磁共振扩散峰度成像在糖尿病肾病的应用价值研究

发布时间：2018-07-21 13:12

【摘要】：目的:利用磁共振扩散峰度成像(diffusion kurtosis imaging,DKI)技术,对糖尿病肾病患者及健康志愿者进行肾脏磁共振扩散峰度成像检查,获得平均峰度(mean kurtosis,MK)、径向峰度(radial kurtosis,K⊥)、轴向峰度(axial kurtosis,K∥)的值以及相应伪彩图,探讨不同时期糖尿病肾病患者肾脏皮髓质MK值、K⊥值、K∥值的改变,分析其与肾功能指标的相关性,以期对糖尿病肾病的诊断提供有效的影像学依据。方法:选择临床确诊的糖尿病肾病患者12例为观察组,根据尿白蛋白排泄率(urinary album in excretion rate,UAER)的结果分为DN早期组7例,DN晚期组5例,选择健康志愿者11例为对照组,观察组及对照组均在3.0T磁共振上进行DKI检查,扩散梯度因子(b值)为(0 1000s/mm22000s/mm2),产生MK、K⊥、K∥的图,对于每个受试者,在左肾和右肾的上极、肾门及下极区域绘制了共12个感兴趣的区域(region of interest,ROI),皮质、髓质各6个,取其平均值,比较左肾及右肾皮质、髓质的MK值、K⊥值、K∥值的差异,并比较对照组与不同分期糖尿病肾病患者之间的皮质、髓质的MK值、K⊥值、K∥值有何不同,绘制ROC曲线,分析皮质MK值在对照组与DN早期组、DN早期组与DN晚期组的诊断灵敏度与特异度,分析各测量值与24小时尿白蛋白之间的相关性。结果:对照组及不同糖尿病肾病患者左肾的皮髓质测量值与右肾的皮髓质测量值均无统计学差异;随着疾病的进展,皮质与髓质的MK、K∥、K⊥值逐渐升高,且皮质测量值的差异具有统计学意义;相邻两组间比较,对照组皮质的MK、K∥、K⊥值均低于DN早期组(p0.05),DN早期组的MK、K⊥值低于DN晚期组(p0.05),相邻两组之间髓质的测量值未观察到明显差异;皮质的MK值在对照组与DN早期组、DN早期组与DN晚期组的诊断中准确性较高(AUC0.8);皮质的MK、K∥、K⊥值与UAER呈正相关,髓质的测量值无明显相关性。结论:(1)DKI技术在糖尿病肾病检查具有可行性。(2)DKI的皮质的MK值可以发现糖尿病肾病的早期损害,对于糖尿病肾病的分期具有一定参考意义。(3)糖尿病肾病患者皮质的MK、K∥、K⊥值与UAER具有显著相关性,可以监测糖尿病肾病的进展情况。
[Abstract]:Objective: to study the renal diffusion-kurtosis imaging of patients with diabetic nephropathy (DN) and healthy volunteers by using (diffusion kurtosis imaging (DKI) technique. The values of mean kurtosis (MK), radial kurtosis (radial kurtosisK) and axial kurtosisK (axial kurtosisK) were obtained, and the corresponding pseudochromograms were obtained. In order to provide effective imaging evidence for the diagnosis of diabetic nephropathy, the correlation between renal function and renal function was analyzed. Methods: twelve patients with diabetic nephropathy were selected as observation group. According to the results of urinary albumin excretion rate (urinary album in excretion), they were divided into early DN group (n = 7), early DN group (n = 7) and healthy volunteers (n = 11) as control group. DKI was performed on 3.0T MRI in both the observation group and the control group. The diffusion gradient factor (b) was (0 1000s/mm22000s/mm2), which produced a map of MKK ~ (?) K /. For each of the subjects, the upper pole of the left and right kidneys was obtained. A total of 12 regions of interest (region of interesting ROI), cortical and medullary were drawn from the hilar region and the lower pole region. The mean values of MK in the left kidney and the right renal cortex were compared between the left kidney and the right renal cortex, and the difference of the MK value of the medulla and that of the medulla was compared. To compare the difference of MK value of medulla between the control group and the patients with different stages of diabetic nephropathy, draw the ROC curve. The diagnostic sensitivity and specificity of cortex MK in control group, early DN group and late DN group were analyzed, and the correlation between the measured values and 24 hour urinary albumin was analyzed. Results: there was no significant difference between the measured values of left kidney and right kidney in control group and patients with different diabetic nephropathy. The differences of cortical measurements were statistically significant. In the control group, the value of MKK _ (K) in the cortex was lower than that in the early DN group (p0.05) and the value of MK _ (K) in the early DN group was lower than that in the late DN group (p0.05). There was no significant difference in medullary measurement between the two adjacent groups. The diagnostic accuracy of MK value in cortex was higher than that in early DN group and early DN group (AUC0.8), and the MKK / K Karabakh value of cortex was positively correlated with UAER, but there was no significant correlation between medullary measurement value and cortex MK value in early DN group and late DN group (AUC0.8). Conclusion: (1) DKI technique is feasible in the detection of diabetic nephropathy. (2) the MK value of the cortex of DKI can be used to detect the early damage of diabetic nephropathy. (3) there is a significant correlation between the value of MKK / K and UAER in the cortex of patients with diabetic nephropathy, which can be used to monitor the progress of diabetic nephropathy.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R587.2;R692.9;R445.2

【参考文献】