BOLD-fMRI评价中晚期慢性肾脏病患者肾功能的研究

The research of BOLD-f MRI on evaluation of renal function in patients with moderate-severe chronic kidney disease

目的通过应用血氧水平依赖磁共振功能成像(BOLD-f MRI)技术定量测量肾脏皮、髓质R2*值,探讨其在慢性肾脏病(CKD)中晚期患者肾功能评价中的应用价值。方法选择CKD中晚期患者33例(包括中期CKD组21例,晚期CKD组12例)及26例健康志愿者(正常对照组),均行MRI常规扫描及BOLD功能成像,分别测量双侧肾脏皮、髓质的R2*值,比较每组皮、髓质的R2*值是否有统计学意义。结果中、晚期CKD组及正常对照组的皮质R2*值均显著低于髓质,差异有统计学意义(P<0.05)。正常对照组、中期CKD组和晚期CKD组3组间肾皮质R2*值比较,差异无统计学意义(P>0.05);正常对照组与中期CKD组肾髓质R2*值比较,差异无统计学意义(P>0.05);正常对照组肾髓质R2*值显著高于晚期CKD组,差异有统计学意义(P<0.05);中期CKD组肾髓质R2*值显著高于晚期CKD组,差异有统计学意义(P<0.05)。以髓质R2*值区分中期CKD组与晚期CKD组,诊断界值为34.10 Hz,灵敏度为78.60%,特异度为66.70%(P<0.05)。结论肾脏BOLD-f MRI对肾髓质缺氧变化灵敏,能够反映CKD中晚期患者肾功能的不同变化。

Objective To explore the value of BOLD- f MRI on evaluation of renal function in patients with moderate- severe chronic kidney disease( CKD). Methods 33 patients with moderate- severe CKD( including 21 with moderate CKD and 12 with severe CKD) as well as 26 healthy volunteers( normal control group) were included. All of them were received a conventional MRI and BOLD- f MRI examinations. The cortical and medullary R2* values of control group and CKD group were measured. Results The renal cortical R2* values of each group were significantly lower than the medullary R2* values,the difference was statistically significant( P< 0. 05). Among the three groups in the renal cortical R2* values,the difference was not statistically significant( P > 0. 05); the renal medullary R2* values were significantly different among the three groups( P < 0. 05). Comparing the control group and the moderate CKD group of renal medullary R2* values,the difference was not statistically significant( P > 0. 05); the normal control group renal medullary R2* values were significantly higher than severe CKD group,and the difference was statistically significance( P < 0. 05); the moderate CKD group of renal medullary R2* values were significantly higher than severe CKD group,and the difference was statistically significant( P < 0. 05). In medullary R2* values distinguish CKD group of moderate and severe group,the diagnostics sector was 34.10 Hz,and the sensitivity was 78. 60%,and the specificity was 66. 70%( P = 0. 001). Conclusion Renal BOLD- f MRI can reflect the different variations of renal function in patients with advanced CKD