慢性肾功能衰竭患者椎体骨质变化的磁共振波谱初步分析

A preliminary study of 1H MRS examination for vertebral bony changes in chronic renal failure

目的：初步探讨慢性肾功能衰竭患者椎体骨质变化的氢质子磁共振波谱（1H—MRS）的特征及其诊断价值。方法：前瞻性的对64例经临床确诊的慢性’肾功能衰竭患者行L2椎体，H—MRS采集，同时以年龄相仿的34名健康志愿者L2椎体-H—MRS作为对照组，定量分析两组感兴趣区脂肪含量（FF％）及脂水比（LWR）的差异，并分析FF％、LWR与eGFR的相关性，及作ROC曲线。结果：慢性肾功能衰竭组L2椎体平均FF％为（52．56＋10．74）％，平均LWR为1．250．68；对照组L2椎体平均FF％为（43．24＋12．19）％，平均LWR为0．85＋0．44，组间差异具有统计学意义（t=-3．752，P=0．000和t=-3．512，P=-0．001）。FF％与eGFR呈负相关关系（r=-0．264，P=0．035），LWR与eGFR呈负相关关系（r=-0．264，P=O．035）。FF％的ROC曲线下面积为0．706，95％CI为0．591—0．821，诊断临界值为33．29％，灵敏度为0．984，特异度为0．296；LWR的ROC曲线下面积为0．706，95％CI为0．591。0．821，诊断临界值为50．00％，灵敏度为0．984，特异度为0．296。结论：1H—MRS可无创性的检测椎体FF％及LWR，进而可以用FF％及TtWR来问棒的评估悒件肾功能衰竭患者的骨后蛮化情况．

Objective： To prospectively analyze IH MRS features of the vertebral bony changes in renal failure patients and evaluate its diagnostic value. Materials and Methods： In 64 patients with clinically diagnosed chronic renal failure had 1H MRS of the second lumbar vertebra （L2） as the chronic renal failure group （CRF） and at the same time, 34 age matched healthy volunteers were recruited as control group. The fat fraction percent （FF%） and lipid-to-water （LWR） in ROI of the L2 were quantitatively analyzed. The differences between the two groups were compared, and the correlation with estimated glomerular filtrate rate （eGFR） and ROC curves were analyzed. Results： The mean FF% and mean LWR of L2 in the CRF group were （52.56~10.74）% and 1.25~0.68 respectively. The mean FF% and mean LVCR of L2 in the control group were （43.24~12.19）% and 0.85_＋0.44 respectively. The mean FF% and the mean LWR of the CRF group were higher than those of the control group, the differences between the two groups were statistically significant （t=-3.752, P=0.000 and t=-3.512, P= 0.001 respectively）. In the CRF group, FF% was negatively related to eGFR（r=-0.264, P=0.035）; the LWR was also negatively related to eGFR （r=-0.264, P=0.035）. The ROC of FF% was 0.706, confidence internal （CI） was 95%（0.591~0.821）, diagnostic critical value was 33.29%, the sensitivity was 0.984, the specificity was 0.296. The ROC of LWR was 0.706, CI was 95% （0.591~0.821）, diagnostic critical value was 50.00%, the sensitivity and specificity were 0.984 and 0.296 respectively. Conclu- sion： IH-MRS can be used as a non-invasive method to analyze the FF% and LVCR of the vertebral body. So it can be used to assess the bony changes indirectly in CRF patients.