慢性肾炎和肾脏占位性病变的DTI实验与临床研究

发布时间：2018-02-21 23:31

本文关键词： 弥散张量成像表观弥散系数各向异性分数慢性肾炎肾肿瘤　出处：《天津医科大学》2014年博士论文　论文类型：学位论文

【摘要】：一、目的本研究通过对正常志愿者弥散张量成像研究,评价不同b值对弥散张量成像测量指标(ADC值、FA值)和图像质量(SNR、CNR)的影响；评价年龄、性别、测量部位对正常肾脏ADC、FA值的影响。探讨慢性肾小球肾炎患者和肾脏占位性病变的弥散张量成像的图像特点,评估弥散张量成像的测量指标在慢性肾小球肾炎早期肾功能损害预警、肾功能分期评估和肾脏良恶性占位病变的鉴别诊断及其与病理学改变相关性的价值。二、材料与方法随机选取60例健康志愿者使用1.5T MRI (Siemens Avanto)行弥散张量成像检查,扫描平面与肾脏长轴一致,行冠状面弥散张量成像的序列参数为：脂肪抑制的ss-EPI序列,GRAPPA并行采集技术,TR1400ms, TE设为最短82ms,半傅立叶采集6/8,相位编码方向右左,矩阵128×128,层厚6mm,层间距为0,层数为10,弥散梯度方向为6,采用呼吸触发模式,平均采集次数为4。b值的选择分别为0、200s/mm2,0、400s/mm2,0、600s/mm2,0、800s/mm2,0、1000s/mm2,分别测量ADC值、FA值,SNR、CNR,对ADC图等级评分,比较不同性别、年龄段及肾脏部位对ADC值、FA值的影响。对75例慢性肾小球肾炎患者,计算估算的肾小球滤过率(estimated glomerular filtration rate,eGFR)并对肾功能分期,比较ADC、FA值与肾功能分期、肾小球硬化面积、肾间质纤维面积的相关性,评价ADC、FA值等测量指标在早期肾功能损害的预警价值。对连续收集的70例肾脏占位性病变行弥散张量成像,采用三组b值(0、400) s/mm2、(0、600) s/mm2、(0、800) s/mm2评价,比较弥散张量成像测量指标对肾脏占位性病变囊、实性成分的良恶性鉴别的价值,比较不同级别的肾脏透明细胞癌的ADC、FA值及E1值与细胞密度、微血管密度的相关性。三、结果 1.正常志愿者DTI:五组不同的b值获得的肾实质、皮质、髓质ADC值、SNR比较具有统计学差异(F值为1846.65、368.93、207.80和951.93,P0.05)；而五组不同的b值获得的肾实质、皮质、髓质FA值、皮髓质信号差比较不具有统计学差异(F值为0.98、1.07、1.14和1.13,P0.05)。b值为(0、800)s/mm2的ADC图像满足诊断要求。肾实质与肾皮质、髓质的ADC值存在相关性(r=0.91和0.92,P0.01)；肾实质与肾皮质、髓质的FA值存在相关性(r=0.90和0.88,P0.01)；不同性别、年龄段之间肾脏实质ADC、FA值比较均不具有统计差异(P0.05),而肾脏实质ADC、FA值随年龄段的增大逐渐减小；肾脏皮、髓质的上、中、下极ADC值、FA值比较均不具有统计学差异(P0.05),左右侧肾脏比较亦不具统计学差异(P0.05)。 2.慢性肾小球肾炎患者DTI:慢性肾小球肾炎者的ADC值、FA值伴随肾功能的下降而降低,不同肾功能分期之间比较,差异均具有统计学意义(P0.05)。ADC值、FA值与eGFR存在显著相关性(r分别为0.89和0.85,P0.05)。ADC值、FA值对区分CKD Ⅰ期与CKD Ⅱ-Ⅴ期的诊断价值较高,其ROC曲线下面积达0.979和0.946(P0.05)。肾脏皮质、髓质的FA值与肾小球硬化面积的负相关性最高(r分别为-0.74,-0.70,P0.05)；肾脏皮质、髓质ADC值与肾小球硬化面积也显著负相关,(相关系数r分别为-0.65和-0.66,P0.05)。肾脏髓质、皮质FA值与肾间质纤维化面积的负相关性最高(r分别为-0.76和-0.70,P0.05)；而髓质、皮质ADC与肾间质纤维面积亦存在显著负相关(r=-0.68,-0.67,P0.05)。 3.肾脏良恶性占位病变DTI：随着b值的增大,ADC、E1值减小,而FA值未发生明显变化。b值为(0、800) s/mm2时,E1值对肾脏占位病变的实性成分鉴别方面具有最高的诊断价值,ROC曲线下面积为0.923,最佳诊断阈值为1.61×10-3mm2/s,敏感度100%,特异度83.3%；ADC值鉴别囊性部分具有最高的诊断价值,ROC曲线下面积为0.932,最佳诊断阈值为2.76×10-3mm2/s,敏感度100%,特异度83.7%。低级别肾透明细胞癌的细胞密度为51.73±6.73,高级别肾透明细胞癌的细胞密度为64.87±9.08,两组比较具有统计学意义(t=-4.50,P0.05)。ADC、E1、FA值与细胞密度间存在相关性(r=-0.796,-0.865,-0.730,P0.05)。低级别肾透明细胞癌的微血管密度为49.33±7.76,高级别肾透明细胞癌的微血管密度为61.27±8.45,两组比较亦具有统计学意义(t=-4.03,P0.05)。ADC、E1、FA值与微血管密度间亦存在相关性(r=-0.739,-0.826,-0.761,P0.05)。四、结论本文通过正常人群和肾脏病变患者人群的系列研究,进一步证实了采用临床型MRI设备的DTI技术,不仅可应用于正常人肾脏结构与功能的评价,而且有助于肾脏慢性疾病肾功能的定量评估和肾脏占位病变良恶性鉴别诊断及病理分级,显示了良好的临床应用前景。具体结论如下： 1.肾脏DTI的b值取值范围为(0,400-800)s/mm2,最佳诊断b值为(0、600)s/mm2;年龄、性别及肾脏不同测量部位等影响因素对ADC、FA值的测量结果无明显的影响。 2.ADC、FA值可早期预警肾功能的损害,有助于评价肾功能的分期以及用于评估与慢性肾衰竭密切相关的肾小球硬化、肾间质纤维化等病理改变。 3.ADC、E1、FA值是鉴别肾脏良恶性占位的重要参数,并可用于评估肾透明细胞癌的细胞密度、微血管密度等病理变化,具有广泛的应用前景。
[Abstract]:First, the purpose
Based on the study of diffusion tensor imaging in normal volunteers, the evaluation of different b values on diffusion tensor imaging measurements (ADC, FA) and image quality (SNR, CNR) effect; evaluation of age, gender, location measurement in normal kidney ADC, the influence of FA. Patients with chronic nephritis and kidney accounted for the image characteristics of lesions by diffusion tensor imaging, diffusion tensor imaging evaluation measure in chronic glomerulonephritis early renal damage in early warning, staging of renal function assessment and differential diagnosis of benign and malignant renal lesions accounted for its value and the pathological changes in correlation.
Two, materials and methods
Randomly selected 60 healthy volunteers using 1.5T MRI (Siemens Avanto) for diffusion tensor imaging. The scanning plane is consistent with the long axis of kidney, coronal sequence parameters of diffusion tensor imaging: ss-EPI fat suppression sequence, GRAPPA parallel acquisition technology, TR1400ms, TE for the shortest 82ms, semi Fu Liye acquisition 6/8, phase encoding the direction of right and left, 128 * 128 matrix, 6mm thickness, layer spacing of 0 layers, 10 diffusion gradient direction is 6, the average number of respiratory triggering mode, acquisition for the selection of 4.b value were 0200s/mm2,0400s/mm2,0600s/ mm2,0800s/mm2,01000s/mm2 and ADC measurements, respectively FA, SNR, CNR, ADC score for the class map, comparison of different gender, age and location of kidney on ADC value and FA value effect.
Of the 75 patients with chronic glomerulonephritis, estimated glomerular filtration rate (estimated, glomerular filtration rate, eGFR) and the staging of renal function, ADC, FA staging and renal function and glomerular sclerosis area, correlation, fiber area between renal evaluation of ADC, FA value measurement index in early renal damage early warning value.
For the continuous collection of 70 cases of renal lesions, diffusion tensor imaging, using three groups of values of B (0400) s/mm2 (0600) s/mm2 (0800) s/mm2 evaluation, comparison of diffusion tensor imaging measurements of lesions on renal cyst, benign and malignant lesions of solid components of the value of renal cell cancer in different levels of the ADC, FA and E1 values and the correlation between cell density and microvessel density.
Three, the result
1. normal volunteers DTI: five groups of different b values of renal parenchyma, the cortex, medulla ADC, SNR was statistically difference (F-measure 1846.65368.93207.80 and 951.93, P0.05); and the five group of different b values of renal parenchyma, the cortex, medulla FA, corticomedular signal is not statistically significant difference (F-measure 0.98,1.07,1.14 and 1.13, P0.05) value of.B (0800) ADC s/mm2 image meets the requirement of diagnosis. Renal parenchyma and renal cortex and medulla of the correlation between ADC value (r=0.91 and 0.92, P0.01); renal parenchyma and renal cortex, medulla FA values are associated (r=0.90 and 0.88, P0.01); gender, age between renal parenchymal ADC, FA value were not statistically difference (P0.05), and renal ADC, FA values increase with age decreased gradually; the renal cortex and medulla, and, under the ADC value, FA value was not statistically significant (P0.05), left and right side kidney There was no statistical difference in the visceral comparison (P0.05).
2. patients with chronic glomerulonephritis DTI: chronic glomerulonephritis and their ADC value, FA value decreased with decreased renal function, different renal function stage between the comparison, the differences were statistically significant (P0.05).ADC, there was a significant correlation between the eGFR and FA values (r = 0.89 and 0.85, P0.05).ADC value, FA value diagnostic value of high differentiated CKD I and CKD II - V period, the ROC area under the curve of 0.979 and 0.946 (P0.05). The renal cortex, medulla FA and glomerular sclerosis area highest negative correlation (r = -0.74, -0.70, P0.05); renal cortex, medulla ADC and glomerular sclerosis the area has a significant negative correlation (correlation coefficient r were -0.65 and -0.66, P0.05). The renal medulla, cortex of the highest FA value and negatively correlated with renal interstitial fibrosis area (r = -0.76 and -0.70, P0.05 and ADC); medulla, cortex and renal interstitial fibrosis area also has a significant negative correlation R=-0.68, -0.67, P0.05.
3. renal benign and malignant lesions of DTI: with the increase of B value, ADC, E1 value decreased, while the FA value did not change significantly.B value (0800) of s/mm2, E1 has the highest diagnostic value of solid component identification of renal occupying lesions. The area under ROC curve is 0.923, the best the diagnostic threshold is 1.61 * 10-3mm2/s, the sensitivity was 100%, specificity was 83.3%; the ADC value of the cystic part of the differential diagnosis value of the highest, ROC area under curve was 0.932, the best diagnostic threshold is 2.76 * 10-3mm2/s, sensitivity 100%, specificity 83.7%.
The low level of renal clear cell carcinoma cell density was 51.73 + 6.73, high-grade renal clear cell carcinoma cell density was 64.87 + 9.08, the two groups was statistically significant (t=-4.50, P0.05).ADC, E1, correlation between the density of cell and FA values (r=-0.796, -0.865, -0.730, P0.05). Microvessel density the low level of renal cell carcinoma was 49.33 + 7.76, the microvessel density of high-grade renal cell carcinoma was 61.27 + 8.45, the two groups were statistically significant (t=-4.03, P0.05).ADC, E1, and correlation with microvessel density between the FA values (r= -0.739, -0.826, -0.761, P0.05).
Four. Conclusion
In this paper, through a series of research in normal subjects and patients with renal disease, confirmed by clinical equipment MRI DTI technology, not only can be used to evaluate the structure and function of normal human kidney, but also contribute to chronic kidney disease renal function assessment and kidney lesions of benign and malignant differential diagnosis and pathological grading, display a good clinical application prospect. The main conclusions are as follows:
1., the b value of kidney DTI was 0400-800 0400-800 s/mm2, and the best diagnosis b value was (0600) s/mm2. There was no significant effect on age, sex and different location of kidney.
2.ADC and FA can early predict renal function damage, help to evaluate the staging of renal function and evaluate pathological changes associated with glomerular sclerosis and interstitial fibrosis, which are closely related to chronic renal failure.
3.ADC, E1 and FA values are important parameters for differentiating benign and malignant kidney, and can be used to evaluate the pathological changes of renal clear cell carcinoma, such as cell density and microvessel density.

【学位授予单位】：天津医科大学
【学位级别】：博士
【学位授予年份】：2014
【分类号】：R445.2;R692.3

【参考文献】