磁共振弥散成像在肾脏中的应用
摘要
磁共振功能成像是一种很有发展潜力的成像方式,它能利用非侵袭性的方式了解脏器的功能状态。常见的方法有弥散成像及灌注成像等。此类成像方法的临床应用之所以受到一定程度的限制,主要是针对活动器官(如肾脏)进行检查时较难获得可信度高、重复性强的数据,甚至对此类检查中所观察到的信号变化的生理学基础还没有彻底了解。
磁共振弥散加权成像(Diffusion-Weighted Imaging DWI)对分子的弥散运动——布朗运动非常敏感,正是分子的这种随机运动可以在梯度场中产生相位转变从而引起磁共振信号的变化。LeBihant等不仅将这种原理拓展到人的体内环境中,还总结出这种随机运动在体素内表达的模式。这种模式包括多种因素,最主要的是微血管的灌注和水分子的弥散。理论上,可以借助测量表观弥散系数(Apparent Diffusion Coefficient ADC)来综合评价体内微血管的灌注及水分子弥散。
由于弥散加权成像对运动特别敏感,其在人体内的应用受到较大的限制。起初,该技术主要应用于颅脑,其对脑缺血性病变非常敏感。随着回波平面成像(Echo-Planar Imaging EPI)的出现,磁共振弥散加权成像开始在腹部应用。
由于肾脏具有对水的重吸收、浓缩及稀释等功能,所以水的转运就成为肾脏的突出表现,同时肾脏血流灌注量也非常之大。另一方面,肾脏又是结构和功能联系非常紧密的脏器。所以在弥散成像中测量肾脏的ADC值有望对多种肾脏疾病(如慢性肾功能不全,尿路梗阻等)的发病
Functional magnetic resonance imaging (FMRI) , such as diffusion weighted imaging(DWI) or perfusion weighted imaging(PWI), has a great potential of development as its manifesting the function of organ noninvasively. Its limitations in clinical applications are due to the difficulties in obtaining reproducible and reliable information in mobile organs (such as kidney). It is also because of less understanding of the physiologic principle for the signal changes observed.MR Diffusion-Weighted Imaging (DWI) is sensitive to molecular diffusion, known as Brownian motion. Since random motion in the field gradients produces in coherent phase shifts that result in signal attenuation. LeBihant et al extended these concepts to the in vivo situation and generalized the types of random motion that occur in tissues in the intravoxel-incoherent motion model. This model consists of many contents such as capillary perfusion and water diffusion. It is theoretically possible to evaluate the combined effects of capillary perfusion and water diffusion in vivo by an apparent diffusion coefficient (ADC).Because of its severe motion sensitivity, DWI in vivo has largely been restricted to the brain at the beginning. It has been accepted that diffusion
measurements are highly sensitive to ischemia. With the use of echo-planar imaging (EPI), diffusion measurement can be obtained in abdomen.As its function of water reabsorption, concentration and dilution, the kidney shows its significant character as water-transportation. It is also an organ with high blood perfusion. In the other side, the structure and function of kidney are closely linked. Consequently, the measurement of the diffusion characteristics of the kidney in DWI may provide useful insights of the mechanisms of various renal diseases including chronic renal failure, ureteral obstruction and so on.Our study presents a retrospective analysis of 127 people (some were excluded because of no follow-up or bad imaging quality, only 86 cases left) with/without renal diseases at the department of radiology, west china hospital, sichan university, from September 2004 to January 2005.In the first part, the technology of kidney DWI had been studied. The parameters were established as: (1) People underwent DWI in a dehydrated state (with fasting for 6-hour). (2) The diffusion-sensitizing gradients were applied along 6 different directions. (3) Four b-values (0, 50, 100 and 400 s/mm ) in each direction were selected for isotropic parameter. (4) Breath trigger had been used. (5) The other parameters were as flow: TR, 2000 ms; TE, 70 ms; Fov, 390 mm; Slice thickness, 5 mm; Noise level, 40. Bandwidth, 1502 HZ; Phase encipher direction A?P.In the second part, to study of ADC values of healthy people, 15 volunteers (9 men, 6 women , ages 29 68 years , mean 46. 9 + 4. 5 years ) underwent DWI in a dyhydrated state .ADC values of each kidney were measured. Then Statistical analysis of ADC measurements for this group was
performed. The average ADC values were 405.366X10 smm2 (for b50); 339.646 X 10 W ( for blOO ). 254.532 X 1O'W( forb400).In the third part, 8 hypertensive (6 men, 2 women, ages 38-65 years, mean 51.4±2.1 years) with the history more than 5 years underwent DWI. The parameters of examination and the method of measure were the same as before. The results showed that ADC values of this group were significantly lower than those of healthy group (b50), but for blOO and b400, there were considerable overlap in ADC values of two groups.In the fourth part, two groups patients underwent the examination. Group one: 12 patients (10 men, 2 women, ages 30-70 yeas, mean 51.2±5.1 yeas) diagnosed as chronic kidney disease (CKD) with CREA normal. Group two:20 patients (12 men, 8 women, ages 26 — 70, mean 50.1±4.8 yeas) confirmed of chronic renal failure(CRF) with serum creatinine(Scr) increased in different degree. ADC values of kidneys with CKD and CRF were all lower than those of the normal kidneys (b50 and b400). But for the latter, it showed a more significant trend. There was a weak linear correlation between ADC values and their clear creatinine rat (Ccr).In the fifth part, 14 patients with unilateral hydronephrosis (7 men, 7 women, ages 26-83 yeas, mean 55.4±3.5 years) were examined with diffusion-weighted imageing. ADC values were decreased in the kidneys with ureter obstruction and slightly increased in the contra-lateral kidneys.The sixth part was the last part of this study. In this part, a primary analysis of the character of lesions in DWI was probed, such as renal cancer, renal simple cyst and renal tuberculous pyonephrosis etc. It shows that MR DWI is a useful technique in differentiating these diseases.
In conclusion, DWI and the measurement of ADC values are a noninvasive way of evaluating the functional state of the kidney and of differentiating various renal diseases, and it also have some potential values in other aspects.
磁共振弥散加权成像(Diffusion-Weighted Imaging DWI)对分子的弥散运动——布朗运动非常敏感,正是分子的这种随机运动可以在梯度场中产生相位转变从而引起磁共振信号的变化。LeBihant等不仅将这种原理拓展到人的体内环境中,还总结出这种随机运动在体素内表达的模式。这种模式包括多种因素,最主要的是微血管的灌注和水分子的弥散。理论上,可以借助测量表观弥散系数(Apparent Diffusion Coefficient ADC)来综合评价体内微血管的灌注及水分子弥散。
由于弥散加权成像对运动特别敏感,其在人体内的应用受到较大的限制。起初,该技术主要应用于颅脑,其对脑缺血性病变非常敏感。随着回波平面成像(Echo-Planar Imaging EPI)的出现,磁共振弥散加权成像开始在腹部应用。
由于肾脏具有对水的重吸收、浓缩及稀释等功能,所以水的转运就成为肾脏的突出表现,同时肾脏血流灌注量也非常之大。另一方面,肾脏又是结构和功能联系非常紧密的脏器。所以在弥散成像中测量肾脏的ADC值有望对多种肾脏疾病(如慢性肾功能不全,尿路梗阻等)的发病
Functional magnetic resonance imaging (FMRI) , such as diffusion weighted imaging(DWI) or perfusion weighted imaging(PWI), has a great potential of development as its manifesting the function of organ noninvasively. Its limitations in clinical applications are due to the difficulties in obtaining reproducible and reliable information in mobile organs (such as kidney). It is also because of less understanding of the physiologic principle for the signal changes observed.MR Diffusion-Weighted Imaging (DWI) is sensitive to molecular diffusion, known as Brownian motion. Since random motion in the field gradients produces in coherent phase shifts that result in signal attenuation. LeBihant et al extended these concepts to the in vivo situation and generalized the types of random motion that occur in tissues in the intravoxel-incoherent motion model. This model consists of many contents such as capillary perfusion and water diffusion. It is theoretically possible to evaluate the combined effects of capillary perfusion and water diffusion in vivo by an apparent diffusion coefficient (ADC).Because of its severe motion sensitivity, DWI in vivo has largely been restricted to the brain at the beginning. It has been accepted that diffusion
measurements are highly sensitive to ischemia. With the use of echo-planar imaging (EPI), diffusion measurement can be obtained in abdomen.As its function of water reabsorption, concentration and dilution, the kidney shows its significant character as water-transportation. It is also an organ with high blood perfusion. In the other side, the structure and function of kidney are closely linked. Consequently, the measurement of the diffusion characteristics of the kidney in DWI may provide useful insights of the mechanisms of various renal diseases including chronic renal failure, ureteral obstruction and so on.Our study presents a retrospective analysis of 127 people (some were excluded because of no follow-up or bad imaging quality, only 86 cases left) with/without renal diseases at the department of radiology, west china hospital, sichan university, from September 2004 to January 2005.In the first part, the technology of kidney DWI had been studied. The parameters were established as: (1) People underwent DWI in a dehydrated state (with fasting for 6-hour). (2) The diffusion-sensitizing gradients were applied along 6 different directions. (3) Four b-values (0, 50, 100 and 400 s/mm ) in each direction were selected for isotropic parameter. (4) Breath trigger had been used. (5) The other parameters were as flow: TR, 2000 ms; TE, 70 ms; Fov, 390 mm; Slice thickness, 5 mm; Noise level, 40. Bandwidth, 1502 HZ; Phase encipher direction A?P.In the second part, to study of ADC values of healthy people, 15 volunteers (9 men, 6 women , ages 29 68 years , mean 46. 9 + 4. 5 years ) underwent DWI in a dyhydrated state .ADC values of each kidney were measured. Then Statistical analysis of ADC measurements for this group was
performed. The average ADC values were 405.366X10 smm2 (for b50); 339.646 X 10 W ( for blOO ). 254.532 X 1O'W( forb400).In the third part, 8 hypertensive (6 men, 2 women, ages 38-65 years, mean 51.4±2.1 years) with the history more than 5 years underwent DWI. The parameters of examination and the method of measure were the same as before. The results showed that ADC values of this group were significantly lower than those of healthy group (b50), but for blOO and b400, there were considerable overlap in ADC values of two groups.In the fourth part, two groups patients underwent the examination. Group one: 12 patients (10 men, 2 women, ages 30-70 yeas, mean 51.2±5.1 yeas) diagnosed as chronic kidney disease (CKD) with CREA normal. Group two:20 patients (12 men, 8 women, ages 26 — 70, mean 50.1±4.8 yeas) confirmed of chronic renal failure(CRF) with serum creatinine(Scr) increased in different degree. ADC values of kidneys with CKD and CRF were all lower than those of the normal kidneys (b50 and b400). But for the latter, it showed a more significant trend. There was a weak linear correlation between ADC values and their clear creatinine rat (Ccr).In the fifth part, 14 patients with unilateral hydronephrosis (7 men, 7 women, ages 26-83 yeas, mean 55.4±3.5 years) were examined with diffusion-weighted imageing. ADC values were decreased in the kidneys with ureter obstruction and slightly increased in the contra-lateral kidneys.The sixth part was the last part of this study. In this part, a primary analysis of the character of lesions in DWI was probed, such as renal cancer, renal simple cyst and renal tuberculous pyonephrosis etc. It shows that MR DWI is a useful technique in differentiating these diseases.
In conclusion, DWI and the measurement of ADC values are a noninvasive way of evaluating the functional state of the kidney and of differentiating various renal diseases, and it also have some potential values in other aspects.
引文
1.邓绍根.中国第一台X光诊断机的引进.中华医史杂志,2002,22(2):99-101.
2. Grenier N, Basseau F, Ries M etal. Functional MRI of the kidney. Abdominal Imaging, 2003, 28: 164-175.
3.周诚,杨正汉,叶晓华.CT、MRI功能成像在肝脏病变的应用进展.中国医学计算机成像杂志,2004,10(5)329-337.
4. Rubin JM, Bude RO, Carson PL, et al. Power Doppler Us: a potentially useful alternatine to mean frequency based colour Doppler.
5. Goldberg BB, Merton DA, Forsberg, et al. Color amplitude imaging: Preliminary results using vascular Sonographic contrast agents. J ultrasound Med, 1996, 15: 127-134.
6. Mandell GA, Eggli DF, Gilday DL, et al. Nuclear medicine procedure guidline for renal cortical scintigraphy in children, J Nucl Med, 1997, 38(12): 1644-1646.
7.聂生东,聂斌.脑功能磁共振成像及其应用进展.中国医学影像技术,2003,19(2):242-245.
8. Gregory W. Diffusion-weighted MRI for evaluation of acute stroke[J]. Neurology, 1998, 51(9): 47-49.
9. Schaefer PW, Gant PE, Conzalez RG. Diffusion-weighted MR imaging of the brain[J]. Radiology, 2000, 217(2): 331-345.
10.任小军,章士正.腹部磁共振成像的应用和进展.国外医学临床放射分册,2003,26(4):231-234.
11. Kim T, Murakami T, Takahashi S, et al. Diffusion-weighted single-shot echoplanar MR imaging for liver disease. AJR, 1999, 173(2): 393-398.
12.王毅翔,江浩.磁共振肾脏功能成像进展.国外医学泌尿系统分册,1999,19(5):212-214.
13. Namimoto T, Yamashita Y,Mitsuzaki K, etal.Measurement of the apparent diffusion coefficient in diffuse renal disease by diffusion-weighted echo-planar MR imaging. Journal of magnetic resonance imaging,. 1999; 9: 832-837.
14. Gray L, Macfall J. Overview of diffusion imaging. MRI clin N Am, 1998, 6(1): 125-138.
15.张宗军,黄伟,卢光明.磁共振弥散加权的原理与临床应用.医学研究生学报,2004,17(2):172-174.
16. Siegel VS, Aisen AM, Ellis JH, etal. Feasibility of MR diffusion studies in the kidney. Journal of magnetic resonance imaging, 1999,9:832-837.
17.尚全良,肖恩华,贺忠,等.GE Signa Twinspeed 1.5T核磁共振肝脏扩散加权成像的技术探讨.中国医学影像技术,2004,20(10)1515-1518.
18. Ichikawa T, Haradome S, Hachiya J, et al. Diffusion-weighted MR imaging with single-shot echo-planar imging in the upper abdomen: preliminary clinical experience in 61 patients[J]. Abdom Imaging, 1999, 24(5): 456-461.
19.张卫东,梁碧玲.磁共振弥散张力成像及临床应用.临床放射学杂志,2003,22(10):889-891.
20.盛复庚,安宁豫.磁共振弥散张量成像的基本原理和临床应用.中国医学影像学杂志,2003,11(1):56-58.
21.许卫国,黄力.磁共振扩散张量成像的概念及应用.国外医学临床放射分册,2003,26(2):119-122.
22.谭湘萍,梁碧玲.扩散张量MR成像.国外医学临床放射分册,2003,26(5):314-316.
23. Sorensen AG, Wu O, Copen, et al. Human acute cerebral ischemia: detection of changes in water diffusion anisotropy by using MR imaging. Radiology, 1999,: 212-785.
24. Pierpaoli C, Jezzard P, Basser PJ, et al, Diffusion tensor MR imaging of the human brain. Radiology, 1996, 201(3): 637-648.
25. Guo AC, Macfall JR, Provenzale JM. Multiple sclerosis: diffusion tensor MR imaging for evaluation of normal-appearing white matter. Radiology, 2002, 222(3): 729-736.
26.张雪辉,梁碧玲,赵继全,等.肝脏常见病变弥散系数的初步研究.中国医学影像技术,2004,20(1):26-28.
27. Fukuda Y, Ohashi I, Hanafusa K, et al. Anisotropic diffusion in kidney: apparent diffusion coefficient measurements for clinical use.[J] Magnetic resonance imaging, 2000, 11: 156-160.
28. Ries M, MSc, Jones RA, et al. Diffusion tensor MRI of the human kidney. [J] Magnetic resonance imaging, 2001, 14: 42-49.
29. Higano S, Zhong J, Shrier DA, etal. Diffusion anisotropy of the internal and the coron radiate in association with stroke and tumor as measured by diffusion-weighted MR imaging. AJNR, 2001, 22: 456-462.
30. Jean-pierre L, David MG, Erik D etal. Hemodynamic effect of iodinated high-viscosity contrast medium in rat kidney: A diffusion-weighted MRI feasibility study. Investigative Radiology, 2000,35(11):647-652.
31. S. T, K. N, S. H, et al. Functional evaluation of hydronephiosis by diffusion-weighted MR imaging Relationship between apparent diffusion coefficient and split glomerular filtration rate. Acta Radiologic, 2000, 41: 642-646.
32.郑肖林,徐辉雄,吕明德,等.磁共振弥散加权成像检测肝内小病灶 的临床应用.中国医学影像技术,2004,20(10):1510-1512.
33. Moteki T, Horikoshi H, Oya N, et al. Evaluation of hepatic lesions and hepatic parenchyma using diffusion-weighted recordered turboflash magnetic resonance imaing. [J]Magnetic resonance imaging, 2002, 15: 567-572.
34.刘彤华,主编.诊断病理学.北京:人民卫生出版社,874-876.
35.王吉耀,主编.内科学(全国高等医学院校教材,供七年制临床医学等专业用).北京:人民卫生出版社,229-244.
36. Mandell GA, Eggli DF, Gilday DL, et al. Nuclear medicine procedure guidline for renal cortical scintigraphy in children, J Nucl Med, 1997, 38(12): 1644-1646.
37. Levey AS. Measurement of renal function in chronic renal disease. Kidney Int, 1990, 38(1): 167-184.
38. Hricak H, Lieto RP. Sonographoic determination of renal volume. Radiology, 1983, 148: 311-312.
39.谢恺庆,王扬,杨红,等.肾脏大小与肾实质厚度的测定在急、慢性肾功能衰竭诊断中的意义.临床荟萃,2002,17(23):1386-1387.
40. Levey AS, Coresh J, Balk E, et al. National Kidney Foundation practice guidelines for chronic kidney disease: evaluation, classification and stratification. Ann-Intern-Med, 2003, 139(2): 137-147.
41.黄晓玲,高云华.二维超声、频谱及彩色多普勒超声在评价性实验性兔急性肾衰竭中的价值比较.中华超声影象学杂志,2000,9(11):625-628.
42. Rubin JM, Bude RO, Carson PL, et al. power Doppler Us: a potentially useful alternatine to mean frequency based colour Doppler US. Radiology, 1994, 190: 853-856.
43.赵金英,李树森,廖明松,等.慢性肾功能衰竭的彩色多普勒能量图分析.中国超声医学杂志,2001,17(2):137-139.
44.牛海燕,简文豪.声学造影在肾脏疾病诊断中的应用及进展.中华超声影像学杂志,2001,10(1):61-62.
45. Georage AT, Carol EB, Brent H, et al. Renol cortical ischemia in rabbits revealed by contrast-enhanced power Doppler Sonography[J], AJR, 1998, 170(2): 417-422.
46. Dawson D. Contrast agent in patients on dialysis. Semin-Dial,2002, 15(4): 232-236.
47. Hackstein N, Bauer J, Hauck E W, et al. Measuring simg-kidney glomerular filtration rate on single-detector helical CT using a Two-Point patlak plot technique in patients with inereased interstitial space. AJR, 2003: 181: 147-156.
48. Miles KA. Measurement of tissue perfusion by dynamic computed tomograph[J], The British Journal of Radiology, 1991, 64(761): 409-412.
49.赵光明,韩丹,宋光义.CT灌注成像原理与技术.中国医学影像技术,2003,19(5):636-638.
50. Baumann D, Rudin M. Quantitative assessment of rat kidney function by measuring the chearance of the centrast agent Gd(DOTA)using dynamic MRI. Magn-reson-Imaging, 2000, 18(5): 587-595.
51. Seong Teh H, Sin Ang W, Cheong wong W, et al. MR renography using a dynamic gradient-echo Sequence and low-dose gadopentetate dimeglumine as alternative to radionuclide renography. AJR, 2003, 181: 441-450.
52. Wen JG, Chen Y, Ringgaard S, et al. Evaluation of renal function in normal and hydonephrotic kidney in rat using gadolinium diethyhenete tramine-pentaacetic acid enhanced dynamic magnetic resonance imaging. J-Urol, 2000, 163(4): 1264-1270.
53.王毅翔,江浩。磁共振肾脏功能成像进展.国外医学泌尿系统分册,1999,19(5):212-214.
54. Mario Ries,MSC,Richard A, Jones,et al.Diffussion tensor MRI of the human kidney. Journal of Magnetic Resonance Imaging,2001:14-42.
55.白文俊,王晓峰,朱积川,等.近期泌尿系统结核诊治体会(附36例报告).中华泌尿外科杂志,1999,20(2):112-113.
56. Prekumar A, Lattimer j, Newhouse jh. CT and sonography of advanced urinary tract tuberculosis[J]. AJR, 1987, 148: 65.
57.魏鹃,李妍,裘丽雯.肾结核误诊为多囊肾1例.中国实用内科杂志,2000,20(8):501-502.
58. Rothpper A, Frager D, Subramanian A, et al. MR urography technique and application. Radiology, 1995, 194: 125-230
59.卢延,洪闻,陆立,等.MR水成像技术的临床应用.中华放射学杂志,1996,30:732-736.
60. Chan JHM, Tsui EYK, Luk SH. et al. MR diffusion-weighted imaging of kidney: Differentiation between hydronephrosis and pyonephrosis. Journal of Clinical Imaging, 2001 25: 110-113.
61. Kanel I R, Bluemke D A, Abusedera R, et al. Role of diffusion-weighted imaging in estimating tumor neciosis after chemoembolization of hepatocellular carcinoma. AJR, 2003, 181(9): 708-711.
62. Guo Y, Cai YQ, Cai ZL, etal. Differentiation of clinically benign and malignant breast lesions using diffusion-weighted imaging.[J]Magnetic resonance imaging, 2002, 16: 172-178.
63. Van Rijswijk C S, Kunz P, Hogendoom P C, et al. Dffusion-weighted MRI in the characterization of soft-tissue tumors. [J]Magnetic resonance imaging, 2002, 15: 302-307.
64.汤光宇,姚冀平,徐武等.鉴别良、恶性椎体骨折的最佳扩散敏感系数值的探讨.中华放射学杂志,2004,38(6):615-619.
65. Fizek C, Mewees T, Fizek S, et al. Diffusion-weighed MRI of the petrous bone. [J] magnetic resonance imaging, 2002, 15: 636-641.
66. Bammer R, Augustin M, Prokesch R W, et al. Diffusion-weighted imaging of the spinal cord: interleaved echo-planar imaging is superior to fast spin-echo. [J] magnetic resonance imaging, 2002, 15: 364-373.
67. Yeung D K, wong S Y, Griffith J F. Bone marrow diffusion in osteoporosis: evaluation with quantitative MR diffusion imaging. [J] magnetic resonance imaging, 2004, 19: 222-228.
68. kenney PJ. Imaging of chronic renal infections. AJR, 1990, 155(3): 485-494.
69. Elenberger CD. Renal tuberculosis. AJR, 1995, 165(1): 199-200.
70. Rothppear A, Frager D, Subramanian A, et al. MR urography technique and application. Radiology. 1995, 194 (1): 125-230.
71.赵耀瑞,孙光,王文成,等.肾结核磁共振尿路成像特点及与病理变化的关系.中华泌尿外科杂志,2003(24)5:303-304.
72. Ebisu T, Tanaka C, Umeda M, et al. Discrimination of brain abscess from necrotic or cystic tumors by diffusion-weighted echo planar imaging. Magn ResonImaging 1996; 14: 1113-1116.
2. Grenier N, Basseau F, Ries M etal. Functional MRI of the kidney. Abdominal Imaging, 2003, 28: 164-175.
3.周诚,杨正汉,叶晓华.CT、MRI功能成像在肝脏病变的应用进展.中国医学计算机成像杂志,2004,10(5)329-337.
4. Rubin JM, Bude RO, Carson PL, et al. Power Doppler Us: a potentially useful alternatine to mean frequency based colour Doppler.
5. Goldberg BB, Merton DA, Forsberg, et al. Color amplitude imaging: Preliminary results using vascular Sonographic contrast agents. J ultrasound Med, 1996, 15: 127-134.
6. Mandell GA, Eggli DF, Gilday DL, et al. Nuclear medicine procedure guidline for renal cortical scintigraphy in children, J Nucl Med, 1997, 38(12): 1644-1646.
7.聂生东,聂斌.脑功能磁共振成像及其应用进展.中国医学影像技术,2003,19(2):242-245.
8. Gregory W. Diffusion-weighted MRI for evaluation of acute stroke[J]. Neurology, 1998, 51(9): 47-49.
9. Schaefer PW, Gant PE, Conzalez RG. Diffusion-weighted MR imaging of the brain[J]. Radiology, 2000, 217(2): 331-345.
10.任小军,章士正.腹部磁共振成像的应用和进展.国外医学临床放射分册,2003,26(4):231-234.
11. Kim T, Murakami T, Takahashi S, et al. Diffusion-weighted single-shot echoplanar MR imaging for liver disease. AJR, 1999, 173(2): 393-398.
12.王毅翔,江浩.磁共振肾脏功能成像进展.国外医学泌尿系统分册,1999,19(5):212-214.
13. Namimoto T, Yamashita Y,Mitsuzaki K, etal.Measurement of the apparent diffusion coefficient in diffuse renal disease by diffusion-weighted echo-planar MR imaging. Journal of magnetic resonance imaging,. 1999; 9: 832-837.
14. Gray L, Macfall J. Overview of diffusion imaging. MRI clin N Am, 1998, 6(1): 125-138.
15.张宗军,黄伟,卢光明.磁共振弥散加权的原理与临床应用.医学研究生学报,2004,17(2):172-174.
16. Siegel VS, Aisen AM, Ellis JH, etal. Feasibility of MR diffusion studies in the kidney. Journal of magnetic resonance imaging, 1999,9:832-837.
17.尚全良,肖恩华,贺忠,等.GE Signa Twinspeed 1.5T核磁共振肝脏扩散加权成像的技术探讨.中国医学影像技术,2004,20(10)1515-1518.
18. Ichikawa T, Haradome S, Hachiya J, et al. Diffusion-weighted MR imaging with single-shot echo-planar imging in the upper abdomen: preliminary clinical experience in 61 patients[J]. Abdom Imaging, 1999, 24(5): 456-461.
19.张卫东,梁碧玲.磁共振弥散张力成像及临床应用.临床放射学杂志,2003,22(10):889-891.
20.盛复庚,安宁豫.磁共振弥散张量成像的基本原理和临床应用.中国医学影像学杂志,2003,11(1):56-58.
21.许卫国,黄力.磁共振扩散张量成像的概念及应用.国外医学临床放射分册,2003,26(2):119-122.
22.谭湘萍,梁碧玲.扩散张量MR成像.国外医学临床放射分册,2003,26(5):314-316.
23. Sorensen AG, Wu O, Copen, et al. Human acute cerebral ischemia: detection of changes in water diffusion anisotropy by using MR imaging. Radiology, 1999,: 212-785.
24. Pierpaoli C, Jezzard P, Basser PJ, et al, Diffusion tensor MR imaging of the human brain. Radiology, 1996, 201(3): 637-648.
25. Guo AC, Macfall JR, Provenzale JM. Multiple sclerosis: diffusion tensor MR imaging for evaluation of normal-appearing white matter. Radiology, 2002, 222(3): 729-736.
26.张雪辉,梁碧玲,赵继全,等.肝脏常见病变弥散系数的初步研究.中国医学影像技术,2004,20(1):26-28.
27. Fukuda Y, Ohashi I, Hanafusa K, et al. Anisotropic diffusion in kidney: apparent diffusion coefficient measurements for clinical use.[J] Magnetic resonance imaging, 2000, 11: 156-160.
28. Ries M, MSc, Jones RA, et al. Diffusion tensor MRI of the human kidney. [J] Magnetic resonance imaging, 2001, 14: 42-49.
29. Higano S, Zhong J, Shrier DA, etal. Diffusion anisotropy of the internal and the coron radiate in association with stroke and tumor as measured by diffusion-weighted MR imaging. AJNR, 2001, 22: 456-462.
30. Jean-pierre L, David MG, Erik D etal. Hemodynamic effect of iodinated high-viscosity contrast medium in rat kidney: A diffusion-weighted MRI feasibility study. Investigative Radiology, 2000,35(11):647-652.
31. S. T, K. N, S. H, et al. Functional evaluation of hydronephiosis by diffusion-weighted MR imaging Relationship between apparent diffusion coefficient and split glomerular filtration rate. Acta Radiologic, 2000, 41: 642-646.
32.郑肖林,徐辉雄,吕明德,等.磁共振弥散加权成像检测肝内小病灶 的临床应用.中国医学影像技术,2004,20(10):1510-1512.
33. Moteki T, Horikoshi H, Oya N, et al. Evaluation of hepatic lesions and hepatic parenchyma using diffusion-weighted recordered turboflash magnetic resonance imaing. [J]Magnetic resonance imaging, 2002, 15: 567-572.
34.刘彤华,主编.诊断病理学.北京:人民卫生出版社,874-876.
35.王吉耀,主编.内科学(全国高等医学院校教材,供七年制临床医学等专业用).北京:人民卫生出版社,229-244.
36. Mandell GA, Eggli DF, Gilday DL, et al. Nuclear medicine procedure guidline for renal cortical scintigraphy in children, J Nucl Med, 1997, 38(12): 1644-1646.
37. Levey AS. Measurement of renal function in chronic renal disease. Kidney Int, 1990, 38(1): 167-184.
38. Hricak H, Lieto RP. Sonographoic determination of renal volume. Radiology, 1983, 148: 311-312.
39.谢恺庆,王扬,杨红,等.肾脏大小与肾实质厚度的测定在急、慢性肾功能衰竭诊断中的意义.临床荟萃,2002,17(23):1386-1387.
40. Levey AS, Coresh J, Balk E, et al. National Kidney Foundation practice guidelines for chronic kidney disease: evaluation, classification and stratification. Ann-Intern-Med, 2003, 139(2): 137-147.
41.黄晓玲,高云华.二维超声、频谱及彩色多普勒超声在评价性实验性兔急性肾衰竭中的价值比较.中华超声影象学杂志,2000,9(11):625-628.
42. Rubin JM, Bude RO, Carson PL, et al. power Doppler Us: a potentially useful alternatine to mean frequency based colour Doppler US. Radiology, 1994, 190: 853-856.
43.赵金英,李树森,廖明松,等.慢性肾功能衰竭的彩色多普勒能量图分析.中国超声医学杂志,2001,17(2):137-139.
44.牛海燕,简文豪.声学造影在肾脏疾病诊断中的应用及进展.中华超声影像学杂志,2001,10(1):61-62.
45. Georage AT, Carol EB, Brent H, et al. Renol cortical ischemia in rabbits revealed by contrast-enhanced power Doppler Sonography[J], AJR, 1998, 170(2): 417-422.
46. Dawson D. Contrast agent in patients on dialysis. Semin-Dial,2002, 15(4): 232-236.
47. Hackstein N, Bauer J, Hauck E W, et al. Measuring simg-kidney glomerular filtration rate on single-detector helical CT using a Two-Point patlak plot technique in patients with inereased interstitial space. AJR, 2003: 181: 147-156.
48. Miles KA. Measurement of tissue perfusion by dynamic computed tomograph[J], The British Journal of Radiology, 1991, 64(761): 409-412.
49.赵光明,韩丹,宋光义.CT灌注成像原理与技术.中国医学影像技术,2003,19(5):636-638.
50. Baumann D, Rudin M. Quantitative assessment of rat kidney function by measuring the chearance of the centrast agent Gd(DOTA)using dynamic MRI. Magn-reson-Imaging, 2000, 18(5): 587-595.
51. Seong Teh H, Sin Ang W, Cheong wong W, et al. MR renography using a dynamic gradient-echo Sequence and low-dose gadopentetate dimeglumine as alternative to radionuclide renography. AJR, 2003, 181: 441-450.
52. Wen JG, Chen Y, Ringgaard S, et al. Evaluation of renal function in normal and hydonephrotic kidney in rat using gadolinium diethyhenete tramine-pentaacetic acid enhanced dynamic magnetic resonance imaging. J-Urol, 2000, 163(4): 1264-1270.
53.王毅翔,江浩。磁共振肾脏功能成像进展.国外医学泌尿系统分册,1999,19(5):212-214.
54. Mario Ries,MSC,Richard A, Jones,et al.Diffussion tensor MRI of the human kidney. Journal of Magnetic Resonance Imaging,2001:14-42.
55.白文俊,王晓峰,朱积川,等.近期泌尿系统结核诊治体会(附36例报告).中华泌尿外科杂志,1999,20(2):112-113.
56. Prekumar A, Lattimer j, Newhouse jh. CT and sonography of advanced urinary tract tuberculosis[J]. AJR, 1987, 148: 65.
57.魏鹃,李妍,裘丽雯.肾结核误诊为多囊肾1例.中国实用内科杂志,2000,20(8):501-502.
58. Rothpper A, Frager D, Subramanian A, et al. MR urography technique and application. Radiology, 1995, 194: 125-230
59.卢延,洪闻,陆立,等.MR水成像技术的临床应用.中华放射学杂志,1996,30:732-736.
60. Chan JHM, Tsui EYK, Luk SH. et al. MR diffusion-weighted imaging of kidney: Differentiation between hydronephrosis and pyonephrosis. Journal of Clinical Imaging, 2001 25: 110-113.
61. Kanel I R, Bluemke D A, Abusedera R, et al. Role of diffusion-weighted imaging in estimating tumor neciosis after chemoembolization of hepatocellular carcinoma. AJR, 2003, 181(9): 708-711.
62. Guo Y, Cai YQ, Cai ZL, etal. Differentiation of clinically benign and malignant breast lesions using diffusion-weighted imaging.[J]Magnetic resonance imaging, 2002, 16: 172-178.
63. Van Rijswijk C S, Kunz P, Hogendoom P C, et al. Dffusion-weighted MRI in the characterization of soft-tissue tumors. [J]Magnetic resonance imaging, 2002, 15: 302-307.
64.汤光宇,姚冀平,徐武等.鉴别良、恶性椎体骨折的最佳扩散敏感系数值的探讨.中华放射学杂志,2004,38(6):615-619.
65. Fizek C, Mewees T, Fizek S, et al. Diffusion-weighed MRI of the petrous bone. [J] magnetic resonance imaging, 2002, 15: 636-641.
66. Bammer R, Augustin M, Prokesch R W, et al. Diffusion-weighted imaging of the spinal cord: interleaved echo-planar imaging is superior to fast spin-echo. [J] magnetic resonance imaging, 2002, 15: 364-373.
67. Yeung D K, wong S Y, Griffith J F. Bone marrow diffusion in osteoporosis: evaluation with quantitative MR diffusion imaging. [J] magnetic resonance imaging, 2004, 19: 222-228.
68. kenney PJ. Imaging of chronic renal infections. AJR, 1990, 155(3): 485-494.
69. Elenberger CD. Renal tuberculosis. AJR, 1995, 165(1): 199-200.
70. Rothppear A, Frager D, Subramanian A, et al. MR urography technique and application. Radiology. 1995, 194 (1): 125-230.
71.赵耀瑞,孙光,王文成,等.肾结核磁共振尿路成像特点及与病理变化的关系.中华泌尿外科杂志,2003(24)5:303-304.
72. Ebisu T, Tanaka C, Umeda M, et al. Discrimination of brain abscess from necrotic or cystic tumors by diffusion-weighted echo planar imaging. Magn ResonImaging 1996; 14: 1113-1116.