CAJ | 학술논문

目的探讨MR扩散张量成像(DTI)在慢性肾病(CKD)分期诊断中的价值.方法前瞻性收集26例符合临床CKD诊断标准,MR图像质量达到诊断要求,并行99m锝-二乙三胺五乙酸肾动态显像测定肾功能的患者,将患者按照CKD分期标准分为轻度肾损害组(12例)和中重度肾损害组(14例).收集同期20名志愿者作为对照组.所有受试者均行双肾MRI常规扫描和DTI检查,测量皮、髓质ADC及FA值.所有受试者肾皮、髓质间ADC值和FA值的比较采用配对样本t检验.3组受试者肾皮、髓质ADC值和FA值的比较采用单因素方差分析,两两比较采用LSD法.CKD患者肾脏皮、髓质ADC值及FA值与肾小球滤过率的相关性采用Pearson相关性分析.结果 46例受试者皮、髓质的ADC值分别为(2.25±0.25)×10-3和(2.10±0.20) ×103mm2/s,FA值分别为3.48±0.61和4.27±0.75,皮质和髓质的测量值差异均有统计学意义(t值分别为6.754和10.043,P值均＜0.01).对照组、CKD轻度肾损害组、CKD中重度肾损害组肾皮质的ADC值分别为(2.25±0.22) ×10-3、(2.31±0.19) ×103和(2.18±0.32)×103mm2/s,肾髓质ADC值分别为(2.09±0.19)×10-3、(2.17±0.17)×10-3和(2.06±0.24)×10-3mm2/s,差异均无统计学意义(F值分别为0.968和0.882,P值均＞0.05).上述3组肾皮质FA值分别为3.85±0.47、3.18±0.62和3.20±0.52,肾髓质分别为4.92±0.38、3.93±0.57和3.62±0.53,差异均有统计学意义(F值分别为8.725和33.705,P值均＜0.01),两两比较对照组FA值均高于CKD两组(P值均＜0.01).CKD患者皮、髓质ADC值及皮质的FA值与肾小球滤过率[(30.14±15.79) ml· min-1· 1.73 m-2]无相关性(r值分别为0.243、0.197及0.196,P值分别为0.231、0.334及0.337),仅髓质FA值与GFR呈正相关(r=0.556,P=0.003).结论 DTI能为CKD的分期诊断提供有价值的信息,肾髓质FA值测量可用于评价肾功能状态.
목적 탐토MR확산장량성상(DTI)재만성신병(CKD)분기진단중적개치.방법 전첨성수집26례부합림상CKD진단표준,MR도상질량체도진단요구,병행99m득-이을삼알오을산신동태현상측정신공능적환자,장환자안조CKD분기표준분위경도신손해조(12례)화중중도신손해조(14례).수집동기20명지원자작위대조조.소유수시자균행쌍신MRI상규소묘화DTI검사,측량피、수질ADC급FA치.소유수시자신피、수질간ADC치화FA치적비교채용배대양본t검험.3조수시자신피、수질ADC치화FA치적비교채용단인소방차분석,량량비교채용LSD법.CKD환자신장피、수질ADC치급FA치여신소구려과솔적상관성채용Pearson상관성분석.결과 46례수시자피、수질적ADC치분별위(2.25±0.25)×10-3화(2.10±0.20) ×103mm2/s,FA치분별위3.48±0.61화4.27±0.75,피질화수질적측량치차이균유통계학의의(t치분별위6.754화10.043,P치균＜0.01).대조조、CKD경도신손해조、CKD중중도신손해조신피질적ADC치분별위(2.25±0.22) ×10-3、(2.31±0.19) ×103화(2.18±0.32)×103mm2/s,신수질ADC치분별위(2.09±0.19)×10-3、(2.17±0.17)×10-3화(2.06±0.24)×10-3mm2/s,차이균무통계학의의(F치분별위0.968화0.882,P치균＞0.05).상술3조신피질FA치분별위3.85±0.47、3.18±0.62화3.20±0.52,신수질분별위4.92±0.38、3.93±0.57화3.62±0.53,차이균유통계학의의(F치분별위8.725화33.705,P치균＜0.01),량량비교대조조FA치균고우CKD량조(P치균＜0.01).CKD환자피、수질ADC치급피질적FA치여신소구려과솔[(30.14±15.79) ml· min-1· 1.73 m-2]무상관성(r치분별위0.243、0.197급0.196,P치분별위0.231、0.334급0.337),부수질FA치여GFR정정상관(r=0.556,P=0.003).결론 DTI능위CKD적분기진단제공유개치적신식,신수질FA치측량가용우평개신공능상태.
Objective To study the value of MR diffusion tensor imaging(DTI) in the staging of chronic kidney disease(CKD).Method MR diffusion tensor imaging was used on 26 CKD patients.All patients were diagnosed as CKD according to the criteria of clinical diagnostic.All MR images achieved diagnostic requirements.Diethylenetriamine pentaacetic acid(99mTc-DTPA) renal dynamic imaging was used to determine the unilateral renal function.CKD patients were determined as mildly renal impairment group and moderately to severely renal impairment group based on the glomerular filtration rate(GFR).Twenty healthy volunteers underwent DTI at the same time.The cortical and medullary ADC value and FA value were measured in all subjects who underwent conventional MRI and DTI.The paired Student's t test was used to compare the cortico-medullary difference of the mean ADC and FA values in all subjects.The oneway analysis of variance(ANOVA) was carried out to assess the difference among the medullary and cortical diffusion parameters(ADC,FA) of all the three groups,and LSD was used to assess multiple comparisons.The correlation of GFR and ADC value of the patients,and FA value of the patients were tested by Pearson correlation analysis.Results The cortical and medullary ADC values of 46 subjects were(2.25±0.25) × 10-3 and(2.10±0.20) × 10-3 mm2/s respectively,FA of them were(3.48±0.61) and(4.27±0.75) respectively(t =6.754,10.043 respectively; P＜0.01).The cortical ADC values of volunteers,mild renal impairment group,severely renal impairment group were(2.25±0.22) ×10-3,(2.31±0.19) ×103,(2.18±0.32) ×10-3mm2/s respectively.The medullary ADC value of the three groups were(2.09±0.19) × 10-3,(2.17±0.17) × 10-3,(2.06±0.24) × 10-3mm2/s respectively(F=0.968,0.882 respectively; P＞0.05).The cortical FA values of the three groups were 3.85± 0.47,3.18±0.62,3.20±0.52 respectively.The medullary FA of the three groups were 4.92±0.38,3.93±0.57,3.62 ± 0.53(F=8.725,33.705 respectively; P＜0.01).There was no correlation between cortical ADC,medullary ADC,cortical FA of the patients and GFR [(30.14±15.79) ml· min-1 · 1.73 m-2](r =0.243,0.197,0.196 respectively; P＞0.05).There was a positive correlation between medullary FA of the patients and GFR (r=0.556,P=0.003).Conclusion FA value has certain value in evaluating CKD early diagnosis and renal function.