四维血流MRI评估移植肾动脉狭窄血流动力学的初步研究  

Four-dimensional flow MRI evaluation of hemodynamic in transplant renal artery stenosis:a preliminary study

作　　者：沈立文 邢兆宇[2] 潘靓[1] 陈杰[1] 郭宋林 邢伟[1] Shen Liwen;Xing Zhaoyu;Pan Liang;Chen Jie;Guo Songlin;Xing Wei(Department of Radiology,the Third Affiliated Hospital of Soochow University,Changzhou 213003,China;Department of Urology,the Third Affiliated Hospital of Soochow University,Changzhou 213003,China)

机构地区：[1]苏州大学附属第三医院放射科,常州213003 [2]苏州大学附属第三医院泌尿外科,常州213003

出　　处：《中华放射学杂志》2025年第3期286-292,共7页Chinese Journal of Radiology

基　　金：国家自然科学基金(82001763,82171901,82302141,82471966);江苏省自然科学基金(BK20241776);常州市科技计划项目(CZ20230027,CJ20244015);南京医科大学常州医学中心重点项目(CMCM202301)。

摘　　要：目的探讨四维血流(4D Flow)MRI评估移植肾动脉狭窄(TRAS)血流动力学变化的价值。方法该研究为横断面研究,回顾性分析2021年1月至2022年10月苏州大学附属第三医院的67例肾移植术后患者,均行非对比增强磁共振血管成像(NCE-MRA)及4D Flow MRI检查,经NCE-MRA评估后分为非狭窄组(39例)、不明显狭窄组(狭窄程度<50%,13例)和明显狭窄组(狭窄程度≥50%,15例)。4D Flow MRI数据采用后处理软件CVI42(加拿大)进行分析,测量非狭窄组移植肾动脉和不明显狭窄组、明显狭窄组狭窄近端、中心及远端的血流动力学参数,包括净流量、最大流量、平均速度、峰值速度、平均壁切应力、最大壁切应力。采用单因素方差分析评估3组患者间及狭窄近端、中心及远端间血流动力学参数差异,两两比较采用最小显著差值(LSD)法。采用Pearson相关系数评估移植肾动脉血流动力学参数与估算的肾小球滤过率(eGFR)之间的相关性。结果移植肾动脉明显狭窄组狭窄近端净流量、最大流量和平均速度明显减低,与非狭窄组和不明显狭窄组间差异有统计学意义(P均<0.05)。明显狭窄组和非明显狭窄组狭窄远端净流量和最大流量均低于非狭窄组,差异有统计学意义(P均<0.001);明显狭窄组狭窄远端平均速度和峰值速度高于非狭窄组,差异有统计学意义(P均<0.05);明显狭窄组狭窄远端最大和平均壁切应力均低于非狭窄组和不明显狭窄组,差异有统计学意义(P均<0.05)。狭窄中心净流量和最大流量低于狭窄近端,差异有统计学意义(P均<0.05);狭窄中心和狭窄远端峰值速度高于狭窄近端,差异有统计学意义(P均<0.05)。TRAS患者狭窄近端、狭窄中心、狭窄远端的净流量与eGFR均呈正相关(r=0.270、0.260、0.320,P=0.044、0.041、0.036),最大流量与eGFR均呈正相关(r=0.306、0.276、0.269,P=0.037、0.041、0.043)。结论TRAS后血流状态发生明显改变,4D Flow MRI可提�ObjectiveTo explore the value of four-dimensional flow(4D Flow)MRI in evaluating hemodynamic changes of transplant renal artery stenosis(TRAS).MethodsThe study was a cross-sectional study.A retrospective analysis of 67 patients after renal transplantation was performed in Third Affiliated Hospital of Soochow University from January 2021 to October 2022.All patients were examined with non-contrast enhanced magnetic resonance angiography(NCE-MRA)and 4D Flow MRI.After NCE-MRA assessment,the patients were divided into a non stenosis group(39 cases),non-obvious stenosis group(stenosis degree<50%,13 cases)and obvious stenosis group(stenosis degree≥50%,15 cases).The 4D Flow MRI data were analyzed using the post-processing software CVI42(Canada)to measure hemodynamic parameters of the transplanted renal artery in the non-stenosis group,as well as the proximal,central,and distal regions of the stenosis in the non-obvious stenosis group and obvious stenosis group.The parameters included net flow rate,maximum flow rate,average velocity,peak velocity,average wall shear stress,and maximum wall shear stress.One way analysis of variance and least significant difference(LSD)were used to test the differences of hemodynamic parameters among the three groups and between the proximal,central and distal regions of the stenosis.Pearson correlation coefficient was used to evaluate the correlation between hemodynamic parameters of transplant renal artery and estimated glomerular filtration rate(eGFR).ResultsThe net flow,maximum flow and average velocity at the proximal region of stenosis in the group with obvious stenosis of transplanted renal artery were significantly lower than those in the non-stenosis group and the non-obvious stenosis group(all P<0.05).The net flow and maximum flow at the distal region of stenosis in both obvious stenosis group and non-obvious stenosis group were lower than those in non-stenosis group,and the differences were statistically significant(both P<0.001).The mean velocity and peak velocity at the dista

关 键 词：肾移植 移植肾动脉狭窄 四维血流磁共振成像 血流动力学 

分 类 号：R73[医药卫生—肿瘤]