BOLD及mDIXON-Quant序列预测慢性肾脏病患者肾功能发展的探讨

Prediction of renal function development in patients with chronic kidney disease by BOLD and mDIXON-Quant se⁃quences

目的 探讨BOLD-MRI和mDIXON-Quant序列在评估慢性肾脏病(CKD)肾功能及预测CKD发展中的应用价值。方法 选取CKD患者35例为CKD组(包括早期CKD组20例,晚期CKD组15例),与对照组30例行常规MRI检查及BOLD功能成像、mDIXON-Quant序列检查,分别测量双侧肾脏皮、髓质的R2*值(BOLD功能成像R2*值为bR2*值,mDIXON-Quant序列R2*值为dR2*值),对结果进行单因素方差分析。结果 所有受检者的皮质bR2*值及dR2*值均显著低于髓质,皮质R2*值组间比较,差异无统计学意义(P>0.05);正常对照组与早期CKD组肾髓质R2*值比较,差异无统计学意义(P>0.05);晚期CKD组髓质R2*值均明显低于对照组及早期CKD组,差异有统计学意义(P<0.05)。CKD组肾脏髓质R2*值的ROC曲线分析,对于区分早期、晚期CKD患者bR2*值:AUC为0.857,敏感度为70%,特异度为93%,诊断界值为36.35Hz(P<0.05);dR2*值:AUC为0.735,敏感度为55%,特异度为93%,诊断界值为34.88 Hz (P<0.05)。结论 肾脏BOLD-fMRI及mDIXON-Quant序列的R2*值可以对肾脏髓质的缺氧变化进行定量分析,评估CKD患者肾功能的变化,预测CKD患者病情发展;对于区别早期、晚期CKD患者,BOLD敏感度明显大于mDIXON-Quant序列。

Objective To investigate the value of BOLD-MRI and mdixon quant sequence in evaluating renal function and predicting the development of chronic kidney disease(CKD).Methods In the experimental group,35 patients with CKD(in-cluding 20 in the early CKD group and 15 in the late CKD group),together with 30 casesin normal control group,underwent rou-tine MR examination,BOLD functional imaging and mDIXON-Quant sequence examination.The R2*values of bilateral renal skin and medulla were measured respectively(BOLD R2*value is bR2*value,and mdixon quant sequence R2*value is dR2*value),and the results were statistically analyzed by one-way ANOVA.Results The cortical bR2*value and dR2*value of all subjects were significantly lower than those of medulla,and there was no significant difference in renal cortical R2*value be-tween groups(P>0.05);There was no significant difference in R2*value of renal medulla between normal control group and early CKD group(P>0.05);The R2*value of medulla in late CKD group was significantly lower than that in control group and early CKD group(P<0.05).ROC curve analysis of R2*value of renal medulla in CKD group was conducted.For distinguishing early and late CKD patients,bR2*value was as follows:AUC was 0.857,sensitivity was 70%,specificity was 93%,and diag-nostic boundary value was 36.35 Hz(P<0.05);dR2*value was as follows:AUC was 0.735,sensitivity was 55%,specificity was 93%,and diagnostic limit was 34.88 Hz(P<0.05).Conclusion The R2*value of renal BOLD fMRI and mDIXON-Quant sequences can quantitatively analyze the hypoxic changes of renal medulla,evaluate the changes of renal function in patients with CKD and predict the development of CKD.For distinguishing early and late CKD patients,BOLD sensitivity is significantly higher than mDIXON-Quant sequence.