体素内不相干运动扩散加权成像在鉴别2型糖尿病患者中糖尿病肾病与非糖尿病肾病的价值

The role of intravoxel incoherent motion diffusion-weighted imaging in distinguishing diabetic nephropathy from non-diabetic renal disease in diabetic patients

目的探究磁共振体素内不相干运动扩散加权成像(IVIM-DWI)在鉴别糖尿病患者中糖尿病肾病(DN)和非糖尿病肾病(NDRD)中的价值。方法诊断性试验。2017年10月至2021年9月前瞻性、连续性纳入在解放军总医院第一医学中心行IVIM-DWI扫描并接受肾脏穿刺活检的2型糖尿患者,测得肾脏皮质、髓质及实质IVIM-DWI参数:灌注分数(f)、纯扩散系数(D)、微循环扩散系数(D*)值,根据肾脏穿刺结果将患者分为DN组和NDRD组。使用Mann-Whitney U检验或独立样本t检验比较两组间的IVIM-DWI参数、临床信息及糖尿病相关生化指标,并通过Spearman相关性分析评估DN组IVIM-DWI参数与DN病理分级、间质病变评分、肾间质纤维化/肾小管萎缩(IFTA)评分、间质炎症评分、血管病变评分、玻璃样变评分及血管硬化评分的相关性,应用受试者工作特征(ROC)曲线评估IVIM-DWI参数对DN与NDRD的诊断效能。结果共27例DN患者及23例NDRD患者纳入了本研究。其中DN组男性19例、女性8例,年龄(52±9)岁;NDRD组男性16例,女性7例,年龄(49±10)岁。相较于NDRD组,DN组具有较高的肾皮质D*值及较低的髓质f值(9.84×10^(-3) mm^(2)/s比7.35×10^(-3) mm^(2)/s,Z=-3.65;41.01%比46.74%,Z=-2.29,均P<0.05)。肾髓质D*值与DN分级、间质病变评分及IFTA评分呈负相关(r=-0.571、-0.409、-0.409,均P<0.05);肾皮质f值与血管硬化评分呈正相关(r=0.413,P=0.032)。在IVIM-DWI相关参数中,肾皮质D*值鉴别DN组与NDRD组的ROC曲线下面积(AUC)为0.802,灵敏度为91.3%,特异度为55.6%。结论基于IVIM-DWI的肾皮质D*值可用于无创鉴别2型糖尿病患者中DN和NDRD,具有辅助临床对糖尿病患者进行无创筛查的潜能。

Objective To investigate the intravoxel incoherent motion(IVIM)diffusion-weighted imaging(DWI)in the differential diagnosis of diabetic nephropathy(DN)and non-diabetic renal disease(NDRD)among patients with type 2 diabetes mellitus(T2DM).Methods A diagnostic test.In this prospective study,patients with T2DM who underwent both IVIM-DWI and renal biopsy at the First Medical Center of Chinese PLA General Hospital between October 2017 and September 2021 were consecutively enrolled.IVIM-DWI parameters including perfusion fraction(f),pure diffusion coefficient(D),and pseudo-diffusion coefficient(D*)were measured in the renal cortex,medulla,and parenchyma.Patients were divided into the DN group and NDRD group based on the renal biopsy results.IVIM-DWI parameters,clinical information,and diabetes-related biochemical indicators between the two groups were compared using Student′s t-test or Mann-Whitney U test.The correlation of IVIM-DWI parameters with diabetic nephropathy histological scores were analyzed using Spearman′s correlation analyzes.The diagnostic efficiency of IVIM-DWI parameters for distinguishing between DN and NDRD were assessed using the receiver operating characteristic(ROC)curves.Results A total of 27 DN patients and 23 NDRD patients were included in this study.The DN group comprised 19 male and 8 female patients,with an average age of 52±9 years.The NDRD group comprised 16 male and 7 female patients,with an average age of 49±10 years.The DN group had a higher D*value in the renal cortex and a lower f value in the renal medulla than the NDRD group(9.84×10^(-3) mm^(2)/s vs.7.35×10^(-3) mm^(2)/s,Z=-3.65;41.01%vs.46.74%,Z=-2.29;all P<0.05).The renal medulla D*value was negatively correlated with DN grades,interstitial lesion score,and interstitial fibrosis and tubular atrophy(IFTA)score(r=-0.571,-0.409,-0.409;all P<0.05)while the renal cortex f value was positively correlated with vascular sclerosis score(r=0.413,P=0.032).The renal cortex D*value had the highest area under the curve(AUC)for discriminating between the DN and NDRD groups(AUC=0.802,sensitivity 91.3%,specificity 55.6%).Conclusion IVIM-derived renal cortex D*value can be used non-invasively to differentiate DN from NDRD in patients with T2DM that can potentially facilitate individualized treatment planning for diabetic patients.