DTI在慢性肾脏病的应用价值

发布时间：2018-02-02 18:09

本文关键词： 慢性肾脏病磁共振成像扩散张量成像 ADC值 FA值肾小球滤过率　出处：《南昌大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的：应用磁共振扩散张量成像技术（DTI）对健康志愿者及各期CKD患者的肾脏进行观察和测量，研究磁共振扩散张量成像在CKD的应用，分析CKD患者肾脏皮髓质ADC值及FA值的改变，分析其与肾功能指标及CKD分期的相关性。探讨DTI在慢性肾脏病中的应用价值。对象和方法：搜集南昌大学第一附属医院肾内科收治的42例慢性肾脏病患者，测量血清肌酐水平(Scr)，，根据简化肾脏病膳食改善（MDRD）方程计算肾小球滤过率估算值（eGFR），并根据eGFR确定CKD分期。搜集20例正常志愿者作为对照组。在1.5T MRI设备上行MRI弥散张量成像检查（b=0，600s/mm2），测量肾脏皮髓质ADC值和FA值，并行髓质纤维束成像。比较各组肾脏皮质、髓质的ADC值和FA值的差异，并比较对照组与不同分期慢性肾脏病患者之间的皮质、髓质的ADC值和FA值的差异，绘制ROC曲线，比较肾皮质ADC值和髓质FA值鉴别对照组与不同分期慢性肾脏病患者的诊断效能，分析肾皮质ADC值和髓质FA值与血清肌酐水平(Scr)、肾小球滤过率估算值（eGFR）及慢性肾脏病分期之间的相关性。结果：正常志愿者、慢性肾脏病患者双肾皮髓质ADC值和FA值之间均无统计学意义（P0.05）。各组肾皮质的ADC值均高于髓质ADC值，各组肾髓质FA值均高于肾皮质FA值。单因素方差分析显示对照组、轻度慢性肾脏病和中重度慢性肾脏病之间肾皮髓质ADC值和FA值均存在统计学差异。其中两两比较显示肾皮质ADC值和髓质FA值在各两组之间的差异明显。肾脏髓质扩散张量成像示踪图显示肾脏髓质的纤维束呈放射状结构自肾门指向肾皮质。结论：磁共振扩散张量成像技术（DTI）在肾脏具有可行性，可以从水分子扩散各向同性及各向异性等方面显示肾脏生理学特征，并能反映慢性肾脏病的病理生理学改变。肾脏ADC值可以反映慢性肾脏病患者肾脏水分子扩散程度不同程度减低，肾脏髓质FA值可以反映慢性肾脏病患者的肾脏髓质内水分子扩散的各向异性不同程度减低，对慢性肾脏病的诊断和不同分期的鉴别均有一定的诊断效能。
[Abstract]:Objective: to observe and measure the kidney of healthy volunteers and patients with CKD by using Mr diffusive Zhang Liang imaging technique, and to study the application of diffusive #internal_person1# imaging in CKD. To analyze the changes of ADC and FA in renal dermatomedullary in patients with CKD, and to analyze the correlation between DTI and renal function and CKD staging, and to explore the application value of DTI in chronic kidney disease. Participants and methods: 42 patients with chronic kidney disease treated in Department of Nephrology, first affiliated Hospital of Nanchang University, were collected and their serum creatinine levels were measured. The estimation of glomerular filtration rate (GFR) was calculated according to the simplified MDRD equation. CKD staging was determined according to eGFR, and 20 normal volunteers were collected as control group. Up to MRI dispersion Zhang Liang imaging was performed on 1.5T MRI equipment. The ADC value and FA value of renal dermatomedullary were measured, and the difference of ADC value and FA value of renal cortex and medulla were compared. The difference of ADC value and FA value of cortex and medulla between the control group and the patients with different stages of chronic kidney disease were compared and the ROC curve was drawn. To compare the diagnostic efficacy of renal cortex ADC and medullary FA between the control group and the patients with different stages of chronic kidney disease, and analyze the renal cortex ADC value, medullary FA value and serum creatinine level. The correlation between glomerular filtration rate (GFR) and stages of chronic kidney disease. Results: there was no significant difference between ADC value and FA value of renal medulla in normal volunteers and patients with chronic kidney disease. The ADC value of renal cortex in each group was higher than that of medullary ADC value. The FA value of renal medulla in each group was higher than that in renal cortex. Univariate analysis of variance showed that the control group. There were significant differences in ADC and FA between mild and moderate and severe chronic kidney disease, and the difference of ADC value and FA value in renal cortex was obvious between the two groups. The renal medullary diffusive Zhang Liang tracer graph showed that the fibrous bundles of the renal medulla were radially oriented from the renal hilum to the renal cortex. Conclusion: magnetic resonance diffusion imaging (DTI) is feasible in kidney, and it can show the physiological characteristics of kidney in the aspects of diffusion isotropy and anisotropy of water molecules. It can reflect the pathophysiological changes of chronic kidney disease. The ADC value of kidney can reflect the decrease of the degree of diffusion of water molecules in the kidney of patients with chronic kidney disease. The FA value of renal medulla can reflect the decrease of anisotropy of water molecule diffusion in renal medulla in patients with chronic kidney disease, and it has certain diagnostic efficacy for the diagnosis and differentiation of different stages of chronic kidney disease.
【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】：R692;R445.2

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