fMRI对移植肾急性排异反应诊断价值的临床研究

发布时间：2018-06-27 20:55

本文选题：扩散张量成像 + 血氧水平依赖成像　；参考：《天津医科大学》2014年硕士论文

【摘要】：目的：探讨扩散张量成像(DTI)、血氧水平依赖成像(BOLD)对移植肾功能正常、急性排异反应(AR)和急性肾小管坏死(ATN)的鉴别诊断价值,以期探寻无创、敏感的评价移植肾功能的方法。方法：本研究经医院伦理委员会批准,所有受试者检查前均签署了知情同意书。选取2012年5月到2014年3月行异体肾移植术后2-3周的患者60例纳入本研究,所有受试者均于Siemens MAGNETOM Trio Tim3.0T超导磁共振扫描仪行常规MR、脂肪抑制平面回波斜冠状面DTI检查(在6个非共线性方向上施加扩散敏感梯度场,b值为0,300s/mm2)及斜冠状面BOLD检查。根据病理穿刺结果,将患者分为三组：即移植肾功能正常组、AR组及ATN组。分别测量并计算各组移植肾皮质、髓质的ADC值、FA值及R2*值,采用配对样本t检验比较各组皮髓质间ADC值、FA值及R2*值的差异,采用单因素方差分析比较各组间移植肾皮质、髓质ADC值、FA值及R2*值的差异。采用ROC曲线比较皮髓质ADC值及R2*值对移植肾功能正常组、AR组以及ATN组的鉴别诊断效能并确定最佳诊断阈值。同时,采用双变量相关性分析方法计算Pearson相关系数分析肾移植术后患者移植肾皮、髓质R2*值与ADC值之间的相关性。结果：(1)移植肾功能正常组、AR组和ATN组髓质FA值均明显大于皮质(P0.01),功能正常组髓质ADC明显小于皮质ADC值(P0.05),AR组及ATN组皮、髓质间ADC值均无明显差异(P0.05)； (2)移植肾功能正常组、AR组与ATN组间皮质FA值两两比较均无明显差异(P0.05)； (3)移植肾功能正常组、AR组与ATN组间髓质FA值两两比较均无明显差异(P0.05)； (4)移植肾功能正常组与ATN组间皮质ADC值无明显差异(P0.05),AR组皮质ADC值小于功能正常组与ATN组(P0.05)； (5)移植肾功能正常组与ATN组间髓质ADC值无明显差异(P0.05),AR组髓质ADC值小于功能正常组(P0.01),AR组髓质ADC值小于ATN组(P0.05)： (6)移植肾功能正常组、AR组和ATN组髓质R2*值均明显大于皮质(P0.05)； (7)移植肾功能正常组、AR组与ATN组间皮质R2*值两两比较均无明显差异(P0.05)； (8)移植肾功能正常组与ATN组间髓质R2*值无明显差异(P0.05),AR组髓质R2*值小于功能正常组及ATN组(P0.05)； (9)皮质ADC值、髓质ADC值及髓质R2*值对功能正常组与AR组鉴别的最佳诊断阈值分别为2.76×10-3mm2/s、2.87×10-3mm2/s、21.4s-1,其敏感性、特异性、阳性预测值及阴性预测值均在70%以上；对AR组与ATN组鉴别的最佳诊断阈值分别为2.68×10-3mm2/s、2.74×10-3mm2/s、22.3s-1,其敏感性、特异性、阳性预测值及阴性预测值均在70%以上；三个参数值对移植肾各组的鉴别诊断效能均无明显统计学差异(P0.05)； (10)移植肾皮质R2*值与皮质ADC值之间无明显的相关性(r=0.217,P0.05),移植肾髓质R2*值与髓质ADC值无显著相关性(r=0.171,P0.05)。结论：DTI、BOLD能无创、有效鉴别移植肾功能正常与AR,以及AR与ATN,其中皮髓质ADC值及髓质R2*值可作为鉴别诊断指标。
[Abstract]:Objective: to investigate the value of diffusion Zhang Liang imaging (DTI) and blood oxygen level dependent imaging (bold) in the differential diagnosis of renal allograft function, acute rejection reaction (AR) and acute tubular necrosis (ATN). Methods: informed consent was signed by all subjects before examination with the approval of the hospital ethics committee. From May 2012 to March 2014, 60 patients who underwent allograft kidney transplantation for 2-3 weeks were included in this study. All the subjects were performed conventional MRs with Siemens Magnetoom Trio Tim3.0T superconducting magnetic resonance scanner, oblique coronal plane of fat suppression echo (applying diffusion-sensitive gradient field (0300s/mm2) in 6 noncollinear directions) and inclined coronal bold. According to the results of pathological puncture, the patients were divided into three groups: AR group and ATN group. The ADC value and R2 * value of renal cortex and medulla of each group were measured and calculated respectively. The difference of ADC value and R2 * value between each group was compared by paired sample t test, and the graft cortex was compared by single factor analysis of variance (ANOVA). Difference of ADC value, FA value and R2 * value in medulla. The value of ADC and R2 * of medulla were compared by ROC curve in the differential diagnosis of AR group and ATN group in normal renal transplantation group and the optimal diagnostic threshold was determined. At the same time, Pearson correlation coefficient was calculated by using bivariate correlation analysis method to analyze the correlation between R2 * value and ADC value of renal graft skin and medulla after renal transplantation. Results: (1) the FA value of medulla in AR group and ATN group was significantly higher than that in cortex group (P0.01). The ADC value of medulla in normal group was significantly lower than that in cortex group (P0.05). There was no significant difference in ADC value between medulla of AR group and ATN group (P0.05). (2) there was no significant difference in FA value of cortex between AR group and); (group (P0.05), and there was no significant difference in FA value between AR group and ATN group in normal renal transplantation group (P0.05). (4) there was no significant difference in ADC value between normal renal transplantation group and ATN group (P0.05). The ADC value of cortex in AR group was lower than that in normal renal transplantation group and ATN group (P0.05). (5) there was no significant difference in ADC value between normal renal transplantation group and ATN group (P0.05). The ADC value of medulla in AR group was lower than that in ATN group (P0.01); (6) the ADC value in AR group and ATN group was lower than that in ATN group (P0.01); (6) the ADC value in AR group and ATN group in normal renal transplantation group was lower than that in ATN group (P0.01). The R2 * value of medulla in group A was significantly higher than that in cortex (P0.05). (7) there was no significant difference in R2 * value between AR group and ATN group (P0.05). (8) there was no significant difference in R2 * value of medulla between normal renal transplantation group and ATN group (P0.05). The medullary R2 * value in AR group was lower than that in normal group and ATN group (P0.05); (9). The best diagnostic threshold for normal group and AR group was 2.76 脳 10 ~ (-3) mm ~ (-2) / s = 2.87 脳 10 ~ (-3) mm ~ (-2) / s ~ (-1) respectively. The sensitivity, specificity, positive predictive value and negative predictive value were all above 70%. The best diagnostic threshold for AR group and ATN group was 2.68 脳 10-3 mm ~ (-2) / s ~ (-1) 2.74 脳 10 ~ (-3) mm ~ (2) 路s ~ (-3) s ~ (-1). The sensitivity, specificity, positive predictive value and negative predictive value of AR group and ATN group were all more than 70%. (10) there was no significant correlation between R2 * value and ADC value (r = 0.217 P 0.05), but there was no significant correlation between R2 * value and ADC value (r = 0.171 P 0.05). Conclusion the differential diagnosis of renal transplantation with normal renal function and AR-AR and ATN is noninvasive. The ADC value of skin medulla and R2 * value of medulla can be used as differential diagnostic index.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R699.2;R445.2

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