应用功能磁共振成像评估狼疮性肾炎患者肾功能预后
|
摘要
目的:观察多模态功能磁共振成像(fMRI)技术与狼疮性肾炎(LN)患者肾组织活动性评分(AI)及肾功能的相关性,探索fMRI技术结合病理学改变对LN肾组织损伤程度的评估。方法:32例经肾活检明确诊断的LN患者,进行fMRI分析,序列包含有体素内不相干运动成像(intravoxel incoherent motion diffusion weighted imaging,IVIM-DWI)、弥散张量成像(diffusion tensor imaging,DTI)、血氧水平依赖成像(blood-oxygen level dependent imaging,BOLD)及磁共振弹性成像(magnetic resonance imaging,MRE)。分析记录肾皮质区功能影像序列参数值。分析LN患者基线临床及肾脏病理评分和随访资料。结果:LN合并急性肾损伤(AKI)患者,IVIM标准表观弥散系数(Standard-ADC值)低于非AKI患者[(15.35±1.33)×10~(-6) mm~2/s vs(17.69±1.71)×10~(-6) mm~2/s,P<0.05],DTI-FA值也低于后者(0.151±0.03μm~2/ms vs 0.181±0.04μm~2/ms,P<0.05);DTI-FA值与AI和慢性化评分(CI)之间均呈显著负相关性(P<0.05)。随访6个月时,血清肌酐(SCr)升高>30%的LN患者基线DTI-FA值显著低于肾功能稳定组(0.164±0.031μm~2/ms vs 0.195±0.065μm~2/ms,P<0.001);并且,DTI-FA值与SCr升高斜率负相关(R=-0.54,P<0.05),且对SCr升高具有一定预测价值(AUC 61.5%,P<0.05)。本研究中BOLD及MRE参数与组织AI、CI值和SCr变化斜率之间无显著相关性。结论:功能影像序列中IVIM-DWI及DTI指标的变化,结合肾组织形态学指标,有助于预测LN患者肾功能的变化。
Objective:this study intends to explore the role of functional magnetic resonance imaging combined with histopathological features in predicting the extent of LN tissue damage,by observing the correlation between multi-mode functional magnetic resonance imaging and renal tissue activity score and the change slope of renal creatinine. Methodology:32 patients with LN were enrolled. The sequences included intravoxel incoherent motion diffusion imaging(IVIM-DWI),diffusion tensor imaging(DTI),blood-oxygen-level dependent imaging(BOLD) and Magnetic resonance imaging(MRE).The sequence parameters of renal cortical functional imaging were analyzed and recorded. Baseline clinicopathological data and follow-up data for LN patients were analyzed.Acute nephritis tissue activity index(AI); chronic index(CI) is based on renal biopsy histomorphological analysis. Results:We found that The stand-ADC(15.35±1.33 vs 17.69±1.71,P<0.05)and FA(0.151±0.03 vs 0.181±0.04,P<0.05)descended in the AKI subgroup of lupus nephritis. In follow-up period,FA(0.164±0.031 vs 0.195±0.065,P<0.001)is much lower in the patients with renal function deterioration,and correlated with the descending slope of serum creatine. The DTI-FA had a predictive value for the change of serum(AUC 61.5%,P<0.05).We did not found any differences between LN with CKD in BOLD and MRE. Conclusion:DTI-FA and IVIM-ADC is promising in prediction of renal function.More effort should be paid to monitor renal function prognosis in the future by functional magnetic resonance imaging.
Objective:this study intends to explore the role of functional magnetic resonance imaging combined with histopathological features in predicting the extent of LN tissue damage,by observing the correlation between multi-mode functional magnetic resonance imaging and renal tissue activity score and the change slope of renal creatinine. Methodology:32 patients with LN were enrolled. The sequences included intravoxel incoherent motion diffusion imaging(IVIM-DWI),diffusion tensor imaging(DTI),blood-oxygen-level dependent imaging(BOLD) and Magnetic resonance imaging(MRE).The sequence parameters of renal cortical functional imaging were analyzed and recorded. Baseline clinicopathological data and follow-up data for LN patients were analyzed.Acute nephritis tissue activity index(AI); chronic index(CI) is based on renal biopsy histomorphological analysis. Results:We found that The stand-ADC(15.35±1.33 vs 17.69±1.71,P<0.05)and FA(0.151±0.03 vs 0.181±0.04,P<0.05)descended in the AKI subgroup of lupus nephritis. In follow-up period,FA(0.164±0.031 vs 0.195±0.065,P<0.001)is much lower in the patients with renal function deterioration,and correlated with the descending slope of serum creatine. The DTI-FA had a predictive value for the change of serum(AUC 61.5%,P<0.05).We did not found any differences between LN with CKD in BOLD and MRE. Conclusion:DTI-FA and IVIM-ADC is promising in prediction of renal function.More effort should be paid to monitor renal function prognosis in the future by functional magnetic resonance imaging.
引文
1 Weening JJ,D′Agati VD,Schwartz MM,et al.The classification of glomerulonephritis in systemic lupus erythematosus revisited.J Am Soc Nephrol,2004,15(2):241-250.
2 Austin HA 3rd,Muenz LR,Joyce KM,et al.Diffuse proliferative lupus nephritis:identification of specific pathologic features affecting renal outcome.Kidney Int,1984,25(4):689-695.
3 Parikh SV,Alvarado A,Malvar A,et al.The Kidney Biopsy in Lupus Nephritis:Past,Present,and Future.Semin Nephrol,2015,35(5):465-477.
4 张炯,刘志红.多参数磁共振影像在评估肾脏纤维化中的应用.肾脏病透析与肾移植,2018,27(6):555-559.
5 Li Q,Li J,Zhang L,et al.Diffusion-weighted imaging in assessing renal pathology of chronic kidney disease:A preliminary clinical study.Eur J Radiol,2014,83(5):756-762.
6 Mao W,Zhou J,Zeng M,et al.Chronic Kidney Disease:Pathological and Functional Evaluation With intravoxel Incoherent Motion Diffusion-Weighted Imaging.J Magn Reson Imaging,2018,47(5):1251-1259.
7 Li X,Xu X,Zhang Q,.Diffusion weighted imaging and blood oxygen level-dependent MR imaging of kidneys in patients with lupus nephritis.J Transl Med,2014,12:295.
8 Hochberg MC.Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus.Arthritis Rheum,1997,40(9):1725.
9 杨静,曾彩虹,刘志红,等.不同亚型狼疮性肾炎患者临床病理特征和预后的比较.肾脏病透析与肾移植,2015,24(3):201-206.
10 Kirpalani A,Hashim E,Leung G,et al.Magnetic Resonance Elastography to Assess Fibrosis in Kidney Allografts.Clin J Am Soc Nephrol,2017,12(10):1671-1679.
11 Hueper K,Hartung D,Gutberlet M,et al.Magnetic Resonance diffusion tensor imaging for evaluation of histopathological changes in a rat model of diabetic nephropathy.Invest Radiol,2012,47(7):430-437.
12 Yu F,Haas M,Glassock R,et al.Redefining lupus nephritis:clinical implications of pathophysiologic subtypes.Nat Rev Nephrol,2017,13(8):483-495.
13 Fan WJ,Ren T,Li Q,et al.Assessment of renal allograft function early after transplantation with isotropic resolution diffusion tensor imaging.Eur Radiol,2016,26(2):567-575.
14 Gaudiano C,Clementi V,Busato F,et al.Diffusion tensor imaging and tractography of the kidneys:assessment of chronic parenchymal diseases.Eur Radiol,2013,23(6):1678-1685.
15 Lu L,Sedor JR,Gulani V,et al.Use of Diffusion tensor MRI to identify early changes in diabetic nephropathy.Am J Nephrol,2011,34(5):476-482.
16 Ishii Y,Sawada T,Kubota K,et al.Injury and progressive loss of peritubular capillaries in the development of chronic allograft nephropathy.Kidney Int,2005,67(1):321-332.
17 Leung G,Kirpalani A,Szeto SG,et al.Could MRI Be Used To Image Kidney Fibrosis?A Review of Recent Advances and Remaining Barriers.Clin J Am Soc Nephrol,2017,12(6):1019-1028.
18 Xin-Long P,Jing-Xia X,Jian-Yu L,et al.A preliminary study of blood-oxygen-level-dependent MRI in patients with chronic kidney disease.Magn Reson Imaging,2012,30(3):330-335.
19 Gloviczki ML,Glockner JF,Crane JA,et al.Blood oxygen level-dependent magnetic resonance imaging identifies cortical hypoxia in severe renovascular disease.Hypertension,2011,58(6):1066-1072.
20 Pruijm M,Milani B,Burnier M.Blood Oxygenation Level-Dependent MRI to Assess Renal Oxygenation in Renal Diseases:Progresses and Challenges.Front Physiol,2017,7:667.
21 Pruijm M,Milani B,Pivin E,et al.Reduced cortical oxygenation predicts a progressive decline of renal function in patients with chronic kidney disease.Kidney Int,2018,93(4):932-940.
2 Austin HA 3rd,Muenz LR,Joyce KM,et al.Diffuse proliferative lupus nephritis:identification of specific pathologic features affecting renal outcome.Kidney Int,1984,25(4):689-695.
3 Parikh SV,Alvarado A,Malvar A,et al.The Kidney Biopsy in Lupus Nephritis:Past,Present,and Future.Semin Nephrol,2015,35(5):465-477.
4 张炯,刘志红.多参数磁共振影像在评估肾脏纤维化中的应用.肾脏病透析与肾移植,2018,27(6):555-559.
5 Li Q,Li J,Zhang L,et al.Diffusion-weighted imaging in assessing renal pathology of chronic kidney disease:A preliminary clinical study.Eur J Radiol,2014,83(5):756-762.
6 Mao W,Zhou J,Zeng M,et al.Chronic Kidney Disease:Pathological and Functional Evaluation With intravoxel Incoherent Motion Diffusion-Weighted Imaging.J Magn Reson Imaging,2018,47(5):1251-1259.
7 Li X,Xu X,Zhang Q,.Diffusion weighted imaging and blood oxygen level-dependent MR imaging of kidneys in patients with lupus nephritis.J Transl Med,2014,12:295.
8 Hochberg MC.Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus.Arthritis Rheum,1997,40(9):1725.
9 杨静,曾彩虹,刘志红,等.不同亚型狼疮性肾炎患者临床病理特征和预后的比较.肾脏病透析与肾移植,2015,24(3):201-206.
10 Kirpalani A,Hashim E,Leung G,et al.Magnetic Resonance Elastography to Assess Fibrosis in Kidney Allografts.Clin J Am Soc Nephrol,2017,12(10):1671-1679.
11 Hueper K,Hartung D,Gutberlet M,et al.Magnetic Resonance diffusion tensor imaging for evaluation of histopathological changes in a rat model of diabetic nephropathy.Invest Radiol,2012,47(7):430-437.
12 Yu F,Haas M,Glassock R,et al.Redefining lupus nephritis:clinical implications of pathophysiologic subtypes.Nat Rev Nephrol,2017,13(8):483-495.
13 Fan WJ,Ren T,Li Q,et al.Assessment of renal allograft function early after transplantation with isotropic resolution diffusion tensor imaging.Eur Radiol,2016,26(2):567-575.
14 Gaudiano C,Clementi V,Busato F,et al.Diffusion tensor imaging and tractography of the kidneys:assessment of chronic parenchymal diseases.Eur Radiol,2013,23(6):1678-1685.
15 Lu L,Sedor JR,Gulani V,et al.Use of Diffusion tensor MRI to identify early changes in diabetic nephropathy.Am J Nephrol,2011,34(5):476-482.
16 Ishii Y,Sawada T,Kubota K,et al.Injury and progressive loss of peritubular capillaries in the development of chronic allograft nephropathy.Kidney Int,2005,67(1):321-332.
17 Leung G,Kirpalani A,Szeto SG,et al.Could MRI Be Used To Image Kidney Fibrosis?A Review of Recent Advances and Remaining Barriers.Clin J Am Soc Nephrol,2017,12(6):1019-1028.
18 Xin-Long P,Jing-Xia X,Jian-Yu L,et al.A preliminary study of blood-oxygen-level-dependent MRI in patients with chronic kidney disease.Magn Reson Imaging,2012,30(3):330-335.
19 Gloviczki ML,Glockner JF,Crane JA,et al.Blood oxygen level-dependent magnetic resonance imaging identifies cortical hypoxia in severe renovascular disease.Hypertension,2011,58(6):1066-1072.
20 Pruijm M,Milani B,Burnier M.Blood Oxygenation Level-Dependent MRI to Assess Renal Oxygenation in Renal Diseases:Progresses and Challenges.Front Physiol,2017,7:667.
21 Pruijm M,Milani B,Pivin E,et al.Reduced cortical oxygenation predicts a progressive decline of renal function in patients with chronic kidney disease.Kidney Int,2018,93(4):932-940.