基于体素分析的终末期肾病患者全脑弥散峰度成像研究

A Voxel-Based Diffusion Kurtosis Imaging Study of Whole-Brain in Patients with End Stage Renal Disease

目的:探寻终末期肾病(ESRD)患者认知功能障碍的客观影像学标志物。方法:前瞻性收集2020年1月至2020年10月南京医科大学附属常州第二人民医院肾内科收治的ESRD患者28例作为试验组,同期纳入26名健康人员作为健康对照组,所有受试者均完成认知功能评估,进行MRI采集数据后通过DKE软件获得弥散峰度成像(DKI)各参数,采用独立样本:检验比较2组间各DKI参数值的差异,对2组间差异有统计学意义的脑区与认知量表评分进行线性相关分析。结果:ESRD组较健康对照组DKI参数值平均弥散峰度(MK)、轴向弥散峰度(AK)差异具有统计学意义,径向弥散峰度(RK)值在2组间差异无统计学意义。其中MK值减低的脑区是右侧额叶Sub-Gyral(体素26个,t=5.87);AK值减低的脑区有扣带回前部(体素55个,t=7.08)、右侧岛叶(体素29个,t=6.18)、右侧中央后回(体素51个,t=6.45)、右侧缘上回(体素30个,t=6.4)。ESRD组右侧额叶Sub-Gyral的MK值及扣带回前部、右侧岛叶的AK值与蒙特利尔认知量表评分存在正相关关系。结论:DKI参数MK,AK可作为评估ESRD患者脑部微观改变的影像学标志物。

Purpose:To explore the imaging markers of cognitive impairment in patients with end stage renal disease(ESRD).Methods:Twenty-eight patients with ESRD(ESRD group)and 26 matched normal subjects(healthy control group)were recruited from January 2020 to October 2020 in Changzhou No.2 People's Hospital.Montreal cognitive assessment(MoCA),trail marking test and MR were performed.Mean kurtosis(MK),axial kurtosis(AK)and radial kurtosis(RK)were obtained by DKE software.Independent sample t-test was performed to evaluate the significant difference of DKI parameters between the two groups.Finally,the correlation between DKI parameter values and neuropsychological scale tests were analyzed.Results:There were significant differences in the MK,AK value between the ESRD group and the healthy control group(P<0.05).The results of this study showed a significant decrease in the MK values of right frontal lobe Sub-Gyral,the AK values of anterior part of cingulate gyrus,right insular lobe,right postcentral gyrus and right supramarginal gyrus when compared with normal subjects(P<0.05).Bivariate correlation analysis suggested that MK values in right frontal lobe Sub-Gyral and AK values of anterior cingulate gyrus and right insular lobe were positively correlated with MoCA scores.Conclusion:MK,AK values may be used as an imaging markers of cognitive impairment for ESRD patients.