磁共振弥散加权成像联合血氧水平依赖成像评价IgA肾病病理及其肾功能的研究

发布时间：2018-05-05 22:36

本文选题：IgA肾病 + 弥散加权成像　；参考：《南昌大学》2015年硕士论文

【摘要】：目的:1、通过完成健康志愿者肾脏磁共振弥散加权成像(DWI)及血氧水平依赖(BOLD)成像扫描,建立正常人肾脏ADC值、R2*值参考值范围及评价体系。2、测量I~V级IgA肾病患者肾脏ADC值、R2*值,并与正常对照组进行两两比较,探讨DWI联合BOLD鉴别IgA肾病不同病理级别的能力。3、分析IgA肾病患者肾脏ADC值、R2*值与其肾小球滤过率(GFR)、病理Katafuchi积分的相关性,探讨应用功能性磁共振评价IgA肾病肾脏滤过功能和组织病理损害程度的临床价值。方法:收集2014年1月~2014年12月南昌大学第二附属医院肾内科经肾穿刺活检、免疫荧光检查确诊为IgA肾病患者35例,平均年龄32岁(17岁~70岁),排除继发性IgA沉积疾病及肾萎缩、肾积水、肾结石等患者。采用99Tcm-DTPA闪烁扫描测定左、右肾的GFR。根据Lee氏评级系统,将IgA肾病分为I~V级。参照Katafuchi评分标准,对IgA肾病患者进行肾脏病理损害评分。同时,选择20例健康志愿者作为对照组,平均年龄33岁(20岁~68岁)。所有研究对象均采用3.0T MR扫描仪(GE Singa HDxt GE3.0T)进行双侧肾脏DWI及BOLD成像,使用呼吸门控技术,表面相控阵线圈。受试者在检查前需停止接受药物治疗、禁食、禁水8小时,呈脱水状态。扫描时,先进行常规轴位T1加权成像(T1WI)、T2加权成像(T2WI)检查,后采用单次激发自旋回波平面成像(SE-EPI)序列进行DWI扫描,扩散敏感因子b选取500s/mm2;采用多梯度回波(mGRE)序列进行BOLD扫描。将扫描的原始数据导入工作站进行后处理,在肾脏皮髓质分界清晰的层面选取感兴趣区(ROI),测量各组肾脏皮、髓质的ADC值和R2*值。将数据进行统计分析:1、比较肾脏皮髓质之间ADC值、R2*值的差异;2、比较对照组与IgA肾病组不同病理级别之间肾脏ADC值、R2*值的差异;3、IgA肾病组分肾皮髓质ADC值、R2*值与分肾GFR值之间的关系;4、IgA肾病组右肾皮髓质ADC值、R2*值与肾穿刺活检病理Katafuchi积分之间的关系。结果:最终纳入图像处理:健康对照组20例,iga肾病组i级3例,iii级21例,iv级11例。结果:1、健康对照组及iga肾病各亚组的肾脏皮质adc值均大于髓质(p0.05),健康对照组、iga肾病i级、iii级及iv级肾脏皮、髓质的adc值(x10-3mm2/s)分别为2.61±0.09vs2.37±0.07、2.57±0.08vs2.19±0.08、2.35±0.12vs2.08±0.06、2.13±0.23vs1.86±0.15。单因素方差分析显示健康对照组与iga肾病各亚组之间皮、髓质adc值均存在统计学差异(p0.05)。进一步采用最小显著值差异(lsd)法进行两两比较,结果显示:iga肾病i级组皮质adc值与健康对照组之间无统计学差异(p0.05),其余任意两组间肾脏皮、髓质adc值均有显著性差异(p0.05)。2、iga肾病组分肾皮、髓质adc值与其gfr值均呈正相关性(p0.05);iga肾病组的右肾皮、髓质adc值与病理katafuchi积分均呈负相关性(p0.05)。3、健康对照组及iga肾病各亚组的肾脏髓质r2*值均大于皮质(p0.05),健康对照组、iga肾病i级、iii级及iv级肾脏皮、髓质的r2*值(xhz)分别为16.23±1.15vs31.22±1.44、17.29±0.52vs32.58±0.69、18.60±1.00vs35.25±1.13、19.43±0.80vs38.68±1.64。单因素方差分析显示健康对照组与iga肾病各亚组之间皮、髓质r2*值的差异均有统计学意义(p0.05)。用lsd法进一步分析:iga肾病i级组皮、髓质r2*值与健康对照组之间无统计学差异(p0.05),iga肾病iii级、iv级组与对照组之间的任意两组肾脏皮、髓质r2*值均有显著性差异(p0.05)。4、iga肾病组的分肾皮、髓质r2*值与其gfr值均呈负相关性(p0.05);iga肾病组的右肾皮、髓质r2*值与病理katafuchi积分均呈正相关性(p0.05)。结论:1、功能性磁共振成像显示肾脏皮髓质之间adc值、r2*值差异明显,可以反映皮髓质各自的生理效能。2、正常人与iga肾病患者的肾脏adc值、r2*值差异明显,提示功能性磁共振对检测肾脏病变有可行性。3、随着iga肾病级别的加重,肾脏皮髓质adc值呈下降趋势,r2*值呈上升趋势,提示功能性磁共振对鉴别IgA肾病的分级有一定的临床价值。4、随着IgA肾病GFR的下降,肾脏皮髓质ADC值呈下降趋势,R2*值呈上升趋势,提示功能性磁共振可用于评价肾脏的滤过功能。5、随着IgA肾病病理Katafuchi积分的升高,肾脏皮髓质ADC值呈下降趋势,R2*值呈上升趋势,提示功能性磁共振对于判断IgA肾病肾脏病理变化有一定的意义,可以作为评估肾脏病理损害的一种非侵入性方法。
[Abstract]:Objective: 1, by completing the renal magnetic resonance diffusion weighted imaging (DWI) and blood oxygen level dependence (BOLD) imaging scan of healthy volunteers, the renal ADC value of normal human kidney, the range of reference value of R2* value and the evaluation system.2 were used to measure the ADC value and R2* value of the patients with I~V grade IgA nephropathy, and to compare with the normal control group, and to explore DWI United BOLD to identify IgA kidney. The ability of.3 to analyze the renal ADC, R2* value and glomerular filtration rate (GFR) and the correlation of pathological Katafuchi score in IgA nephropathy, and to explore the clinical value of functional MRI for evaluating renal filtration and histopathological damage of IgA nephropathy. Methods: Nanchang University, January 2014, December, second In the Affiliated Hospital, 35 cases of IgA nephropathy were diagnosed by renal biopsy and immunofluorescence. The average age was 32 years old (17 years old ~70). The patients with secondary IgA and renal atrophy, hydronephrosis and kidney stones were excluded. The GFR. of left and right kidney was determined by Lee rating system by 99Tcm-DTPA scintigraphy, and IgA nephropathy was divided into I~V grade. Reference K The atafuchi scoring standard was used to score the renal pathological damage of patients with IgA nephropathy. At the same time, 20 healthy volunteers were selected as the control group, with an average age of 33 years (20 years old). All the subjects were treated with 3.0T MR scanner (GE Singa HDxt GE3.0T) for bilateral kidney DWI and BOLD imaging, and the surface phased array coil was used by the respiratory gated technique. The subjects were required to stop receiving medical treatment, fasting and water prohibition for 8 hours before examination. When scanning, the conventional axial T1 weighted imaging (T1WI), T2 weighted imaging (T2WI) were performed, and then the single excited spin echo plane imaging (SE-EPI) sequence was used for DWI scan, the diffusion sensitivity factor B was selected as 500s/mm2, and multiple gradient echoes (mGR) were used. E) BOLD scan. The scanned original data were introduced into the workstation for post-processing. The region of interest (ROI) was selected at the clear and clear layer of the renal cortex. The renal cortex, the ADC value and the R2* value of the medulla were measured. The data were statistically analyzed. 1, the ADC value, the difference of R2* value between the renal medulla and the renal medulla were compared; and 2, compared with the control group and IgA nephropathy. Group ADC value and R2* value difference between different pathological grades; 3, IgA nephropathy group renal cortex medulla ADC value, R2* value and renal GFR value; 4, IgA nephrotic group right renal cortex medulla ADC value, R2* value and renal biopsy pathology Katafuchi integral. Results: finally included in the image processing: 20 healthy control group, IgA nephrotic group I grade 3 cases The results were as follows: 21 cases of III and 11 cases of grade IV. Results: 1. The renal cortical ADC values in the healthy control group and the IgA nephropathy group were all larger than the medulla (P0.05), the healthy control group, the IgA nephropathy I grade, the III and IV renal cortex and the ADC value of the medulla (x10-3mm2/s) were 2.61 +. The analysis of factor variance showed that there were significant differences in the ADC values of the skin and medulla between the healthy control group and the IgA nephropathy group (P0.05). The difference of the minimum significant difference (LSD) was further compared. The results showed that there was no statistical difference between the ADC value of the I grade group of IgA nephropathy and the healthy control group (P0.05), and the other two groups of renal cortex, The ADC values of the medulla were significantly different (P0.05).2. The renal cortex of the IgA nephropathy group and the ADC value of the medulla were positively correlated with the GFR value (P0.05). The right renal cortex and the medulla ADC value of the IgA nephrosis group were negatively correlated with the pathological katafuchi integral (P0.05).3. The renal medullary values of the healthy control group and the kidney subgroups were all greater than those of the cortex and the healthy control group. IgA nephropathy I, III grade and IV grade renal cortex and r2* value of medulla (XHZ) were 16.23 + 1.15vs31.22 + 1.44,17.29 + 0.52vs32.58 + 0.69,18.60 + 1.00vs35.25 + 1.13,19.43 + variance analysis, which showed that the difference of skin and medullary medullary values between the healthy control group and the kidney subgroups were statistically significant. Method further analysis: there was no statistical difference between the I grade group of IgA nephropathy and the r2* value of medulla and the healthy control group (P0.05), IgA nephropathy III grade, the r2* value of the medulla r2* value of all two groups between the IV group and the control group was significantly different (P0.05).4, the renal cortex of the IgA nephrotic group, the medulla r2* value and the value of the renal medulla were negatively correlated. There was a positive correlation between the right renal cortex and the r2* value of the medulla and the pathological katafuchi score (P0.05). Conclusion: 1, the functional magnetic resonance imaging (fMRI) showed the ADC value between the medulla of the renal cortex, and the difference of r2* value was obvious, which could reflect the physiological efficacy of the medulla,.2, and the ADC value of the renal organs of the normal people and the patients with IgA nephropathy, and the difference of r2* values was obvious, suggesting functional magnetic resonance imaging. The measurement of renal lesions was feasible.3. With the aggravation of IgA nephropathy, the ADC values of renal cortex and medulla were decreasing, and the value of r2* showed an upward trend. It suggested that functional magnetic resonance has a certain clinical value for the differentiation of IgA nephropathy. With the decrease of GFR in IgA nephropathy, the ADC values of renal cortex and medulla are decreasing, and R2* values are on the rise, suggesting that R2* values are on the rise, suggesting the function of the renal medulla, suggesting the function of the renal medulla. Sexual magnetic resonance can be used to evaluate the renal filtration function.5. With the increase of the pathological Katafuchi integral of IgA nephropathy, the ADC value of the renal cortex is declining, and the R2* value is on the rise. It suggests that functional magnetic resonance is of certain significance in judging the pathological changes of kidney in IgA nephropathy. It can be used as a non invasive prescription for evaluating renal pathological damage. Law.

【学位授予单位】：南昌大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R692.31

【参考文献】