MR功能成像对慢性肾脏病肾脏损伤的临床相关研究
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摘要
慢性肾脏病（chronic kidney disease, CKD）是以慢性肾小球和/或肾小管间质病变导致的进行性肾功能损伤为特征的疾病，其发病率高，肾脏纤维化和组织缺氧被认为是导致CKD进展的重要因素。目前所用的临床指标对早期CKD的识别，以及对肾功能和肾脏病理改变的检测缺乏敏感性和特异性。探索无创性的、敏感性及可重复性强的检查方法来评价肾损伤的程度，是当前临床工作者热切关注的课题。本研究应用3.0T MR对慢性肾脏病患者及健康志愿者的肾脏进行弥散加权成像（diffusion weightedimaging, DWI）、弥散张量成像（diffusion tensor imaging, DTI）和血氧水平依赖（blood oxygen level dependent, BOLD）成像，分别测量研究对象的肾脏皮质和髓质表观弥散系数（apparent diffusion coefficient, ADC）值、各向异性分数（fractional anisotropy, FA）值及R2*值，并比较CKD患者与健康志愿者肾脏各检测值的差异，同时与临床相关指标、肾脏病理组织学评分及免疫组织化学指标进行对照分析，探讨MR功能成像对CKD患者肾脏损伤程度临床应用的价值。
第一部分MR弥散加权成像对慢性肾脏病肾组织纤维化的研究
目的：应用3.0T MR弥散加权成像对慢性肾脏病患者的肾脏纤维化程度进行检测，评价其临床应用价值。
方法：选取2012年5月至2013年6月间在河北医科大学第三医院肾内科就诊的40例CKD患者，其中男性25例，女性15例，年龄16-71岁，平均年龄41.6±17.1岁。选取30例健康志愿者作为对照组，其中男性20例，女性10例，年龄24-60岁，平均年龄38.3±14.1岁。所有CKD患者及健康志愿者均采用3.0T MR进行扫描。扫描序列包括MRI常规扫描及弥散加权成像。在ADC图上肾皮质和髓质均放置感兴趣区域（region ofinterest, ROI），测量双侧肾脏皮质及髓质的ADC值。在MR检查前后一周时间内，对CKD患者留取血尿样本，检测血肌酐（serum creatinine, SCr）和24小时尿蛋白（24-h-urinary protein,24-h-UPRO）。通过SCr值计算出估算的肾小球滤过率（estimated glomerular filtration rate, eGFR）。其中有25例患者在MR检查后不超过2周的时间内进行了肾组织活检。肾活检标本行常规苏木素-伊红染色（atoxvlin and eosin stain，HE）、糖元染色（Periodic Acid．Shift's Reaction，PAS）、Masson染色及过碘酸六胺银染色（periodic acid．silver metheramine，PASM）检查，观察CKD肾脏病理损伤程度，分别对肾小球、肾小管间质和肾小管周血管的纤维化硬化进行观察，并得出评分。免疫组织化学法检测肾组织中TGF-β1及α-SMA蛋白的表达，光镜下观察并进行图像采集，每例标本随机选取10个高倍视野，计算每个视野内阳色染色区域的积分光密度值，最后计算其均值用于统计学分析。CKD患者和健康对照组之间肾髓质和肾皮质的ADC值的差异性分别进行了两独立样本t检验。肾皮质ADC值和肾髓质ADC值之间的差异也采用两独立样本t检验比较。探讨ADC值和SCr/24-h-UPRO/eGFR之间的关系，通过bivariate相关分析计算相关系数，肾小球病变/肾小管病变组织病理学评分和免疫组织化学指标TGF-β1及α-SMA同肾皮质/肾髓质的ADC值也进行bivariate相关分析。
结果：40例CKD患者中有35例图像可以进行分析。肾皮质和髓质的ADC值的组内相关系数（intraclass correlation coefficients, ICC）分别为0.79和0.82。CKD组肾皮质和髓质的ADC值与健康对照组相比均明显降低。CKD组显示肾皮质的ADC值和SCr/24-h-UPRO呈显著的负相关，而与eGFR呈显著正相关。肾髓质的ADC值和SCr之间也有显著的负相关性。发现肾髓质的ADC值与eGFR和24-h-UPRO之间没有显著的相关性。肾皮质ADC值与肾小球病变组织病理学评分呈显著负相关，r=-0.610，p=0.001。肾皮质ADC值与肾小管病变组织病理学评分呈显著负相关，r=-0.778，p=0.000。肾髓质ADC值与肾小球病变组织病理学评分呈显著负相关，r=-0.398，p=0.049。肾髓质ADC值与肾小管病变组织病理学评分呈显著负相关，r=-0.640，p=0.001。肾皮质ADC值与α-SMA的积分光密度值之间呈显著负相关，r=-0.441，p=0.027。肾髓质ADC值与α-SMA的积分光密度值之间无显著相关性，r=-0.354，p=0.083。肾皮质ADC值与TGF-β1积分光密度值之间无显著相关性，r=-0.362，p=0.075。肾髓质的ADC值与TGF-β1积分光密度值之间无显著相关性，r=-0.289，p=0.162。
结论：3.0T MR弥散加权成像检测CKD患者肾脏的ADC值与eGFR、肾脏组织纤维化程度及α-SMA表达之间具有一定的相关性，可用于CKD患者肾脏纤维化程度的检查评估。第二部分MR弥散张量成像对慢性肾脏病肾组织病变的研究
目的：应用3.0T MR弥散张量成像对慢性肾脏病患者的肾脏病变程度进行检测，评价其临床应用价值。
方法：选取2012年5月至2013年6月间在河北医科大学第三医院肾内科就诊的40例CKD患者，其中男性25例，女性15例，年龄16-71岁，平均年龄41.6±17.1岁。64名健康志愿者作为对照组，其中男性39例，女性25例，年龄21-60岁，平均年龄38.5±13.3岁。所有CKD患者及健康志愿者均采用3.0T MR进行扫描。扫描序列包括MRI常规扫描及弥散张量成像。在FA图上分别测量双侧肾脏皮质及髓质的FA值。每个研究对象均选择最靠近肾门的冠状面FA图像进行感兴趣区的测量。分别在肾的上极、中部及下极肾皮质区放置3个ROI，采用的结果为双侧肾6个肾皮质上ROI的平均值。在MR检查前后一周时间内，对CKD患者留取血尿样本，检测血肌酐（SCr）和24小时尿蛋白（24-h-UPRO）。通过SCr值计算出估算的肾小球滤过率（eGFR）。其中有24例患者在MR检查后不超过2周的时间内进行了肾组织活检。肾活检标本行常规HE染色、PAS染色、Masson染色及PASM染色检查。观察CKD肾脏病理损伤程度，分别对肾小球、肾小管间质和肾小管周血管的纤维化硬化进行观察，并得出评分。免疫组织化学法检测肾组织中TGF-β1及α-SMA蛋白的表达，光镜下观察并进行图像采集，每例标本随机选取10个高倍视野，计算每个视野内阳色染色区域的积分光密度值，最后计算其均值用于统计学分析。将两位医师测得的肾皮质和肾髓质FA值用组内相关系数进行一致性分析。CKD患者和健康对照组之间肾髓质和肾皮质的FA值分别进行了比较，进行两独立样本t检验。肾皮质FA值和肾髓质FA值之间的差异也采用两独立样本t检验进行比较。通过bivariate相关分析探讨FA值和SCr/24-h-UPRO/eGFR之间的关系，肾小球、肾小管病理学评分、免疫组织化学TGF-β1、α-SMA的积分光密度值分别同肾皮质、肾髓质的FA值也进行bivariate相关性分析。
结果：40例CKD患者中排除7例患者DTI图像伪影较重，共对33例患者图像进行了分析。肾皮质和髓质的FA值的组内相关系数分别为0.77和0.56。CKD组肾皮质和肾髓质FA值与健康对照组相比均具有显著性差异，CKD组肾皮质FA值明显低于对照组。CKD组肾髓质的FA值与对照组相比也明显降低。CKD组肾皮质FA值明显低于髓质FA值，t=-3.598，p=0.001。对照组肾皮质FA值也明显低于髓质FA值， t=-15.703，p=0.000。
肾皮质的FA值和SCr呈显著的负相关，肾皮质的FA值与eGFR显著正相关。临床指标中肾髓质的FA值仅与eGFR呈显著正相关。无论是肾皮质还是肾髓质的FA值和24-h-UPRO之间均无显著的相关性。肾皮质FA值与组织病理学肾小球的评分呈显著负相关，r=-0.448，p=0.028。肾皮质FA值与组织病理学肾小管的评分呈显著负相关，r=-0.487，p=0.016。肾髓质的FA值与组织病理学肾小球评分呈显著负相关，r=-0.463，p=0.023。肾髓质的FA值与组织病理学肾小管评分呈显著性负相关，r=-0.430，p=0.036。肾皮质FA值与α-SMA的积分光密度值之间呈显著负相关，r=-0.636，p=0.001。肾髓质FA值与α-SMA的积分光密度值之间呈显著相关性，r=-0.432，p=0.035。肾皮质FA值与TGF-β1积分光密度值之间无显著相关性，r=-0.175，p=0.401。肾髓质的FA值与TGF-β1积分光密度值之间无显著相关性，r=-0.189，p=0.357。
结论：3.0T MR弥散加权成像获得的FA值，可在一定程度上定量评价CKD患者肾功能及肾脏病理变化的程度。第三部分MR BOLD成像对慢性肾脏病肾组织氧合状态的研究
目的：评价3.0T MR血氧水平依赖（BOLD）成像对慢性肾脏病患者肾组织氧合状态的探测能力及临床应用价值。
方法：选取2012年5月至2013年6月间在河北医科大学第三医院肾内科就诊的40例CKD患者，其中男性25例，女性15例，年龄16-71岁，平均年龄41.6±17.1岁。65名健康志愿者作为对照组，其中男性39例，女性26例，平均年龄38.3±13.3岁，年龄范围21-60岁。所有CKD患者及健康志愿者均采用3.0T MR进行扫描。扫描序列包括MRI常规成像及BOLD成像。在T2*图上分别测量双侧肾脏皮质及髓质的T2*值，并计算得出R2*值。每个研究对象均选择最靠近肾门的冠状面BOLD图像进行感兴趣区的测量。分别得到肾皮质R2*值、肾髓质R2*值，并计算出肾髓质/肾皮质R2*比值。在MR检查前后一周时间内，对CKD患者留取血尿样本，检测血肌酐（SCr）和24小时尿蛋白（24-h-UPRO）。通过SCr值计算出估算的肾小球滤过率（eGFR）。其中有25例患者在MR检查后不超过2周的时间内进行了肾组织活检。肾活检标本行常规HE染色、PAS染色、Masson染色及PASM染色检查。观察CKD肾脏病理损伤程度，分别对肾小球、肾小管间质和肾小管周血管的纤维化硬化进行观察，并得出评分。免疫组织化学法检测肾组织中TGF-β1及α-SMA蛋白的表达，光镜下观察并进行图像采集，每例标本随机选取10个高倍视野，计算每个视野内阳色染色区域的积分光密度值，最后计算其均值用于统计学分析。将两位医师测得的肾皮质R2*值、肾髓质R2*值用组内相关系数进行一致性分析。采用两独立样本t检验分别比较CKD患者和健康对照组之间肾皮质R2*值、肾髓质R2*值及肾髓质/肾皮质R2*比值的差异。肾皮质R2*值和肾髓质R2*值之间的差异也采用两独立样本t检验比较。通过bivariate相关分析探讨肾皮质R2*值、肾髓质R2*值以及肾髓质/肾皮质R2*比值和SCr/24-h-UPRO/eGFR之间的相关关系，肾小球、肾小管病理学评分和免疫组织化学TGF-β1、α-SMA的积分光密度值分别同肾皮质R2*值、肾髓质R2*值及肾髓质/肾皮质R2*比值进行bivariate相关分析。
结果：40例CKD患者中35例患者BOLD图像进行了分析。肾皮质和髓质的R2*值的组内相关系数分别为0.81和0.72。CKD组肾皮质R2*明显低于肾髓质R2*值，t=-7.576，p=0.000。对照组肾皮质R2*明显低于髓质R2*值，t=-13.467，p=0.000。CKD组肾髓质的R2*值与对照组肾髓质相比明显增高，CKD组肾髓质/肾皮质R2*比值与对照组相比明显增高，CKD组肾皮质R2*值与健康对照组无显著性差异。肾皮质R2*值、肾髓质的R2*值以及肾髓质/肾皮质R2*比值和各临床指标及病理组织学评分均无显著的相关性。肾皮质R2*值与组织病理学肾小管的评分无显著相关。肾髓质与组织病理学肾小球及肾小管病变的评分呈显著相关。肾髓质/肾皮质R2*比值与肾小球病变评分呈显著相关。肾皮质R2*值与仅与TGF-β1积分光密度值之间有显著相关性。肾髓质R2*值与α-SMA的积分光密度值及TGF-β1积分光密度值之间无显著相关性。肾髓质/肾皮质R2*比值与α-SMA的积分光密度值及TGF-β1积分光密度值之间无显著相关性。
结论：3.0T MR BOLD成像能够在一定程度上定量评价CKD患者肾脏氧合变化的程度。
Chronic kidney disease (CKD) is a prevalence disease and characterizedby progressive loss of kidney function due to chronic glomerular and/ortubulointerstitial injury. Renal fibrosis and hypoxia is considered to beimportant factors leading to the development of CKD. Clinical indicatorscurrently used for early CKD lack of sensitivity and specificity for thedetection of changes in renal function and renal pathology. To explore anoninvasive, sensitive and repeatable inspection method to evaluate the degreeof renal damage, is the current clinical workers eager concern. Diffusionweighted imaging (DWI), diffusion tensor imaging (DTI), and bloodoxygenation level dependent (BOLD) MRI were used to evaluate CKD patientsin our study. Apparent diffusion coefficient (ADC) value, FA value, and R2*value were measured on both renal cortex and medulla in patients with CKDusing3.0T MR scanner. The difference between healthy volunteers and CKDpatients were analyzed according to renal cortex and medulla. The aim of thisstudy was to explore the clinical application value of functional MR imaging inpatients with CKD. The correlation between MR data and clinical indexes,renal histopathological scores and immunohistochemical markers wereanalyzed.
Part1Assessment of renal fibrosis in chronic kidney disease using
diffusion weighted magnetic resonance imaging
Objective: To assess the performance of diffusion weighted imaging(DWI) for the assessment of renal fibrosis in chronic kidney disease (CKD),with histopathology as a reference standard.
Methods: From May2013to June2012, forty patients (25male,15female, mean age41.6±17.1years, range16-71years) with a clinicaldiagnosis of CKD were recruited for participation in this study in nephrology department of the third hospital of Hebei medical university. Thirty healthyvolunteers (20male and10women; average age38.3±14.1years, range24-60years) were also recruited and served as controls. All subjects underwent bothstandard MRI and DW MRI. To measure ADC values of both kidneys, ROIswere placed in the medulla and cortex on the ADC map. For CKD patients,serum creatinine (SCr) and24-h-urinary protein(24-h-UPRO) were obtainedwithin one week before or after MR scan. eGFRs were calculated from SCrmeasurements for all subjects. Renal biopsy was performed in25patients withCKD within2weeks following the MRI scans. The atoxvlin and eosin (HE)stain, periodic acid shift's reaction (PAS) stain, Masson stain, and periodicacid-silver methenamine (PASM) stain were used for pathologic score of renalfibrosis. The sclerotic/fibrotic lesions of glomerulus and renal tubuleinterstitial were evaluated and scored. For the immunohistochemistry test ofTGF-β1and α-SMA, the images were obtained and analzed by the imageanalysis system under light microscope. Ten observation fields were selectedrandomly for each case. After scaled the image, the integrated optical densitywas calculated for each view. Finally, average of the integrated optical densitywas served as data for statistic. Mean medullary and cortical ADC valuesbetween CKD patients and healthy control subjects were compared using twoindependent samples t test, respectively. The difference between renal corticalADC and medullary ADC were analyzed using two independent sample t testfor healthy control subjects and CKD patients respectively. Bivariatecorrelation coefficients were used to investigate the relationship between ADCvalue and SCr/24-h-UPRO/eGFR. Bivariate correlation coefficients were usedto evaluate the relationship between ADC value and renalglomeruli/tubulo-interstial histopathological scores and immunohistochemicalmarkers for TGF-β1and α-SMA respectively.
Results: Data from35out of40patients could be successfully analyzed.ICC of renal cortical ADC values and medullary ADC values were0.79and0.82respectively. Cortical and medullary ADC values in patients with CKDwere significantly decreased when compared to those from healthy controls. In CKD group, a significant negative correlation was found between corticalADC values and SCr/24-h-UPRO, and significant positive correlation wasfound between cortical ADC values and eGFR. There was also significantnegative correlation between medullary ADC values and SCr. No significantlycorrelation was found between medullary ADC values and eGFR/24-h-UPRO.There was a significant inverse correlation between cortical ADC andglomeruli lesions histopathologic score, with r=-0.610, p=0.001. There wasa significant inverse correlation between cortical ADC and tubulo-interstiallesions histopathologic score, with r=-0.778, p=0.000. Significant inversecorrelation was found between medullary ADC and glomeruli lesionshistopathologic score, with r=-0.398, p=0.049. Significant inversecorrelation was found between medullary ADC and tubulo-interstial lesionshistopathologic score, with r=-0.640, p=0.001. There was a significantinverse correlation between cortical ADC and theintegrated optical density ofα-SMA, with r=-0.441，p=0.027. No significant correlation was foundbetween medullary ADC and theintegrated optical density of α-SMA, with r=-0.354, p=0.083. No significant correlation was found between cortical ADCand theintegrated optical density of TGF-β1, with r=-0.362, p=0.075. Nosignificant correlation was found between medullary ADC and theintegratedoptical density of TGF-β1, with r=-0.289, p=0.162.
Conclusion:3.0T MR diffusion weighted imaging in detection of renalADC in patients with CKD has certain correlation with eGFR and expressionofα-SMA. This can be used to assess the severity of renal fibrosis in patientswith CKD.
Part2Assessment of renal lesions in patients with chronic kidney
disease by diffusion tensor magnetic resonance imaging
Objective: To evaluate the clinical value of3.0T diffusion tensor MRimaging in detecting renal lesions in patients with chronic kidney disease.
Methods: From May2013to June2012, forty patients (25male,15female, mean age41.6±17.1years, range16-71years) with a clinicaldiagnosis of CKD were recruited for participation in this study in nephrology department of the third hospital of Hebei medical university. Sixty-fourhealthy volunteers (39male and25women; average age38.5±13.3years,range21-60years) were also recruited and served as controls. All of thesubjects underwent both standard MRI and diffusion tensor MRI. To measureFA values of both kidneys, ROIs were placed in the medulla and cortex on theADC map. The coronal slices closest to the renal hilum of the left and rightkidneys were selected for ROI analysis. ROIs were placed at the upper, middleand lower pole of each kidney in the medulla and cortex on the FA map. Foreach subject, mean cortical ADC values were obtained by averaging6corticalROIs obtained from both kidneys. Similarly, mean medullary ADC valueswere obtained by averaging6medullary ROIs obtained from both kidneys.For CKD patients, serum creatinine (SCr) and24-h-urinary protein(24-h-UPRO) were obtained within one week before or after MR scan. eGFRswere calculated from SCr measurements for all subjects.
Renal biopsy was performed in25patients with CKD within2weeksfollowing the MRI scans. The HE stain, PAS stain, Masson stain, and PASMstain were used for pathologic score of renal fibrosis. The sclerotic/fibroticlesions of glomerulus and renal tubule interstitial were evaluated and scored.For the immunohistochemistry test of TGF-β1and α-SMA, the images wereobtained and analzed by the image analysis system under light microscope.Ten observation fields were selected randomly for each case. After scaled theimage, theintegrated optical density was calculated for each view. Finally,average of theintegrated optical density was served as data for statistic. Dataon intra-observer agreement was determined by intraclass correlationcoefficients (ICC). Mean medullary and cortical FA values between CKDpatients and healthy control subjects were compared using two independentsamples t test, respectively. The difference between renal cortical FA andmedullary FA were analyzed using two independent sample t test for healthycontrol subjects and CKD patients respectively. Bivariate correlationcoefficients were used to investigate the relationship between FA value andSCr/24-h-UPRO/eGFR. Bivariate correlation coefficients were used to evaluate the relationship between FA values and renal histopathological scoresand immunohistochemical markers for TGF-β1and α-SMA respectively.
Results: Data from33out of40patients could be successfully analyzed.ICC of renal cortical FA values and medullary FA values were0.77and0.56respectively. Cortical and medullary FA values in patients with CKD weresignificantly decreased when compared to those from healthy controls. InCKD group, cortical FA was significantly lower than medullary FA, witht=-3.598，p=0.001. In control group, cortical FA was significantly lower thanmedullary FA, with t=-15.703，p=0.000. Significant negative correlation wasfound between cortical ADC values and SCr for CKD group. Significantpositive correlation was found between cortical FA values and eGFR. Therewas significant positive correlation between medullary FA values and eGFR.No significantly correlation was found between cortical/medullary ADCvalues and eGFR/24-h-UPRO. There was a significant inverse correlationbetween cortical FA and glomeruli lesions histopathologic score, with r=-0.448, p=0.028. There was a significant inverse correlation between corticalFA and tubulo-interstial lesions histopathologic score with r=-0.487, p=0.016.Significant inverse correlation was found between medullary FA andglomeruli lesions histopathologic score, with r=-0.463, p=0.023. Significantinverse correlation was found between medullaryFA and tubulo-interstiallesions histopathologic score, with r=-0.430, p=0.036.
There was a significant inverse correlation between cortical FA and theintegrated optical density of α-SMA, with r=-0.636, p=0.001. There was asignificant inverse correlation between medullary FA and the integratedoptical density of α-SMA, with r=-0.432, p=0.035. No significantcorrelation was found between cortical FA and theintegrated optical density ofTGF-β1, with r=-0.175, p=0.401。No significant correlation was foundbetween medullary FA and the integrated optical density of TGF-β1, with r=-0.189, p=0.357.
Conclusion: Renal ADC values of3.0T MR DTI could quantitivelyevaluate the renal pathology changes in patients with CKD.
Part3Assessment of renal oxygenation in patients with chronic kidney
disease by blood oxygenation level dependent MR imagingObjective: To evaluate the value of clinical application of3.0T blood oxygenlevel-dependent (BOLD)MR imaging in detecting renal oxygenation inpatients with chronic kidney disease.
Methods: From May2013to June2012, forty patients (25male,15female, mean age41.6±17.1years, range16-71years) with a clinicaldiagnosis of CKD were recruited for participation in this study in nephrologydepartment of the third hospital of Hebei medical university. Sixty-fivehealthy volunteers (39male and26women; average age38.3±13.3years,range21-60years) were also recruited and served as controls. All of thesubjects underwent both standard MRI and BOLD MRI. To measure T2*values of both kidneys, ROIs were placed in the medulla and cortex on theT2*map. The coronal slices closest to the renal hilum of the left and rightkidneys were selected for ROI analysis. Then cortical R2*values, medullaryR2*values and medulla/cortex R2*ratio could be calculated. For CKDpatients, serum creatinine (SCr) and24-h-urinary protein (24-h-UPRO) wereobtained within one week before or after MR scan. eGFRs were calculatedfrom SCr measurements for all subjects. Renal biopsy was performed in25patients with CKD within2weeks following the MRI scans. The HE stain,PAS stain, Masson stain, and PASM stain were used for pathologic score ofrenal fibrosis. The sclerotic/fibrotic lesions of glomerulus and renal tubuleinterstitial were evaluated and scored. For the immunohistochemistry test ofTGF-β1and α-SMA, the images were obtained and analzed by the imageanalysis system under light microscope. Ten observation fields were selectedrandomly for each case. After scaled the image, the integrated optical densitywas calculated for each view. Finally, average of the integrated optical densitywas served as data for statistic. Data on intra-observer agreement wasdetermined by intraclass correlation coefficients (ICC). Mean cortical R2*values, medullary R2*values and medulla/cortex R2*ratio between CKDpatients and healthy control subjects were compared using two independent samples t test, respectively. The difference between renal cortical R2*andmedullary R2*were analyzed using two independent sample t test for healthycontrol subjects and CKD patients respectively. Bivariate correlationcoefficients were used to investigate the relationship between R2*value andSCr/24-h-UPRO/eGFR. Bivariate correlation coefficients were used toevaluate the relationship between cortical R2*values, medullary R2*values,medulla/cortex R2*ratio, and glomeruli lesions histopathologic score,tubulo-interstial lesions histopathologic score, the integrated optical density ofα-SMA, the integrated optical density of TGF-β1.
Results: Data from35out of40patients could be successfully analyzed.ICC of renal cortical R2*values and medullary R2*values were0.81and0.72respectively. cortical R2*was significantly lower than medullary FA, with t=-7.576, p=0.000. In control group, cortical R2*was significantly lower thanmedullary FA, with t=-13.467, p=0.000. Medullary R2*values in patientswith CKD were significantly increased when compared to those from healthycontrols. Medulla/cortex R2*ratio in patients with CKD were significantlyincreased when compared to those from healthy controls. No significantlydifference of cortical R2*between CKD and controls. No significantlycorrelation was found between cortical R2*values, medullary R2*values,medulla/cortex R2*ratio, and SCr,24-h-UPRO, eGFR, glomeruli lesionshistopathologic score, tubulo-interstial lesions histopathologic score.Significant correlation was found between medullary R2*values andglomeruli lesions histopathologic score, tubulo-interstial lesionshistopathologic score. Significant correlation was found betweenmedulla/cortex R2*ratio and glomeruli lesions histopathologic score,tubulo-interstial lesions histopathologic score. There was a significantcorrelation between corticalR2*and the integrated optical density of TGF-β1.No significant correlation was found between medullary R2*and theintegrated optical density of α-SMA and TGF-β1. No significant correlationwas found between medulla/cortex R2*ratio and the integrated optical densityof α-SMA or TGF-β1.
Conclusion:3.0T BOLD MR could quantitively evaluate theoxygenation changes in patients with CKD.
第一部分MR弥散加权成像对慢性肾脏病肾组织纤维化的研究
目的：应用3.0T MR弥散加权成像对慢性肾脏病患者的肾脏纤维化程度进行检测，评价其临床应用价值。
方法：选取2012年5月至2013年6月间在河北医科大学第三医院肾内科就诊的40例CKD患者，其中男性25例，女性15例，年龄16-71岁，平均年龄41.6±17.1岁。选取30例健康志愿者作为对照组，其中男性20例，女性10例，年龄24-60岁，平均年龄38.3±14.1岁。所有CKD患者及健康志愿者均采用3.0T MR进行扫描。扫描序列包括MRI常规扫描及弥散加权成像。在ADC图上肾皮质和髓质均放置感兴趣区域（region ofinterest, ROI），测量双侧肾脏皮质及髓质的ADC值。在MR检查前后一周时间内，对CKD患者留取血尿样本，检测血肌酐（serum creatinine, SCr）和24小时尿蛋白（24-h-urinary protein,24-h-UPRO）。通过SCr值计算出估算的肾小球滤过率（estimated glomerular filtration rate, eGFR）。其中有25例患者在MR检查后不超过2周的时间内进行了肾组织活检。肾活检标本行常规苏木素-伊红染色（atoxvlin and eosin stain，HE）、糖元染色（Periodic Acid．Shift's Reaction，PAS）、Masson染色及过碘酸六胺银染色（periodic acid．silver metheramine，PASM）检查，观察CKD肾脏病理损伤程度，分别对肾小球、肾小管间质和肾小管周血管的纤维化硬化进行观察，并得出评分。免疫组织化学法检测肾组织中TGF-β1及α-SMA蛋白的表达，光镜下观察并进行图像采集，每例标本随机选取10个高倍视野，计算每个视野内阳色染色区域的积分光密度值，最后计算其均值用于统计学分析。CKD患者和健康对照组之间肾髓质和肾皮质的ADC值的差异性分别进行了两独立样本t检验。肾皮质ADC值和肾髓质ADC值之间的差异也采用两独立样本t检验比较。探讨ADC值和SCr/24-h-UPRO/eGFR之间的关系，通过bivariate相关分析计算相关系数，肾小球病变/肾小管病变组织病理学评分和免疫组织化学指标TGF-β1及α-SMA同肾皮质/肾髓质的ADC值也进行bivariate相关分析。
结果：40例CKD患者中有35例图像可以进行分析。肾皮质和髓质的ADC值的组内相关系数（intraclass correlation coefficients, ICC）分别为0.79和0.82。CKD组肾皮质和髓质的ADC值与健康对照组相比均明显降低。CKD组显示肾皮质的ADC值和SCr/24-h-UPRO呈显著的负相关，而与eGFR呈显著正相关。肾髓质的ADC值和SCr之间也有显著的负相关性。发现肾髓质的ADC值与eGFR和24-h-UPRO之间没有显著的相关性。肾皮质ADC值与肾小球病变组织病理学评分呈显著负相关，r=-0.610，p=0.001。肾皮质ADC值与肾小管病变组织病理学评分呈显著负相关，r=-0.778，p=0.000。肾髓质ADC值与肾小球病变组织病理学评分呈显著负相关，r=-0.398，p=0.049。肾髓质ADC值与肾小管病变组织病理学评分呈显著负相关，r=-0.640，p=0.001。肾皮质ADC值与α-SMA的积分光密度值之间呈显著负相关，r=-0.441，p=0.027。肾髓质ADC值与α-SMA的积分光密度值之间无显著相关性，r=-0.354，p=0.083。肾皮质ADC值与TGF-β1积分光密度值之间无显著相关性，r=-0.362，p=0.075。肾髓质的ADC值与TGF-β1积分光密度值之间无显著相关性，r=-0.289，p=0.162。
结论：3.0T MR弥散加权成像检测CKD患者肾脏的ADC值与eGFR、肾脏组织纤维化程度及α-SMA表达之间具有一定的相关性，可用于CKD患者肾脏纤维化程度的检查评估。第二部分MR弥散张量成像对慢性肾脏病肾组织病变的研究
目的：应用3.0T MR弥散张量成像对慢性肾脏病患者的肾脏病变程度进行检测，评价其临床应用价值。
方法：选取2012年5月至2013年6月间在河北医科大学第三医院肾内科就诊的40例CKD患者，其中男性25例，女性15例，年龄16-71岁，平均年龄41.6±17.1岁。64名健康志愿者作为对照组，其中男性39例，女性25例，年龄21-60岁，平均年龄38.5±13.3岁。所有CKD患者及健康志愿者均采用3.0T MR进行扫描。扫描序列包括MRI常规扫描及弥散张量成像。在FA图上分别测量双侧肾脏皮质及髓质的FA值。每个研究对象均选择最靠近肾门的冠状面FA图像进行感兴趣区的测量。分别在肾的上极、中部及下极肾皮质区放置3个ROI，采用的结果为双侧肾6个肾皮质上ROI的平均值。在MR检查前后一周时间内，对CKD患者留取血尿样本，检测血肌酐（SCr）和24小时尿蛋白（24-h-UPRO）。通过SCr值计算出估算的肾小球滤过率（eGFR）。其中有24例患者在MR检查后不超过2周的时间内进行了肾组织活检。肾活检标本行常规HE染色、PAS染色、Masson染色及PASM染色检查。观察CKD肾脏病理损伤程度，分别对肾小球、肾小管间质和肾小管周血管的纤维化硬化进行观察，并得出评分。免疫组织化学法检测肾组织中TGF-β1及α-SMA蛋白的表达，光镜下观察并进行图像采集，每例标本随机选取10个高倍视野，计算每个视野内阳色染色区域的积分光密度值，最后计算其均值用于统计学分析。将两位医师测得的肾皮质和肾髓质FA值用组内相关系数进行一致性分析。CKD患者和健康对照组之间肾髓质和肾皮质的FA值分别进行了比较，进行两独立样本t检验。肾皮质FA值和肾髓质FA值之间的差异也采用两独立样本t检验进行比较。通过bivariate相关分析探讨FA值和SCr/24-h-UPRO/eGFR之间的关系，肾小球、肾小管病理学评分、免疫组织化学TGF-β1、α-SMA的积分光密度值分别同肾皮质、肾髓质的FA值也进行bivariate相关性分析。
结果：40例CKD患者中排除7例患者DTI图像伪影较重，共对33例患者图像进行了分析。肾皮质和髓质的FA值的组内相关系数分别为0.77和0.56。CKD组肾皮质和肾髓质FA值与健康对照组相比均具有显著性差异，CKD组肾皮质FA值明显低于对照组。CKD组肾髓质的FA值与对照组相比也明显降低。CKD组肾皮质FA值明显低于髓质FA值，t=-3.598，p=0.001。对照组肾皮质FA值也明显低于髓质FA值， t=-15.703，p=0.000。
肾皮质的FA值和SCr呈显著的负相关，肾皮质的FA值与eGFR显著正相关。临床指标中肾髓质的FA值仅与eGFR呈显著正相关。无论是肾皮质还是肾髓质的FA值和24-h-UPRO之间均无显著的相关性。肾皮质FA值与组织病理学肾小球的评分呈显著负相关，r=-0.448，p=0.028。肾皮质FA值与组织病理学肾小管的评分呈显著负相关，r=-0.487，p=0.016。肾髓质的FA值与组织病理学肾小球评分呈显著负相关，r=-0.463，p=0.023。肾髓质的FA值与组织病理学肾小管评分呈显著性负相关，r=-0.430，p=0.036。肾皮质FA值与α-SMA的积分光密度值之间呈显著负相关，r=-0.636，p=0.001。肾髓质FA值与α-SMA的积分光密度值之间呈显著相关性，r=-0.432，p=0.035。肾皮质FA值与TGF-β1积分光密度值之间无显著相关性，r=-0.175，p=0.401。肾髓质的FA值与TGF-β1积分光密度值之间无显著相关性，r=-0.189，p=0.357。
结论：3.0T MR弥散加权成像获得的FA值，可在一定程度上定量评价CKD患者肾功能及肾脏病理变化的程度。第三部分MR BOLD成像对慢性肾脏病肾组织氧合状态的研究
目的：评价3.0T MR血氧水平依赖（BOLD）成像对慢性肾脏病患者肾组织氧合状态的探测能力及临床应用价值。
方法：选取2012年5月至2013年6月间在河北医科大学第三医院肾内科就诊的40例CKD患者，其中男性25例，女性15例，年龄16-71岁，平均年龄41.6±17.1岁。65名健康志愿者作为对照组，其中男性39例，女性26例，平均年龄38.3±13.3岁，年龄范围21-60岁。所有CKD患者及健康志愿者均采用3.0T MR进行扫描。扫描序列包括MRI常规成像及BOLD成像。在T2*图上分别测量双侧肾脏皮质及髓质的T2*值，并计算得出R2*值。每个研究对象均选择最靠近肾门的冠状面BOLD图像进行感兴趣区的测量。分别得到肾皮质R2*值、肾髓质R2*值，并计算出肾髓质/肾皮质R2*比值。在MR检查前后一周时间内，对CKD患者留取血尿样本，检测血肌酐（SCr）和24小时尿蛋白（24-h-UPRO）。通过SCr值计算出估算的肾小球滤过率（eGFR）。其中有25例患者在MR检查后不超过2周的时间内进行了肾组织活检。肾活检标本行常规HE染色、PAS染色、Masson染色及PASM染色检查。观察CKD肾脏病理损伤程度，分别对肾小球、肾小管间质和肾小管周血管的纤维化硬化进行观察，并得出评分。免疫组织化学法检测肾组织中TGF-β1及α-SMA蛋白的表达，光镜下观察并进行图像采集，每例标本随机选取10个高倍视野，计算每个视野内阳色染色区域的积分光密度值，最后计算其均值用于统计学分析。将两位医师测得的肾皮质R2*值、肾髓质R2*值用组内相关系数进行一致性分析。采用两独立样本t检验分别比较CKD患者和健康对照组之间肾皮质R2*值、肾髓质R2*值及肾髓质/肾皮质R2*比值的差异。肾皮质R2*值和肾髓质R2*值之间的差异也采用两独立样本t检验比较。通过bivariate相关分析探讨肾皮质R2*值、肾髓质R2*值以及肾髓质/肾皮质R2*比值和SCr/24-h-UPRO/eGFR之间的相关关系，肾小球、肾小管病理学评分和免疫组织化学TGF-β1、α-SMA的积分光密度值分别同肾皮质R2*值、肾髓质R2*值及肾髓质/肾皮质R2*比值进行bivariate相关分析。
结果：40例CKD患者中35例患者BOLD图像进行了分析。肾皮质和髓质的R2*值的组内相关系数分别为0.81和0.72。CKD组肾皮质R2*明显低于肾髓质R2*值，t=-7.576，p=0.000。对照组肾皮质R2*明显低于髓质R2*值，t=-13.467，p=0.000。CKD组肾髓质的R2*值与对照组肾髓质相比明显增高，CKD组肾髓质/肾皮质R2*比值与对照组相比明显增高，CKD组肾皮质R2*值与健康对照组无显著性差异。肾皮质R2*值、肾髓质的R2*值以及肾髓质/肾皮质R2*比值和各临床指标及病理组织学评分均无显著的相关性。肾皮质R2*值与组织病理学肾小管的评分无显著相关。肾髓质与组织病理学肾小球及肾小管病变的评分呈显著相关。肾髓质/肾皮质R2*比值与肾小球病变评分呈显著相关。肾皮质R2*值与仅与TGF-β1积分光密度值之间有显著相关性。肾髓质R2*值与α-SMA的积分光密度值及TGF-β1积分光密度值之间无显著相关性。肾髓质/肾皮质R2*比值与α-SMA的积分光密度值及TGF-β1积分光密度值之间无显著相关性。
结论：3.0T MR BOLD成像能够在一定程度上定量评价CKD患者肾脏氧合变化的程度。
Chronic kidney disease (CKD) is a prevalence disease and characterizedby progressive loss of kidney function due to chronic glomerular and/ortubulointerstitial injury. Renal fibrosis and hypoxia is considered to beimportant factors leading to the development of CKD. Clinical indicatorscurrently used for early CKD lack of sensitivity and specificity for thedetection of changes in renal function and renal pathology. To explore anoninvasive, sensitive and repeatable inspection method to evaluate the degreeof renal damage, is the current clinical workers eager concern. Diffusionweighted imaging (DWI), diffusion tensor imaging (DTI), and bloodoxygenation level dependent (BOLD) MRI were used to evaluate CKD patientsin our study. Apparent diffusion coefficient (ADC) value, FA value, and R2*value were measured on both renal cortex and medulla in patients with CKDusing3.0T MR scanner. The difference between healthy volunteers and CKDpatients were analyzed according to renal cortex and medulla. The aim of thisstudy was to explore the clinical application value of functional MR imaging inpatients with CKD. The correlation between MR data and clinical indexes,renal histopathological scores and immunohistochemical markers wereanalyzed.
Part1Assessment of renal fibrosis in chronic kidney disease using
diffusion weighted magnetic resonance imaging
Objective: To assess the performance of diffusion weighted imaging(DWI) for the assessment of renal fibrosis in chronic kidney disease (CKD),with histopathology as a reference standard.
Methods: From May2013to June2012, forty patients (25male,15female, mean age41.6±17.1years, range16-71years) with a clinicaldiagnosis of CKD were recruited for participation in this study in nephrology department of the third hospital of Hebei medical university. Thirty healthyvolunteers (20male and10women; average age38.3±14.1years, range24-60years) were also recruited and served as controls. All subjects underwent bothstandard MRI and DW MRI. To measure ADC values of both kidneys, ROIswere placed in the medulla and cortex on the ADC map. For CKD patients,serum creatinine (SCr) and24-h-urinary protein(24-h-UPRO) were obtainedwithin one week before or after MR scan. eGFRs were calculated from SCrmeasurements for all subjects. Renal biopsy was performed in25patients withCKD within2weeks following the MRI scans. The atoxvlin and eosin (HE)stain, periodic acid shift's reaction (PAS) stain, Masson stain, and periodicacid-silver methenamine (PASM) stain were used for pathologic score of renalfibrosis. The sclerotic/fibrotic lesions of glomerulus and renal tubuleinterstitial were evaluated and scored. For the immunohistochemistry test ofTGF-β1and α-SMA, the images were obtained and analzed by the imageanalysis system under light microscope. Ten observation fields were selectedrandomly for each case. After scaled the image, the integrated optical densitywas calculated for each view. Finally, average of the integrated optical densitywas served as data for statistic. Mean medullary and cortical ADC valuesbetween CKD patients and healthy control subjects were compared using twoindependent samples t test, respectively. The difference between renal corticalADC and medullary ADC were analyzed using two independent sample t testfor healthy control subjects and CKD patients respectively. Bivariatecorrelation coefficients were used to investigate the relationship between ADCvalue and SCr/24-h-UPRO/eGFR. Bivariate correlation coefficients were usedto evaluate the relationship between ADC value and renalglomeruli/tubulo-interstial histopathological scores and immunohistochemicalmarkers for TGF-β1and α-SMA respectively.
Results: Data from35out of40patients could be successfully analyzed.ICC of renal cortical ADC values and medullary ADC values were0.79and0.82respectively. Cortical and medullary ADC values in patients with CKDwere significantly decreased when compared to those from healthy controls. In CKD group, a significant negative correlation was found between corticalADC values and SCr/24-h-UPRO, and significant positive correlation wasfound between cortical ADC values and eGFR. There was also significantnegative correlation between medullary ADC values and SCr. No significantlycorrelation was found between medullary ADC values and eGFR/24-h-UPRO.There was a significant inverse correlation between cortical ADC andglomeruli lesions histopathologic score, with r=-0.610, p=0.001. There wasa significant inverse correlation between cortical ADC and tubulo-interstiallesions histopathologic score, with r=-0.778, p=0.000. Significant inversecorrelation was found between medullary ADC and glomeruli lesionshistopathologic score, with r=-0.398, p=0.049. Significant inversecorrelation was found between medullary ADC and tubulo-interstial lesionshistopathologic score, with r=-0.640, p=0.001. There was a significantinverse correlation between cortical ADC and theintegrated optical density ofα-SMA, with r=-0.441，p=0.027. No significant correlation was foundbetween medullary ADC and theintegrated optical density of α-SMA, with r=-0.354, p=0.083. No significant correlation was found between cortical ADCand theintegrated optical density of TGF-β1, with r=-0.362, p=0.075. Nosignificant correlation was found between medullary ADC and theintegratedoptical density of TGF-β1, with r=-0.289, p=0.162.
Conclusion:3.0T MR diffusion weighted imaging in detection of renalADC in patients with CKD has certain correlation with eGFR and expressionofα-SMA. This can be used to assess the severity of renal fibrosis in patientswith CKD.
Part2Assessment of renal lesions in patients with chronic kidney
disease by diffusion tensor magnetic resonance imaging
Objective: To evaluate the clinical value of3.0T diffusion tensor MRimaging in detecting renal lesions in patients with chronic kidney disease.
Methods: From May2013to June2012, forty patients (25male,15female, mean age41.6±17.1years, range16-71years) with a clinicaldiagnosis of CKD were recruited for participation in this study in nephrology department of the third hospital of Hebei medical university. Sixty-fourhealthy volunteers (39male and25women; average age38.5±13.3years,range21-60years) were also recruited and served as controls. All of thesubjects underwent both standard MRI and diffusion tensor MRI. To measureFA values of both kidneys, ROIs were placed in the medulla and cortex on theADC map. The coronal slices closest to the renal hilum of the left and rightkidneys were selected for ROI analysis. ROIs were placed at the upper, middleand lower pole of each kidney in the medulla and cortex on the FA map. Foreach subject, mean cortical ADC values were obtained by averaging6corticalROIs obtained from both kidneys. Similarly, mean medullary ADC valueswere obtained by averaging6medullary ROIs obtained from both kidneys.For CKD patients, serum creatinine (SCr) and24-h-urinary protein(24-h-UPRO) were obtained within one week before or after MR scan. eGFRswere calculated from SCr measurements for all subjects.
Renal biopsy was performed in25patients with CKD within2weeksfollowing the MRI scans. The HE stain, PAS stain, Masson stain, and PASMstain were used for pathologic score of renal fibrosis. The sclerotic/fibroticlesions of glomerulus and renal tubule interstitial were evaluated and scored.For the immunohistochemistry test of TGF-β1and α-SMA, the images wereobtained and analzed by the image analysis system under light microscope.Ten observation fields were selected randomly for each case. After scaled theimage, theintegrated optical density was calculated for each view. Finally,average of theintegrated optical density was served as data for statistic. Dataon intra-observer agreement was determined by intraclass correlationcoefficients (ICC). Mean medullary and cortical FA values between CKDpatients and healthy control subjects were compared using two independentsamples t test, respectively. The difference between renal cortical FA andmedullary FA were analyzed using two independent sample t test for healthycontrol subjects and CKD patients respectively. Bivariate correlationcoefficients were used to investigate the relationship between FA value andSCr/24-h-UPRO/eGFR. Bivariate correlation coefficients were used to evaluate the relationship between FA values and renal histopathological scoresand immunohistochemical markers for TGF-β1and α-SMA respectively.
Results: Data from33out of40patients could be successfully analyzed.ICC of renal cortical FA values and medullary FA values were0.77and0.56respectively. Cortical and medullary FA values in patients with CKD weresignificantly decreased when compared to those from healthy controls. InCKD group, cortical FA was significantly lower than medullary FA, witht=-3.598，p=0.001. In control group, cortical FA was significantly lower thanmedullary FA, with t=-15.703，p=0.000. Significant negative correlation wasfound between cortical ADC values and SCr for CKD group. Significantpositive correlation was found between cortical FA values and eGFR. Therewas significant positive correlation between medullary FA values and eGFR.No significantly correlation was found between cortical/medullary ADCvalues and eGFR/24-h-UPRO. There was a significant inverse correlationbetween cortical FA and glomeruli lesions histopathologic score, with r=-0.448, p=0.028. There was a significant inverse correlation between corticalFA and tubulo-interstial lesions histopathologic score with r=-0.487, p=0.016.Significant inverse correlation was found between medullary FA andglomeruli lesions histopathologic score, with r=-0.463, p=0.023. Significantinverse correlation was found between medullaryFA and tubulo-interstiallesions histopathologic score, with r=-0.430, p=0.036.
There was a significant inverse correlation between cortical FA and theintegrated optical density of α-SMA, with r=-0.636, p=0.001. There was asignificant inverse correlation between medullary FA and the integratedoptical density of α-SMA, with r=-0.432, p=0.035. No significantcorrelation was found between cortical FA and theintegrated optical density ofTGF-β1, with r=-0.175, p=0.401。No significant correlation was foundbetween medullary FA and the integrated optical density of TGF-β1, with r=-0.189, p=0.357.
Conclusion: Renal ADC values of3.0T MR DTI could quantitivelyevaluate the renal pathology changes in patients with CKD.
Part3Assessment of renal oxygenation in patients with chronic kidney
disease by blood oxygenation level dependent MR imagingObjective: To evaluate the value of clinical application of3.0T blood oxygenlevel-dependent (BOLD)MR imaging in detecting renal oxygenation inpatients with chronic kidney disease.
Methods: From May2013to June2012, forty patients (25male,15female, mean age41.6±17.1years, range16-71years) with a clinicaldiagnosis of CKD were recruited for participation in this study in nephrologydepartment of the third hospital of Hebei medical university. Sixty-fivehealthy volunteers (39male and26women; average age38.3±13.3years,range21-60years) were also recruited and served as controls. All of thesubjects underwent both standard MRI and BOLD MRI. To measure T2*values of both kidneys, ROIs were placed in the medulla and cortex on theT2*map. The coronal slices closest to the renal hilum of the left and rightkidneys were selected for ROI analysis. Then cortical R2*values, medullaryR2*values and medulla/cortex R2*ratio could be calculated. For CKDpatients, serum creatinine (SCr) and24-h-urinary protein (24-h-UPRO) wereobtained within one week before or after MR scan. eGFRs were calculatedfrom SCr measurements for all subjects. Renal biopsy was performed in25patients with CKD within2weeks following the MRI scans. The HE stain,PAS stain, Masson stain, and PASM stain were used for pathologic score ofrenal fibrosis. The sclerotic/fibrotic lesions of glomerulus and renal tubuleinterstitial were evaluated and scored. For the immunohistochemistry test ofTGF-β1and α-SMA, the images were obtained and analzed by the imageanalysis system under light microscope. Ten observation fields were selectedrandomly for each case. After scaled the image, the integrated optical densitywas calculated for each view. Finally, average of the integrated optical densitywas served as data for statistic. Data on intra-observer agreement wasdetermined by intraclass correlation coefficients (ICC). Mean cortical R2*values, medullary R2*values and medulla/cortex R2*ratio between CKDpatients and healthy control subjects were compared using two independent samples t test, respectively. The difference between renal cortical R2*andmedullary R2*were analyzed using two independent sample t test for healthycontrol subjects and CKD patients respectively. Bivariate correlationcoefficients were used to investigate the relationship between R2*value andSCr/24-h-UPRO/eGFR. Bivariate correlation coefficients were used toevaluate the relationship between cortical R2*values, medullary R2*values,medulla/cortex R2*ratio, and glomeruli lesions histopathologic score,tubulo-interstial lesions histopathologic score, the integrated optical density ofα-SMA, the integrated optical density of TGF-β1.
Results: Data from35out of40patients could be successfully analyzed.ICC of renal cortical R2*values and medullary R2*values were0.81and0.72respectively. cortical R2*was significantly lower than medullary FA, with t=-7.576, p=0.000. In control group, cortical R2*was significantly lower thanmedullary FA, with t=-13.467, p=0.000. Medullary R2*values in patientswith CKD were significantly increased when compared to those from healthycontrols. Medulla/cortex R2*ratio in patients with CKD were significantlyincreased when compared to those from healthy controls. No significantlydifference of cortical R2*between CKD and controls. No significantlycorrelation was found between cortical R2*values, medullary R2*values,medulla/cortex R2*ratio, and SCr,24-h-UPRO, eGFR, glomeruli lesionshistopathologic score, tubulo-interstial lesions histopathologic score.Significant correlation was found between medullary R2*values andglomeruli lesions histopathologic score, tubulo-interstial lesionshistopathologic score. Significant correlation was found betweenmedulla/cortex R2*ratio and glomeruli lesions histopathologic score,tubulo-interstial lesions histopathologic score. There was a significantcorrelation between corticalR2*and the integrated optical density of TGF-β1.No significant correlation was found between medullary R2*and theintegrated optical density of α-SMA and TGF-β1. No significant correlationwas found between medulla/cortex R2*ratio and the integrated optical densityof α-SMA or TGF-β1.
Conclusion:3.0T BOLD MR could quantitively evaluate theoxygenation changes in patients with CKD.
引文
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5Prasad PV, Edelman RR, Epstein FH. Noninvasive evaluation ofintrarenal oxygenation with BOLD MRI. Circulation1996;94(12):3271-3275
6Thoeny HC, Zumstein D, Simon-Zoula S, et al. Functional evaluation oftransplanted kidneys with diffusion-weighted and BOLD MR imaging:initial experience. Radiology2006;241(3):812-821
7Djamali A, Sadowski EA, Muehrer RJ, et al. BOLD-MRI assessment ofintrarenal oxygenation and oxidative stress in patients with chronickidney allograft dysfunction. Am J Physiol Renal Physiol2007;292(2):F513-522
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28Prasad PV, Priatna A. Functional imaging of the kidneys with fast MRItechniques. Eur J Radiol1999;29(2):133-148
29El-Diasty TA, El-Ghar ME, Shokeir AA, et al. Magnetic resonanceimaging as a sole method for the morphological and functional evaluationof live kidney donors. BJU Int2005;96(1):111-116
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