增强磁共振与SPECT肾动态显像评估移植肾肾小球滤过率的对比分析

Comparison of DCE-MRI renography, SPECT renography and endogenous creatinine clearance rate in kidney transplant recipients

目的 对比分析动态对比增强磁共振（DCE-MRI）与单光子发射计算机断层成像术（SPECT）肾动态显像测定移植肾肾小球滤过率（GFR）的准确性.方法 选取60例2015年12月至2016年7月接受肾移植手术的受者,分别采用DCE-MRI及SPECT测定其移植肾GFR,并与内生肌酐清除率（Ccr）进行对比,对两组结果行统计分析.结果 60例受者中,矫正Ccr为（60.63±24.83）ml·min-1 ·1.73 m-2,SPECT和MRI测得的矫正移植肾GFR（GFR-SPECT和GFR-MRI）分别为（65.31±17.08）和（50.44±22.78）ml·min-1·1.73 m-2.以矫正Ccr为基础值,GFR-SPECT偏倚为4.69ml·min-1 ·1.73 m-2,精度为23.76 ml·min-1 ·1.73m-2;GFR-MRI偏倚为-10.18 ml·min-1 ·1.73 m-2,精度为13.87 ml·min-1·1.73m-2.Ccr与GFR-SPECT的相关系数（r）=0.406,P＜0.01,直线回归方程为Ccr=34.169＋0.591＆#215;GFR（SPECT）;Ccr与GFR-MRI的r=0.833,P＜0.01,直线回归方程为Ccr=22.298＋0.831＆#215;GFR（MRI）;MRI所测得GFR与Ccr线性关系更为显著.GFR-SPECT和GFR-MRI的r=0.342,P＜0.01,直线回归方程为GFR（SPECT）=16.192＋0.342＆#215;GFR（MRI）,二者呈弱相关.通过Bland-Altman分析,GFR-SPECT的可信区间为95.3 ml·min-1 ·1.73 m-2,GFR-MRI的可信区间为62.3ml·min-1·1.73m-2,MRI的可信区间更窄.结论 与SPECT相比,DCE-MRI测得GFR与矫正Ccr偏倚较大,但与矫正Ccr具有更好的相关性及一致性.DCE-MRI在评估移植肾及尿路解剖结构的同时,同样能准确地评价移植肾功能.

Objective To compare the accuracy of dynamic contrast-enhanced magnetic resonance （DCE-MRI） and SPECT in the measurement of glomerular filtration rate （GFR） in renal allografts.Methods Sixty renal transplant recipients were enrolled in this study.DCE-MRI and SPECT were used to measure the GFR of the transplanted kidneys,and compared with the endogenous creatinine clearance rate （Ccr）.Bias,precision,correlation and Bland-Altman agreement were calculated for each modality compared with the endogenous Ccr.Results In 60 renal transplant recipients,the corrected Ccr was （60.63 ± 24.83） ml · min-1 · 1.73 m-2.The GFR measured by SPECT was （65.31 ± 17.08） ml · min-1 · 1.73 m-2,and （50.44 ± 22.78） ml · min-1 · 1.73 m-2 by MRI,respectively.The bias of GFR-SPECT was 4.69 ml·min-1 · 1.73 m-2,and the precision was 23.76 ml·min-1 1.73 m-2.The bias of GFR-MRI was-10.18 ml·min-1 ·1.73 m-2,and the precision was 13.87 ml·min-1 · 1.73 m-2.Correlation analysis showed that GFR-MRI and the endogenous Ccr had a good correlation （r=0.833,P〈0.01）,GFR-SPECT and the endogenous Ccr had a moderate correlation （r=0.406,P〈0.01）,and GFR-MRI and GFR-MRI had a poor correlation （r=0.342,P 〈0.01）.Bland-Altman analysis showed a confidence interval of 95.3 ml·min-1 ·1.73 m-2 for GFR-SPECT and 62.3 ml· min-1 · 1.73 m-2 for GFR-MRI.Conclusion DCE-MRI can be used as confidently as SPECT to evaluate the renal function of transplanted kidneys in the same time of determining anatomical information.