CAJ | 학술논문

目的探讨磁共振(MR)扩散张量成像(DTI)评价肾移植术后早期移植肾功能的可行性.方法选取51例肾移植术后1个月内的受者及26例健康志愿者,行肾脏斜冠状面3.0T MRDTI检查(扩散梯度方向6,b值为0、300 s/mm2).依据接受DTI MR检查当天的估算肾小球滤过率(eGFR),将所有受试者分为4组,(1)正常对照组(1组),为正常志愿者26例;(2)eGFR≥60ml·min-1 ·1.73 m-2组(2组),24例受者;(3)30 ml·min-1·1.73 m-2≤eGFR＜60 ml· min-1·1.73m-2组(3组),19例受者;(4) eGFR＜30 ml· min-1·1.73 m-2组(4组),8例受者.分别测量和计算各组肾脏皮髓质的ADC值和FA值,并采用配对样本t检验和单因素方差分析进行比较,采用Pearson积差相关分析分析移植肾皮髓质ADC值和FA值与eGFR间相关性.结果各移植组受者间皮质FA值均无明显差异(P＞0.05),但均显著低于1组的皮质FA值(P＜0.01).随着eGFR的降低,各移植组髓质FA值、ADC值及皮质ADC值均呈递减趋势,且各组间差异均有显著统计学意义(P＜0.05),其中以髓质FA值的差异最为显著.移植肾髓质FA值、ADC值及皮质ADC值与eGFR呈明显正相关(r值分别为0.812、0.756、0.757,P＜0.01).FA图和ADC图显示,3组与4组移植肾皮髓质分辨明显减低,扩散张量示踪图显示3组与4组移植肾髓质内纤维束样结构明显稀疏、减少,尤以4组为著.结论 DTI评价肾移植术后早期移植肾功能的改变具有可行性,不仅能够定量,而且可以从形态学上有效鉴别处于不同功能状态的移植肾.
목적 탐토자공진(MR)확산장량성상(DTI)평개신이식술후조기이식신공능적가행성.방법 선취51례신이식술후1개월내적수자급26례건강지원자,행신장사관상면3.0T MRDTI검사(확산제도방향6,b치위0、300 s/mm2).의거접수DTI MR검사당천적고산신소구려과솔(eGFR),장소유수시자분위4조,(1)정상대조조(1조),위정상지원자26례;(2)eGFR≥60ml·min-1 ·1.73 m-2조(2조),24례수자;(3)30 ml·min-1·1.73 m-2≤eGFR＜60 ml· min-1·1.73m-2조(3조),19례수자;(4) eGFR＜30 ml· min-1·1.73 m-2조(4조),8례수자.분별측량화계산각조신장피수질적ADC치화FA치,병채용배대양본t검험화단인소방차분석진행비교,채용Pearson적차상관분석분석이식신피수질ADC치화FA치여eGFR간상관성.결과 각이식조수자간피질FA치균무명현차이(P＞0.05),단균현저저우1조적피질FA치(P＜0.01).수착eGFR적강저,각이식조수질FA치、ADC치급피질ADC치균정체감추세,차각조간차이균유현저통계학의의(P＜0.05),기중이수질FA치적차이최위현저.이식신수질FA치、ADC치급피질ADC치여eGFR정명현정상관(r치분별위0.812、0.756、0.757,P＜0.01).FA도화ADC도현시,3조여4조이식신피수질분변명현감저,확산장량시종도현시3조여4조이식신수질내섬유속양결구명현희소、감소,우이4조위저.결론 DTI평개신이식술후조기이식신공능적개변구유가행성,불부능구정량,이차가이종형태학상유효감별처우불동공능상태적이식신.
Objective To investigate the feasibility of magnetic resonance diffusion tensor imaging (DTI) as a noninvasive way for assessment of kidney transplant function in the early posttransplantation period.Method Fifty-one kidney transplant recipients less than 1 month after kidney transplantation and 26 age-matched healthy volunteers were included and examined using a fatsaturated echo-planar DTI sequence in oblique-coronal orientation at 3.0 Tesla magnetic resonance (MR) imager (diffusion directions=6,b =0,300 s/mm2).According to the estimated glomerular filtration rate (eGFR) recorded and calculated on the examined day,all subjects were divided into four groups:group 1,healthy volunteers (n =26) ; group 2,eGFR≥60 mL/min/1.73 m2 (n =24) ; group 3,30≤eGFR＜60 mL/min/1.73 m2 (n =19) ; group 4,eGFR＜30 mL/min/1.73 m2 (n =8).Mean apparent diffusion coefficient (ADC) and mean fractional anisotropy (FA) were determined separately for the cortex and the medulla.The paired Students t test was used to compare ADC and FA between cortex and medulla within each group.ADC and FA between groups were compared by using the one-way analysis of variance test.Relationship between ADC and FA with eGFR of the transplants was assessed by using Pearson correlation analysis.Result Mean cortical FA was significantly higher in group 1 than in other three groups (P＜0.01 for all),while differences among groups of allograft recipients were not significant (P＞0.05 for all).There was a gradually decreasing trend of medullary FA and ADC,and cortical ADC from group 2 to group 4,and the differences among groups were all pronounced (P＜0.05 for all).In renal allografts,there was a significant positive correlation between eGFR and medullary FA,medullary ADC as well as cortical ADC (r =0.812,0.756,0.757,respectively,P＜0.01).The cortical-medullary discrimination of FA-map and ADC-map in group 3 and group 4 apparently decreased.Meanwhile,DTI revealed that the radial diffusion tracts in the medulla of group 3 and group 4 obviously broke off and reduced,especially in group 4.Conclusion DTI is a promising way to evaluate kidney transplant function early after transplantion,and can quantitatively and visually distinguish transplants with different functions.