender.Two independent or paired sample t-tests,and linear correlation analyses,were adopted for the statistical analysis.Results:(1)There were 84 pregnant women in the CAKUT group,including a twin pregnancy,with an average age of(29±4)years old,ranging from 21 to 39 years old.The gestational age at MRI was(26±4)weeks with a range of 21-34 weeks.Of the 85 fetuses,52 were male(61.2%),and 33 were female(38.8%).The polycystic dysplastic kidney was found in 32 cases(37.6%),hydronephrosis in 29 cases(34.1%),and an isolated kidney in 24 cases(28.2%).There were 97 singleton pregnancies in the control group,including 45(46.4%)male and 52(53.6%)female fetuses.The average maternal age was(30±5)years old,with a range of 19-41 years old,and the gestational week at MRI was(27±4)weeks,with a range of 21-34 weeks.(2)In the control group,the mean ADC value and renal volume were(1.255±0.112)×10-3 mm2/s and(4747±2479)mm 3,which were negatively(R 2=0.30,P<0.01)and positively correlated(R 2=0.80,P<0.01)with the gestational age,respectively.There was no significant difference between ADC value and renal volume between different fetal gender in the control group.(3)The ADC value and the renal volume of fetuses with polycystic dysplastic kidney[(1.720±0.200)×10-3 mm2/s and(8154±8337)mm 3]were higher than those in the control group(t=-1

关 键 词：泌尿生殖系统畸形 膀胱输尿管反流 肾 弥散磁共振成像 产前诊断 

分 类 号：R714.5[医药卫生—妇产科学]