磁共振动脉自旋标记技术与动态对比增强技术对不同年龄肾功能肾脏形态学和血流量的评估

发布时间：2018-01-22 15:20

本文关键词： 磁共振成像肾血流量年龄形态学肾小球滤过率　出处：《大连医科大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的:使用磁共振动脉自旋标记技术(arterial spin labeling,ASL)与动态对比增强磁共振(dynamic contrast-enhanced MR,DCE-MR)评估不同年龄肾功能正常人群肾脏皮质血流的变化,并分析肾血流灌注与形态学、肾功能改变的关系。探讨ASL技术与DCE-MR评估肾血流灌注的差异。材料与方法:回顾性收集2015年6月至2015年12月间,在本院应用GE公司生产的1.5T MR行LAVA四期强化及单激发快速自旋回波-流动反转恢复序列(single shot fast spin echo-flow sensitive alternating inversion recovery,SSFSE-FAIR)扫描,且常规序列[T1WI、T2WI、冠状位二维稳态采集快速成像序列(two-dimensional fast imaging employing steady state acquisition,2D FIESTA)]确认肾脏无明显病变,MR检查一周内实验室结果确认肾功能正常的受检者。将所有受检者按年龄段分为三组,组1年龄范围21-40岁,组2年龄范围41-60岁,组3年龄范围61-80岁,每组各随机抽样20例进行研究。采用冠状位2D FIESTA序列图像测量双肾长度及宽度;采用轴位LAVA增强皮质早期图像测量双肾皮质厚度;采用轴位LAVA-MASK图像及增强皮质期图像测量双肾皮质信号值,按照增强率(enhancemengt ratio,ER)=(皮质期信号值-平扫信号值)/平扫信号值的公式对双肾皮质的皮质期ER进行计算;采用FAIR后处理所得灌注图像测量双肾皮质肾血流量(renal blood flow,RBF);所有数据取双肾均值进行最后统计学分析。估算肾小球滤过率(estimated glomerular filtration rate,e GFR)的计算采用CKD-EPI公式。三组间性别构成差异的比较采用卡方检验(经Bonferroni法校正);三组间形态学(肾脏皮质厚度、长度、宽度)、RBF、ER比较采用方差分析检定方差齐性,并比较三组间各参数是否存在总体差异,若方差齐,则采用Bonferroni法进行两两比较,若方差不齐,则采用Tamhane's T2法进行两两比较;年龄与各参数相关性分析以及RBF与形态学各参数、e GFR之间的相关性分析采用Spearman相关、RBF与ER间的相关性分析,ER与形态学各参数、e GFR之间的相关性分析采用Pearson相关。结果:(1)RBF三组间总体比较差异有统计学意义(P=0.005),RBF组1与组3之间差异有统计学意义(P=0.004);但ER三组间总体与两两比较差异均无统计学意义(总体比较P=0.050)。(2)RBF与ER无显著相关性(P=0.911),RBF与皮质厚度、宽度间有显著相关性(P=0.026,0.027),ER与皮质厚度有显著相关性(P=0.033)。(3)皮质厚度、长度、宽度三组间总体比较差异有统计学意义,其中皮质厚度两两比较差异均有统计学意义,长度仅组1与组3之间差异有统计学意义,宽度组2与组3、组1与组3间差异有统计学意义(P0.05)。(4)e GFR三组间总体与两两比较时差异均有统计学意义(P0.05)。(5)肾脏皮质厚度、长度、宽度、皮质RBF、ER以及e GFR均与年龄呈负相关。(6)RBF、ER与e GFR之间均无显著相关性。结论:ASL技术较DCE-MRI对年龄增长导致的肾皮质血流的改变更加敏感,并且能够更好地反应随年龄增长肾血流量与形态学改变的相关性。正常人随年龄增长,肾血流量减低,肾脏皮质厚度变薄。
[Abstract]:Objective: using arterial spin labeling magnetic resonance imaging (arterial spin, labeling, ASL) and dynamic contrast-enhanced magnetic resonance (DCE-MR dynamic contrast-enhanced MR) to assess changes in different age groups with normal renal function of renal cortical blood flow, and the analysis of renal blood perfusion and morphology, the relationship between the change of renal function. The differences of ASL and DCE-MR evaluation of renal perfusion. Materials and methods: retrospectively collected from June 2015 to December 2015 in our hospital, recovery sequence by GE company 1.5T MR LAVA four phases enhanced and single shot fast spin echo (single shot fast spin reverse flow echo-flow sensitive alternating inversion recovery, SSFSE-FAIR) scanning, and conventional sequence [T1WI T2WI, coronal two-dimensional steady-state acquisition fast imaging sequence (two-dimensional fast imaging employing steady state acquisition, 2D FIESTA)] to confirm the kidney Dirty no significant lesions, MR examination within one week of laboratory results confirmed renal function in normal subjects. All subjects were divided into three groups according to age group, 1 age range 21-40 years, 2 age range 41-60 years, 3 age range 61-80 years old, each with a random sample of 20 cases studied. Using coronal renal 2D FIESTA image sequence measuring length and width; the axial LAVA enhanced cortical early image measurement double renal cortical thickness; the axial LAVA-MASK image enhancement and image measurement of double renal cortical phase signal value, in accordance with the enhancement rate (enhancemengt = ratio, ER) (cortical phase value - scan signal signal value) / cortical phase ER scan signal value formula of double renal cortex were calculated; the measurement of renal cortical perfusion images of double renal blood flow by FAIR (renal blood flow, RBF); all data of the two kidneys mean the final statistical analysis. The estimation of renal small (estimated glomerular filtration ball filtration rate rate, e GFR) calculated by CKD-EPI formula. The comparison between the three groups in gender differences in the chi square test (by Bonferroni method; morphological correction) between the three groups (renal cortical thickness, length, width, RBF, ER) were compared using analysis of variance and variance test. The comparison between three groups of parameters are overall difference, if the variance, then Bonferroni method was used to compare 22, if the variance is not homogeneous, using the Tamhane's T2 method was 22; age and analysis of parameters and correlation between RBF and morphological parameters, correlation analysis using Spearman correlation between E GFR and RBF, correlation analysis ER, ER and the parameters of morphology, correlation analysis between E GFR by Pearson. Results: (1) RBF was significant in the three groups (P= 0.005), RBF group 1 and group 3 the difference between the Statistically significant (P=0.004); but there were no significant differences between the three groups and 22 ER overall difference (generally P=0.050). (2) there is no significant correlation between RBF and ER (P=0.911), RBF and cortical thickness, width was significantly correlated (P=0.026,0.027), ER was significantly correlated with cortical thickness (P=0.033). (3) cortical thickness, length and width of the three groups showed statistically significant difference between the cortical thickness of 22, there were significant differences in length, only between group 1 and group 3 had significant difference, the width of group 2 and group 3, statistically significant differences between group 1 and group 3 (P0.05). (4) e GFR between the three groups and 22 overall comparison difference had statistical significance (P0.05). (5) renal cortical thickness, length, width, RBF ER and E GFR cortex, were negatively correlated with age. (6) RBF, between ER and E GFR have no significant correlation. Conclusion: ASL DCE-MRI technology is to guide the growth of the age The change of renal cortex blood flow is more sensitive, and it can better reflect the correlation between renal blood flow and morphological changes with age. In normal persons, the renal blood flow decreases with age, and the thickness of renal cortex becomes thinner.

【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R445.2;R692

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