皮质期CT增强扫描联合表观扩散系数预测慢性肾脏病分期的临床价值

Clinical value of cortical phase enhanced CT combined with apparent diffusion coefficient in predicting stages of chronic kidney disease

目的探讨皮质期CT增强扫描联合表观扩散系数(ADC)在预测慢性肾脏病(CKD)分期中的价值。方法回顾2018年1月至2022年10月宁波市医疗中心李惠利医院兴宁院区及东部院区76例CKD患者临床及影像资料,并收集同时期性别、年龄相匹配健康成人35名作为健康对照组。根据估算的肾小球滤过率(eGFR)结果将CKD患者分为轻度CKD组42例及中重度CKD组34例。比较3组受试者影像学测量参数主要包括肾脏皮髓质ADC、皮层厚度、相应层面腹主动脉直径/皮层厚度、肾脏皮质期皮层增强幅度。各单一影像学参数及联合模型(肾脏皮质ADC值与肾脏皮层厚度联合)对CKD分期的判定能力大小采用ROC曲线分析。结果健康对照组左侧与右侧肾脏皮质、髓质ADC值差异均无统计学意义(均P>0.05)。3组受试者皮质与髓质间ADC值差异均有统计学意义(均P<0.05),且皮质ADC值大于髓质。3组间肾脏皮髓质ADC值、增强幅度、皮层厚度、相应层面腹主动脉直径/皮层厚度差异均有统计学意义(均P<0.05),其中CKD分期随着肾脏皮髓质ADC值、皮层厚度降低而升高,随着相应层面腹主动脉直径/皮层厚度升高而升高;与健康对照组相比,轻度CKD组皮质期皮层增强幅度降低,差异有统计学意义(P<0.05);在轻度CKD组与中重度CKD组中,皮质期皮层增强幅度差异无统计学意义(P>0.05)。在鉴别健康对照组与轻度CKD组中,联合模型、皮质及髓质ADC值、皮层厚度的AUC分别为0.780、0.670、0.617、0.652;在鉴别轻度与中重度CKD组中,其AUC分别为0.765、0.640、0.619、0.649。结论皮质期CT增强扫描联合ADC方法可间接反映肾脏分期,且具有较高的诊断效能,在CKD患者的无创诊断中有一定价值。

Objective To explore the value of cortical phase enhanced CT combined with apparent diffusion coefficient(ADC)in predicting stages of chronic kidney disease(CKD).Methods Clinical and imaging data of the 76 patients with CKD in Xingning Branch and East Branch of Ningbo Medical Center Lihuili Hospital enrolled from January 2018 to October 2022 were retrospectively collected.At the same time,35 healthy adults matched with age and gender were collected as the healthy control group.According to the estimated glomerular filtration rate(eGFR),the CKD patients were divided into mild CKD group(n=42)and moderate-to-severe CKD group(n=34).The imaging data mainly included ADC of renal cortex and medulla,cortical thickness,ratio of abdominal aorta diameter to cortical thickness at the corresponding level,and cortical enhancement in renal cortical phase were compared among three groups.The ability of each single imaging parameter and the combined model(of two imaging parameters of renal cortical ADC and renal cortical thickness)to determine the stage of CKD was evaluated by using receiver operating characteristic(ROC)curve.Results There was no statistically significant difference in ADC values of cortex and medulla between the bilateral kidneys in healthy control group,while significant differences in ADC values were observed between cortex and medulla within each group,with values of cortex being greater.There were significant differences in ADC values of renal cortex and medulla,cortical thickness,and the ratio of abdominal aorta diameter to cortical thickness at the corresponding level among the three groups.CKD stage advanced with the decrease of ADC values of renal cortex and medulla and cortical thickness,and with the increased ratio of abdominal aorta diameter to cortical thickness at the corresponding level.Compared with the healthy control group,the degree of cortical enhancement in the mild CKD group decreased,and the difference was statistically significant.There was no significant difference in cortical enhancement between mild CKD group and moderate-to-severe CKD group.In terms of identifying healthy control group and mild CKD group,the AUC values of the combined model,cortex and medulla ADC,and cortical thickness were 0.780,0.670,0.617,and 0.652,respectively.In terms of differentiating mild CKD from moderate-to severe CKD,the corresponding AUC values were 0.765,0.640,0.619 and 0.649,respectively.Conclusion Cortical phase enhanced CT combined with ADC method can indirectly reflect the renal stage,with a high diagnostic efficiency,which show certain value in the non-invasive diagnosis of CKD.