Department of Radiology, West China Hospital of Sichuan University, No 37 Guoxue Street, Wuhou District, Chengdu, Sichuan 610041, China.
Eur J Radiol. 2012 Jul;81(7):1426-31. doi: 10.1016/j.ejrad.2011.03.045. Epub 2011 Apr 5.
To evaluate the renal oxygenation in type 2 diabetes by blood oxygenation level dependent magnetic resonance imaging (BOLD-MRI).
Forty-eight patients with type 2 diabetes and 67 healthy controls were recruited. All patients were further divided into four subgroups based on renal functional level. Bilateral renal cortical R2* (CR2*) and medullary R2* (MR2*) values were extracted and quantified on BOLD-MRI, then R2* ratio between medulla and cortex (MCR) was calculated. CR2*, MR2* and MCR were compared among the groups separately. The relationships were analyzed between R2* values and clinical index of renal function.
Compared with controls, MR2* and CR2* in diabetes were significantly increased. The positive relationship was found between MR2* and estimated glomerular filtration rate (eGFR), and CR2* was negatively correlated with eGFR. Interestingly, the MCR increased in early stage of diabetes and decreased along with the aggravation of diabetic nephropathy (DN).
BOLD-MRI can non-invasively detect and assess the renal hypoxia in diabetes. Our findings suggest that hypoxia in medulla is more apparent and earlier than in cortex. During the progression of DN, a reversion of corticomedullary oxygenation gradient can be detected, thus, MCR would be adopted to suppose the progression and prognosis of DN.
通过血氧水平依赖磁共振成像（BOLD-MRI）评估 2 型糖尿病患者的肾脏氧合情况。
共纳入 48 例 2 型糖尿病患者和 67 名健康对照者。所有患者均根据肾功能水平进一步分为四组。在 BOLD-MRI 上提取并量化双侧肾皮质 R2*（CR2*）和髓质 R2*（MR2*）值，然后计算髓质与皮质之间的 R2比值（MCR）。分别比较各组间的 CR2、MR2和 MCR 值。分析 R2值与肾功能临床指标之间的关系。
与对照组相比，糖尿病患者的 MR2和 CR2明显升高。MR2与估算肾小球滤过率（eGFR）呈正相关，CR2与 eGFR 呈负相关。有趣的是，MCR 在糖尿病早期增加，随着糖尿病肾病（DN）的加重而降低。
BOLD-MRI 可以无创地检测和评估糖尿病患者的肾脏缺氧情况。我们的研究结果表明，髓质缺氧比皮质更明显且更早。在 DN 的进展过程中，可以检测到皮质-髓质氧合梯度的逆转，因此，MCR 可用于推测 DN 的进展和预后。
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