扩散张量成像在原发性肾小球肾炎早期病理损害的临床应用价值
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摘要
目的评价扩散张量成像(DTI)参数表观扩散系数(ADC)值、各向异性分数(FA)值在定量分析原发性肾小球肾炎患者肾脏功能状态及早期病理损伤的临床应用价值。方法选择经病理证实的原发性肾小球肾炎患者60例(病变组)及健康志愿者20名(对照组),行MRI常规及DTI序列扫描,并在MRI检查前及检查后1周内完成肾功能指标及肾脏穿刺活检检查。根据Katafuchi肾病积分标准将病变组分为两个亚组(轻度组和中-重度组),分别测量肾脏皮髓质ADC值及FA值。采用单因素方差分析(ANOVA)比较对照组与病变组差异,用Pearson相关分析检验ADC值及FA值与肾功能指标、临床分期及病理损伤积分的相关性。结果对照组、病变组比较,肾皮髓质的ADC值及FA值均存在显著统计学差异(P均<0.05);肾皮髓质的ADC值及FA值随病理损伤程度加重均有一定程度的下降;病变组肾髓质ADC值、FA值与估算肾小球滤过率(eGFR)呈正相关(r=0.475,P<0.05;r=0.864,P<0.001),而与血清肌酐(Scr)、24h尿蛋白(24h-Upro)、CKD分期呈负相关,相关性均具有统计学意义(P均<0.05),并且肾髓质的FA值相关性明显高于ADC值;髓质FA值与3项病理损害积分呈明显负相关(r分别为-0.768、-0.848、-0.468,P均<0.05);鉴别对照组与轻度组时,髓质FA值具有较好的诊断效能,准确率89.2%,髓质FA值最佳诊断阈值取0.453时,敏感度及特异度分别为92.4%、84.6%。结论 DTI可以无创地评价原发性肾小球肾炎患者肾功能改变及肾脏病理损伤情况,特别是髓质FA值不仅可以反映肾小球损伤、肾小管-间质纤维化的程度,而且对原发性肾小球肾炎早期病理损害具有较好的诊断价值。
Objective To assess the clinical value of 3.0 T magnetic resonance diffusion tensor imaging parameters(the ADC value and the FA value) for renal function and pathological damage of patients with primary glomerulonephritis. Methods Sixty patients with primary glomerulonephritis confirmed by the pathology and 20 healthy volunteers were selected into our study,and were examined by MR routine and DTI sequence scan. All of patients to complete the examination of renal biopsy and renal function index before or after MR scan. All of the patients were divided into two subgroups according to Katafuchi's Nephrology score. The ADC value and FA value was measured,and the difference between the normal control group and the lesion group was compared by one-way analysis of variance(ANOVA). Pearson correlation analyses were used for the relationship between ADC value and FA value and renal function index, clinical stage and pathological damage. Results The ADC values and FA values of renal cortex and medulla were significant differences between the control group,the mild injury group and the moderate-severe injury group(all P<0.05); The ADC value and FA value of renal cortex medulla was decreased with the degree of pathological damage increased.There was a positive correlation between renal medulla ADC value,FA value and eGFR in patients with primary glomerulonephritis(r=0.475,P<0.05;r=0.846,P<0.001),but negatively correlated with Scr,24-upro and CKD staging(all P<0.05); The correlation of renal medulla FA value was significantly higher than that of the ADC value. There was a significant negative correlation between the medullary FA value and the score of the three pathological lesions(r =-0.768、-0.848、-0.468,respectively; all P<0.05). Identify the control group and the mild injury group,the medulla FA value showed better diagnostic ability with accuracy of 89.2%,and the best diagnostic value of medulla FA value was 0.463,the sensitivity and specificity were 92.4% and 84.6%,respectively. Conclusion DTI can invasively evaluate the renal function changes and renal pathological damage in patients with primary glomerulonephritis,in particular,changes of the medulla FA value can reflect glomerular injury and the degree of renal tubular-interstitial fibrosis. DTI showed a better diagnostic value for the early pathological damage of patients with primary glomerulonephritis.
Objective To assess the clinical value of 3.0 T magnetic resonance diffusion tensor imaging parameters(the ADC value and the FA value) for renal function and pathological damage of patients with primary glomerulonephritis. Methods Sixty patients with primary glomerulonephritis confirmed by the pathology and 20 healthy volunteers were selected into our study,and were examined by MR routine and DTI sequence scan. All of patients to complete the examination of renal biopsy and renal function index before or after MR scan. All of the patients were divided into two subgroups according to Katafuchi's Nephrology score. The ADC value and FA value was measured,and the difference between the normal control group and the lesion group was compared by one-way analysis of variance(ANOVA). Pearson correlation analyses were used for the relationship between ADC value and FA value and renal function index, clinical stage and pathological damage. Results The ADC values and FA values of renal cortex and medulla were significant differences between the control group,the mild injury group and the moderate-severe injury group(all P<0.05); The ADC value and FA value of renal cortex medulla was decreased with the degree of pathological damage increased.There was a positive correlation between renal medulla ADC value,FA value and eGFR in patients with primary glomerulonephritis(r=0.475,P<0.05;r=0.846,P<0.001),but negatively correlated with Scr,24-upro and CKD staging(all P<0.05); The correlation of renal medulla FA value was significantly higher than that of the ADC value. There was a significant negative correlation between the medullary FA value and the score of the three pathological lesions(r =-0.768、-0.848、-0.468,respectively; all P<0.05). Identify the control group and the mild injury group,the medulla FA value showed better diagnostic ability with accuracy of 89.2%,and the best diagnostic value of medulla FA value was 0.463,the sensitivity and specificity were 92.4% and 84.6%,respectively. Conclusion DTI can invasively evaluate the renal function changes and renal pathological damage in patients with primary glomerulonephritis,in particular,changes of the medulla FA value can reflect glomerular injury and the degree of renal tubular-interstitial fibrosis. DTI showed a better diagnostic value for the early pathological damage of patients with primary glomerulonephritis.
引文
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13叶靖,吴晶涛,张萍.磁共振扩散张量成像对新西兰白兔糖尿病肾病诊断价值的初步研究[J].中国现代医学杂志,2012,22:37-39.
14钮亚珍,高明,冯娜,等.慢性肾脏病患者肾脏皮髓质各向异性分数值与肾脏功能的相关性研究[J].中国医师进修杂志,2014,37:59-61.
15 Cheung JS,Fan SJ,Chow AM,et al.Diffusion tensor imaging of renal ischemia reperfusion injury in an experimental model[J].NMRin Biomedicine,2010,23:496-502.
16 Xiao WB,Wang QD,Xu JJ,et al.Evaluation of kidney oxygen bioavailability in acute renal failure by blood oxygen level dependent magnetic resonance imaging[J].Zhejiang da xue xue bao.Medical sciences,2010,39:157-162.
17 Togao O,Doi S,Kuro-o M,et al.Assessment of Renal Fibrosis with Diffusion-weighted MR Imaging:Study with Murine Model of Unilateral Ureteral Obstruction 1[J].Radiology,2010,255:772-780.
2 Jha V,Garcia-Garcia G,Iseki K,et al.Chronic kidney disease:global dimension and perspectives[J].The Lancet,2013,382:260-272.
3 Inker LA,Schmid CH,Tighiouart H,et al.Estimating glomerular filtration rate from serum creatinine and cystatin C[J].New England Journal of Medicine,2012,367:20-29.
4 Liu Z,Xu Y,Zhang J,et al.Chronic kidney disease:pathological and functional assessment with diffusion tensor imaging at 3T MR[J].European radiology,2015,25:652-660.
5 Jiang SH,Karpe KM,Talaulikar GS.Safety and predictors of complications of renal biopsy in the outpatient setting[J].Clinical nephrology,2011,76:464-469.
6 Wang YC,Feng Y,Lu CQ,et al.Renal fat fraction and diffusion tensor imaging in patients with early-stage diabetic nephropathy[J].European radiology,2018,12:1-9.
7王文娟,郭燕,王丽琴,等.正常人肾脏磁共振扩散张量成像及可重复性[J].中国医学影像技术,2012,28:2064-2067.
8 Kataoka M,Kido A,Yamamoto A,et al.Diffusion tensor imaging of kidneys with respiratory triggering:optimization of parameters to demonstrate anisotropic structures on fraction anisotropy maps[J].Journal of Magnetic Resonance Imaging,2009,29:736-744.
9 Li Y,Lee MM,Worters PW,et al.Pilot Study of Renal Diffusion Tensor Imaging as a Correlate to Histopathology in Pediatric Renal Allografts[J].American Journal of Roentgenology,2017,208:1358-1364.
10 Zheng Z,Shi H,Zhang J,et al.Renal water molecular diffusion characteristics in healthy native kidneys:assessment with diffusion tensor MR imaging[J].Plo S one,2014,9:e113469.
11 Lanzman RS,Ljimani A,Pentang G,et al.Kidney transplant:functional assessment with diffusion-tensor MR imaging at 3T[J].Radiology,2013,266:218-225.
12 Kaimori JY,Isaka Y,Hatanaka M,et al.Visualization of kidney fibrosis in diabetic nephropathy by long diffusion tensor imaging MRIwith spin-echo sequence[J].Scientific Reports,2017,7:5731.
13叶靖,吴晶涛,张萍.磁共振扩散张量成像对新西兰白兔糖尿病肾病诊断价值的初步研究[J].中国现代医学杂志,2012,22:37-39.
14钮亚珍,高明,冯娜,等.慢性肾脏病患者肾脏皮髓质各向异性分数值与肾脏功能的相关性研究[J].中国医师进修杂志,2014,37:59-61.
15 Cheung JS,Fan SJ,Chow AM,et al.Diffusion tensor imaging of renal ischemia reperfusion injury in an experimental model[J].NMRin Biomedicine,2010,23:496-502.
16 Xiao WB,Wang QD,Xu JJ,et al.Evaluation of kidney oxygen bioavailability in acute renal failure by blood oxygen level dependent magnetic resonance imaging[J].Zhejiang da xue xue bao.Medical sciences,2010,39:157-162.
17 Togao O,Doi S,Kuro-o M,et al.Assessment of Renal Fibrosis with Diffusion-weighted MR Imaging:Study with Murine Model of Unilateral Ureteral Obstruction 1[J].Radiology,2010,255:772-780.