磁共振扩散张量成像及血氧水平依赖成像在慢性肾病中的初步研究

发布时间：2018-05-03 14:01

本文选题：慢性肾病 + 肾小球虑过率　；参考：《南昌大学》2014年硕士论文

【摘要】：目的：对慢性肾病患者进行肾脏常规MRI、DTI及BOLD扫描，，测量肾皮质、髓质FA值、ADC值及R2*值，与肾小球率过滤进行相关性分析，探讨肾脏DTI及BOLD成像在慢性肾病分期及肾功能评估中的价值。资料与方法：收集2012年11月至2013年9月期间经我院临床诊断为慢性肾病的患者54例，其中男性28例，女性26例，年龄23～76岁，平均（45±15）岁。健康志愿者20例，其中男性11例，女性9例，年龄24～64岁，平均（41±12）岁。所有研究对象均接受MRI扫描。扫描采用3.0T超导磁共振扫描仪（GE，Signa HDXt），8通道TORSO相控阵线圈。先行常规双肾MRI扫描，然后行双肾长轴平行的斜冠状面DTI及BOLD扫描。所有原始图像自动导入GE Medical Systems AW4.4工作站，用Functool软件进行后处理及数据测量。采用盲法，由两位年轻影像科大夫，在b值为0s/mm2图像上，于右侧肾脏手动勾画皮质轮廓作为皮质感兴趣区（ROI），选择近肾门的层面，于肾脏上、中、下极髓质各放置1个椭圆形ROI，求其均值作为髓质ROI，分别测量所有受试者肾皮髓质FA值及ADC值。同样的方法于BOLD原始图上选择成像质量最好的回波图像上进行皮髓质R2*值的测量。采用99Tcm-DTPA肾动态显像测定单侧肾小球滤过率。根据美国肾脏病基金会颁布的肾脏病患者生存质量指导（kidney disease outcomes quality initiative，K-DOQI）中关于慢性肾脏病的定义及分期标准，将54例患者分为四组：A、B、C、D组，分别对应于该分期中1、2、3、4~5期，由于4期及5期患者相对较少，因此将两期合为D组。结果：（1）皮、髓质MR相关参数的比较：对照组、CKD组皮质的ADC值均高于髓质（P值均＜0.01），对照组、CKD组皮质的FA值均低于髓质（P值均＜0.01），对照组、CKD组皮质的R2*值均低于髓质（P值均＜0.01）。（2）对照组及CKD患者各亚组两两比较：对于皮质FA值，除对照组与A组、A组与B组、B组与C组，C组与D组比较差异无统计学意义（P值均＞0.05），余差异均有统计学意义（P值均＜0.05）；对于髓质FA值，除对照组与A组比较差异无统计学意义外（P值＞0.05），余均有统计学意义（P值均＜0.05）。对于皮质R2*值：除对照组与A组、A组与B组、C组与D组比较差异无统计学意义外，（P值均＞0.05），余差异均有统计学意义（P值均＜0.05）；对于髓质FA值，除对照组与A组比较差异无统计学意义外（P值＞0.05），余均有统计学意义（P值均＜0.05）。（3）所有测量参数与GFR相关性分析：皮质、髓质FA值与肾GFR呈正相关，其相关系数分别为0.408和0.536，P值均＜0.01；皮质、髓质R2*值与肾GFR呈负相关，其相关系数分别为-0.547和-0.723，P值均＜0.01。皮质及髓质ADC值与GFR没有相关性（P值均＞0.05）。结论：慢性肾病DTI及BOLD的应用中，FA值较ADC值更具有敏感性，FA值及R2*值能在CKD患者的分期诊断中提供有价值的信息，且皮髓质FA值及R2*值与GFR显示了良好的相关性，提示CKD患者肾脏DTI及BOLD扫描可用于肾功能状态的评估。
[Abstract]:Objective: Renal routine MRII-DTI and BOLD scans were performed in patients with chronic nephropathy. The renal cortex, medulla FA value and R2 * value were measured, and the correlation analysis was made with glomerular filtration. The value of renal DTI and BOLD imaging in the stage of chronic nephropathy and the evaluation of renal function were discussed. Information and methods: From November 2012 to September 2013, 54 cases of chronic nephropathy diagnosed by our hospital were collected, including 28 males and 26 females, aged 2376 years with an average age of 45 卤15 years. There were 20 healthy volunteers, including 11 males and 9 females, aged 24 to 64 years, with an average age of 41 卤12 years. All subjects underwent MRI scanning. A 3.0T superconducting magnetic resonance scanner was used to scan the TORSO phased array coil. Routine MRI scans of both kidneys were performed, and then DTI and BOLD scans of oblique coronal plane parallel to the long axis of the two kidneys were performed. All the original images were automatically imported into GE Medical Systems AW4.4 workstation, and the post processing and data measurement were carried out with Functool software. Using the blind method, two young imaging doctors, on 0s/mm2 images with b value, manually delineated the contours of the cortex on the right kidney as the cortical region of interest, and selected the layer near the hilum of the kidney, on the kidney, in the middle. One oval roi was placed in the inferior medulla and the mean value was used as the medullary ROI. The FA value and ADC value of renal medulla were measured respectively. The same method is used to measure the R2 * value of the skin medulla on the best echo image on the BOLD original image. 99Tcm-DTPA renal dynamic imaging was used to measure the unilateral glomerular filtration rate. According to the definition and staging standard of chronic kidney disease in Kidney disease outcomes quality initiation KDOQI issued by the American Nephrology Foundation, 54 patients were divided into four groups: group D: 1: 2, 3 / 4, respectively. Due to the relatively small number of stage 4 and 5 patients, the two stages were divided into D group. Results: Comparison of Mr related parameters of cortex and medulla: the ADC value of cortex in control group was higher than that of medullary P < 0.01, the FA value of cortex in control group was lower than that of medullary P < 0.01, and the value of R2 * in cortex of control group was lower than that of medulla P < 0.01. (2) comparison between the control group and each subgroup of CKD patients: for the cortical FA value, There was no significant difference between C group and D group except control group and A group, A group and B group, and there was no significant difference between C group and D group (P > 0.05). There was no significant difference between control group and group A (P > 0.05), but there was significant difference between control group and group A (P < 0.05). For the cortical R2 * value, there was no significant difference between the two groups except the control group and group A, group A and group B, group C and group D, all P values were more than 0.05, and the remaining differences were all statistically significant (P < 0.05), and for the FA value of medulla, there was no significant difference between the two groups. There was no significant difference between control group and group A (P > 0.05), but there was significant difference between control group and group A (P < 0.05). (3) correlation analysis of all measured parameters with GFR: cortical, medullary FA was positively correlated with renal GFR, and cortical, medullary R2 * was negatively correlated with renal GFR (P < 0.01), and cortical and medullary R2 * were negatively correlated with renal GFR (-0.547 and -0.723 P < 0.01, respectively). There was no correlation between cortical and medullary ADC and GFR (P > 0.05). Conclusion: In the application of DTI and BOLD in chronic nephropathy, FA value and R2 * value are more sensitive than ADC value, which can provide valuable information in staging diagnosis of CKD patients, and the FA value and R2 * value of skin medulla have good correlation with GFR. The results suggest that DTI and BOLD can be used to evaluate renal function in CKD patients.
【学位授予单位】：南昌大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R445.2;R692

【引证文献】