Department of Urology, University of Bern, Inselspital, Bern, Switzerland.
Neuro-Urology, Spinal Cord Injury Centre and Research, University of Zurich, Balgrist University Hospital, Zurich, Switzerland.
J Urol. 2014 Aug;192(2):434-9. doi: 10.1016/j.juro.2014.02.048. Epub 2014 Feb 25.
Little data are available on noninvasive magnetic resonance imaging based assessment of renal function during upper urinary tract obstruction. We determined whether functional multiparametric kidney magnetic resonance imaging could monitor the treatment response in cases of acute unilateral upper urinary tract obstruction.
Between January 2008 and January 2010, 18 patients with acute unilateral upper urinary tract obstruction due to calculi were prospectively enrolled to undergo kidney magnetic resonance imaging with conventional, blood oxygen level dependent and diffusion-weighted sequences upon emergency hospital admission and after release of obstruction. We assessed functional imaging parameters of obstructed and contralateral unobstructed kidneys derived from blood oxygen level dependent (apparent spin relaxation rate) and diffusion-weighted (total apparent diffusion coefficient, pure diffusion coefficient and perfusion fraction) sequences during acute upper urinary tract obstruction and after its release.
During acute obstruction the apparent spin relaxation rate and perfusion fraction were lower in the cortex (p=0.020 and 0.031) and medulla (p=0.012 and 0.190, respectively) of obstructed kidneys compared to contralateral unobstructed kidneys. After obstruction release the apparent spin relaxation rate and perfusion fraction increased in the cortex (p=0.016 and 0.004) and medulla (p=0.071 and 0.044, respectively) of formerly obstructed kidneys to values similar to those in contralateral kidneys. Total apparent diffusion coefficient and pure diffusion coefficient values did not significantly differ between obstructed and contralateral unobstructed kidneys during or after obstruction.
In our patients with acute unilateral upper urinary tract obstruction due to calculi functional kidney magnetic resonance imaging using blood oxygen level dependent and diffusion-weighted sequences enabled us to monitor pathophysiological changes in obstructed kidneys during obstruction and after its release.
关于上尿路梗阻时基于磁共振成像的肾功能无创评估，相关数据较少。我们旨在确定功能多参数肾脏磁共振成像是否可监测急性单侧上尿路梗阻的治疗反应。
2008 年 1 月至 2010 年 1 月，前瞻性纳入 18 例因结石导致的急性单侧上尿路梗阻患者，于急症入院时和梗阻解除后分别行常规、血氧水平依赖和弥散加权序列肾脏磁共振成像。我们评估了在急性单侧上尿路梗阻期间和梗阻解除后，来源于血氧水平依赖（表观自旋弛豫率）和弥散加权序列（总表观弥散系数、纯弥散系数和灌注分数）的功能性成像参数。
在急性梗阻期间，与对侧无梗阻肾脏相比，梗阻肾脏的皮质（p=0.020 和 0.031）和髓质（p=0.012 和 0.190）中的表观自旋弛豫率和灌注分数较低。在梗阻解除后，皮质（p=0.016 和 0.004）和髓质（p=0.071 和 0.044）中的表观自旋弛豫率和灌注分数增加，与对侧肾脏相似。在梗阻期间或梗阻解除后，总表观弥散系数和纯弥散系数在梗阻肾脏和对侧无梗阻肾脏之间无显著差异。
在我们因结石导致的急性单侧上尿路梗阻患者中，应用血氧水平依赖和弥散加权序列的功能性肾脏磁共振成像可在梗阻期间和梗阻解除后监测梗阻肾脏的病理生理变化。
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