核磁共振BOLD成像及DWI在慢性肾脏病中的应用研究

发布时间：2018-05-07 08:02

本文选题：慢性肾脏病 + 血氧水平依赖核磁共振成像（BOLD　；参考：《苏州大学》2014年硕士论文

【摘要】：目的本研究旨在通过对核磁共振BOLD成像及DWI的研究，探讨双肾皮、髓质ADC值及R2*值与慢性肾脏病患者肾脏结构和功能变化的关系，探讨核磁共振BOLD成像及DWI作为一种无创性、无毒性的检查方法在慢性肾脏病早期发现、预后判断及病程检测中的临床价值。材料与方法 2012年12月-2013年12月对68例实验对象进行核磁共振BOLD及DWI成像。其中健康对照组19例。CKD组：选取慢性肾脏病患者共49例，其中行肾脏穿刺活检者26人，按照CKD分期将患者分为两个亚组。记录扫描对象的性别，年龄，体重，血肌酐及尿素氮，通过CG公式计算出其eGFR，并检测患者晨尿白蛋白、尿肌酐及胱抑素C的含量，肾活检患者使用单项病理损害积分半定量方法：对9项病理指标进行病理积分，均为0-3分。所有实验对象扫描均使用采用3.0T MRI扫描仪。定位像：横断，冠状位及矢状位；常规MRI序列：T2WI横断位及冠状位，T1WI横断位，快速旋转回波序列；BOLD成像序列：冠状位，序列为多次梯度回波序列，DW：b值为800s/mm2。扫描过程中使用SENSE Cardiac线圈及呼吸门控技术。BOLD序列扫描患者需闭气16s。全部数据使用SPSS17.0软件包进行统计学分析，所有计量资料均进行正态分布和方差齐性检验,结果用均数±标准差表示。分别比较各组间肾脏皮、髓质ADC值与R2*值的差异及与肾功能及病理相关指标的关系。分别使用方差分析、t检验、Pearson相关分析及Spearman相关分析,P0．05为差异有统计学意义。结果 1.对照组及CKD组皮质ADC值均明显高于髓质（P0.05）；两组皮质R2*值均明显小于髓质（P0.05）。CKD组左右两侧肾脏皮、髓质ADC值无明显差异（P0.05）；CKD组患者左右两侧肾脏皮、髓质ADC值及R2*比较无明显差异（P0.05）。 2. CKD组与对照组肾脏皮质ADC值及R2*值比较，ADC值明显降低，R2*值明显升高，差异有统计学意义（P0.05）；CKD组与正常组肾脏髓质ADC值及R2*值比较明显降低，差异有统计学意义（P0.05）。 3.对照组肾脏皮髓质的ADC值及R2*值与早期肾功能损害组及中晚期肾功能损害组比较，两亚组皮、髓质ADC值及髓质R2*值明显降低，皮质R2*明显升高，差异均有统计学意义（P0.05）；中晚期肾功能损害组与早期肾功能损害组相比较，皮质ADC值及髓质R2*值明显降低，差异有统计学意义（P0.05）；两亚组髓质ADC值及皮质R2*值之间差异无统计学意义（P0.05）。 4.肾脏皮质ADC值与血肌酐、尿素氮呈负相关，与eGFR呈正相关（r分别为-0.14、-0.27、0.35，P均0.05）；皮质R2*值与尿白蛋白/肌酐呈负相关（r=-0.4，P0.05）；髓质R2*值与血肌酐、尿素氮、尿胱抑素C呈负相关，与eGFR呈正相关（r分别为-0.39、-0.48、0.21、-0.34，P均0.05）。 5.肾活检患者皮质ADC值与系膜细胞增殖、球囊连/小新月体、肾小管萎缩、间质炎细胞浸润、间质纤维化、小动脉病变呈负相关，有统计学意义（r值分别为-0.44、-0.55、-0.41、-0.55、-0.55、-0.4，P均0.05）；皮质R2*值与系膜细胞增殖呈正相关（r=0.47，P0.05）。结论 1.肾脏核磁共振BOLD成像及DWI能够显示肾脏皮质及髓质之间的结构及功能差异，，从而能够反映肾脏皮、髓质的生理功能。 2.测量肾脏ADC值及R2*值可以作为慢性肾脏病早期诊断的依据； 3.肾脏皮质ADC值可以作为一种无创性评估肾脏功能，监测慢性肾脏病患者病情进展，判断治疗效果的重要方法之一； 4.肾脏髓质R2*值与皮质R2*值结合，能够较为全面的判断肾小球及肾脏小管间质病变，无创监测肾功能进展； 5.肾脏核磁共振BOLD成像及DWI相结合能够更加全面的评价肾脏功能及病理改变，在未来慢性肾脏病诊疗中有非常重要的作用。
[Abstract]:objective
The purpose of this study is to explore the relationship between the renal structure and function of the renal cortex, the ADC value of medulla and the value of R2* and the changes of renal function in patients with chronic renal disease by the study of nuclear magnetic resonance BOLD imaging and DWI. The purpose of this study is to explore the early detection of NMR BOLD imaging and DWI as a noninvasive and non-toxic method in the early detection of chronic kidney disease, prognosis judgment and course detection. The clinical value of it.
Materials and methods
NMR BOLD and DWI imaging were performed in 68 subjects in December -2013 December 2012. In the healthy control group, 19 patients with chronic kidney disease were selected, including 49 patients with chronic kidney disease, including 26 kidney biopsy subjects. The patients were divided into two subgroups according to CKD stage. The eGFR was calculated by CG formula and the content of early morning urine albumin, urine creatinine and cystatin C were measured. The renal biopsy patients used a semi quantitative method of single pathological damage score: the pathological scores of 9 pathological indexes were 0-3 points.
All the subjects were scanned using 3.0T MRI scanner. Location image: transection, coronal and sagittal position; conventional MRI sequence: T2WI transverse and coronal, T1WI transversal, fast rotating echo sequence; BOLD imaging sequence: coronal position, sequence as multiple gradient echo sequence, DW:b value for 800s/mm2. scanning process using SENSE Car. DIAC coil and respiratory gating technology.BOLD sequence scanning patients need 16s.
All data were statistically analyzed using SPSS17.0 software package. All the data were tested in normal distribution and homogeneity of variance. The results were expressed with mean standard deviation. The differences in renal cortex, medulla ADC value and R2* value were compared and the relationship with renal function and pathological indexes were compared. Variance analysis, t test, and Pearson were used respectively. Correlation analysis and Spearman correlation analysis showed that P0.05 was statistically significant.
Result
The cortical ADC values of 1. control groups and CKD groups were significantly higher than that of medulla (P0.05), and the R2* values in two groups were significantly smaller than those of the medulla (P0.05).CKD group, and the medulla ADC values were not significantly different (P0.05), and there was no significant difference between the left and right renal cortex of the left and right sides of the CKD group, the ADC value of medulla and R2* (P0.05).
2. CKD group and the control group compared with the renal cortex ADC value and R2* value, ADC value decreased significantly, R2* value increased significantly, the difference was statistically significant (P0.05), CKD group and normal group renal medullary ADC value and R2* value was significantly lower, the difference was statistically significant (P0.05).
The ADC value and R2* value of renal cortex medulla in 3. control groups were compared with the early renal function damage group and the middle and late renal impairment group. The two subgroups, the ADC value and the medulla R2* value of the medulla, and the cortical R2* were significantly increased, the difference was statistically significant (P0.05); the middle and late renal function damage group was compared with the early renal function damage group, and the cortical ADC value was compared with the early renal function damage group. The R2* value of medulla decreased significantly (P0.05); there was no significant difference in ADC value and cortical R2* value between the two subgroups (P0.05).
4. the ADC value of renal cortex was negatively correlated with serum creatinine, urea nitrogen and positive correlation with eGFR (r was -0.14, -0.27,0.35, P 0.05, respectively), and the cortical R2* value was negatively correlated with urinary albumin / creatinine (r=-0.4, P0.05), and the R2* value of medulla was negatively correlated with serum creatinine, urea nitrogen and urinary cystatin C, and was positively correlated with eGFR (0.05 ).
5. the ADC values of renal biopsy and mesangial cell proliferation, balloon connection / small new month body, renal tubule atrophy, interstitial inflammatory cell infiltration, interstitial fibrosis and negative correlation of arteriopathy were negative (r value was -0.44, -0.55, -0.41, -0.55, -0.55, -0.4, P 0.05), and the cortical R2* value was positively correlated with the proliferation of mesangial cells (r=0.47, P0.05).
conclusion
1. renal magnetic resonance imaging (BOLD) and DWI can show differences in structure and function between renal cortex and medulla, which can reflect the physiological functions of renal cortex and medulla.
2. measuring renal ADC and R2* values can be used as the basis for early diagnosis of chronic kidney disease.
3. the ADC value of renal cortex can be used as a non-invasive method for assessing renal function, monitoring the progression of chronic kidney disease and determining the therapeutic effect.
4. the R2* value of renal medulla combined with the R2* value of cortex can be used to judge glomeruli and tubulointerstitial lesions in a more comprehensive way.
5. the combination of renal nuclear magnetic resonance BOLD imaging and DWI can make a more comprehensive evaluation of renal function and pathological changes. It has a very important role in the diagnosis and treatment of chronic kidney disease in the future.

【学位授予单位】：苏州大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R692;R445.2

【参考文献】