Li Xiao, Xu Xueqin, Zhang Qianying, Ren Hong, Zhang Wen, Liu Yan, Yan Fuhua, Chen Nan
J Transl Med. 2014 Oct 24;12:295. doi: 10.1186/s12967-014-0295-x.
Lupus nephritis (LN) is one of most common secondary glomerulonephritis. There is no ideal method to simultaneously assess renal structure and function in patients with LN. The aim of this study is to investigate the utility of diffusion weighted imaging (DWI) and blood oxygen level-dependent (BOLD) MR imaging in the assessment of renal involvement and pathological changes in patients with LN.
Sixty-five patients with LN and 16 healthy volunteers underwent coronal echo-planar DWI and BOLD MR imaging of the kidneys. The apparent diffusion coefficient (ADC) and R2* values of the kidneys were calculated with b values of 0 and 500 s/mm(2). The relationship between the renal injury variables and the ADCs or R2* values were evaluated. And 16 of 65 patients with LN underwent a repeated evaluation after the induction treatment for 9 to 12 months.
The mean ADC values of kidneys in patients with LN were 2.40 ± 0.25 × 10(-3) mm(2)/s, the mean R2* values of the renal cortex and medulla were 11.03 ± 1.60/sec and 14.05 ± 3.38/sec respectively, which were all significantly lower than that in volunteers. In patients with LN, the mean ADC values were correlated with eGFR (r = 0.510, p < 0.01). There was a negative correlation between the mean ADC values and renal pathology chronicity indexes (r = -0.249, p < 0.05), the R2* values of the renal medulla and proteinuria (r = -0.244, p < 0.05), and the degree of tubulointerstitial lesions (r = -0.242, p < 0.05). The ADC and R2* values of kidneys were significantly higher than those of pre-treatment in complete remission patients.
DWI and BOLD MR imaging of kidneys may be used to noninvasively monitor the disease activity and evaluate therapeutic efficacy in lupus nephritis.
狼疮性肾炎（LN）是最常见的继发性肾小球肾炎之一。目前尚无理想方法可同时评估LN患者的肾脏结构和功能。本研究旨在探讨扩散加权成像（DWI）和血氧水平依赖性功能磁共振成像（BOLD）在评估LN患者肾脏受累情况及病理改变中的应用价值。
对65例LN患者和16名健康志愿者进行肾脏冠状位回波平面DWI和BOLD磁共振成像检查。采用b值为0和500 s/mm²计算肾脏的表观扩散系数（ADC）和R2值。评估肾脏损伤变量与ADC或R2值之间的关系。65例LN患者中有16例在诱导治疗9至12个月后接受了重复评估。
LN患者肾脏的平均ADC值为2.40±0.25×10⁻³mm²/s，肾皮质和髓质的平均R2值分别为11.03±1.60/秒和14.05±3.38/秒，均显著低于志愿者。在LN患者中，平均ADC值与估算肾小球滤过率（eGFR）相关（r = 0.510，p < 0.01）。平均ADC值与肾脏病理慢性指数呈负相关（r = -0.249，p < 0.05），肾髓质的R2值与蛋白尿呈负相关（r = -0.244，p < 0.05），与肾小管间质病变程度呈负相关（r = -0.242，p < 0.05）。完全缓解患者肾脏的ADC和R2*值显著高于治疗前。
肾脏DWI和BOLD磁共振成像可用于无创监测狼疮性肾炎的疾病活动度并评估治疗效果。
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