磁共振扩散加权成像检测值与慢性肾脏病滤过功能及病理的相关性研究

Correlation of Renal Apparent Diffusion Coefficients with Glomerular Filtration Rate and Pathological Characteristics in Chronic Kidney Disease

目的研究磁共振(MR)扩散加权成像(DWI)检测值与慢性肾脏病(CKD)患者肾脏滤过功能及其病理改变的相关性。方法收集2012年2—12月在南昌大学第二附属医院肾内科就诊的CKD患者50例(100个肾脏)为CKD组,另选取同时期体检健康志愿者20例(40个肾脏)为对照组,测量两组双侧肾皮质和肾髓质表观弥散系数(ADC)值。根据99Tcm-DTPA肾动态显像测定的分肾肾小球滤过率(SKGFR),将CKD组的100个肾脏分为肾功能正常组36个、肾功能轻度受损组44个和肾功能中度受损组20个,比较肾皮质和肾髓质ADC值与SKGFR的相关性;18例CKD患者行右肾穿刺活检,分析其肾皮质和肾髓质ADC值与病理损害积分的相关性。结果对照组及不同肾功能CKD组患者肾皮质ADC值均大于肾髓质(P<0.05)。肾功能正常组、肾功能轻度受损组、肾功能中度受损组肾皮质和肾髓质ADC值较对照组降低(P<0.05),肾功能轻度受损组、肾功能中度受损组较肾功能正常组降低(P<0.05),肾功能中度受损组较肾功能轻度受损组降低(P<0.05)。Pearson相关分析结果显示:CKD组肾皮质和肾髓质的ADC值与SKGFR均呈正相关(r皮=0.697,P<0.01;r髓=0.800,P<0.01);CKD患者肾皮质和肾髓质ADC值与病理损害积分均呈负相关(r皮=-0.814,P<0.01;r髓=-0.800,P<0.01)。结论 DWI是一种无创的新技术,在其基础上测量的ADC值能在一定程度上反映CKD患者的肾脏滤过功能及病理损害程度,对早期诊断CKD患者肾功能的损害具有重要价值。

Objective To explore the correlation of renal apparent diffusion coefficient （ADC） values with glomerular filtration rates （GFR） and pathological characteristics in patients with chronic kidney disease （CKD） . Methods A total of 50 CKD patients （100 kidneys） treated in our department from February to December 2012 were included in our study, and 20 healthy adults （40 kidneys） visiting our hospital for regular physical examination were enrolled as the control group. The cortical and medullary ADC values were tested by diffusion weighted imaging （DWI） . According to the single kidney glomerular filtration rate （$KGFR） calculated with ~Tc＇＊ - DTPA scintigraphy, the 100 kidneys of CKD group were divided into 3 groups： normal re- nal function （36 kidneys） ; mild renal impairment （44 kidneys） ; moderate renal impairment （20 kidneys） . The correlations of the cortical and medullary ADC values with SKGFR were analyzed. The correlations between the renal cortical and medullary ADC values with pathological lesion were also analyzed in 18 patients who received renal biopsy. Results The cortical ADC val- ues were significantly higher than the medullary ADC values in the control group and the CKD group （ P 〈 0. 05 ） . The cortex and medullary ADC values of normal renal group, mild renal impairment group and moderate renal impairment group were all signifi- cantly lower than the control group （P 〈 0. 05 ）, ADC values of the mild renal impairment group and the moderate renal impair- ment group were lower than those of normal renal function group （ P 〈 0.05 ）, and ADC values of moderate renal impairment group were lower than mild renal impairment group （ P 〈 0. 05 ） . Pearson correlation analyses showed that the cortical and medul- lary ADC values were positively correlated with GFR （r^o,~~,~ = 0. 697, tin.doll., = 0. 800, P 〈 0. 01 ） and negatively correlated with pathological lesion degree （roo,~o^l = -0. 814, r~,aull~, = -0.800, P 〈0.01） . Conclusion ADC values tested by the noninva- sive DWI can reflect GFR and pathological lesion, and can be used as a marker for early detection of renal disfunction in CKD patients.