1 Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
AJR Am J Roentgenol. 2015 May;204(5):1024-30. doi: 10.2214/AJR.14.13418.
The purpose of this study was to investigate the utility of diffusion-weighted MRI (DWI) at 3 T for assessing renal function impairment in patients with liver cirrhosis.
Sixty-four patients with liver cirrhosis who underwent both DWI at 3 T and renal function testing were retrospectively included. Twenty-two patients had moderate or severe renal function impairment (group A, estimated glomerular filtration rate [eGFR] < 60 mL/min/1.73 m(2)) and 42 had good renal function or mild renal function impairment (group B, eGFR ≥ 60 mL/min/1.73 m(2)). Cortical and medullary apparent diffusion coefficients (ADCs) of both kidneys were measured. AUC was assessed for predicting group A with ADC. The correlation between renal ADC and eGFR or serum creatinine was analyzed. The reproducibility of ADC measurement was investigated.
Both cortical and medullary ADCs were lower in group A than in group B, (both, p < 0.05). In all patients, AUCs were 0.784 and 0.737 with cortical and medullary ADCs, respectively, for predicting group A. Both cortical and medullary ADCs had linear correlation with eGFR or serum creatinine (both, p < 0.05). The reproducibility of measurement was excellent for cortex (intraclass coefficient [ICC] = 0.808) and good for medulla (ICC = 0.692), with 1.6% or less variability.
DWI may have potential for assessing renal function impairment in patients with liver cirrhosis.
本研究旨在探讨 3T 扩散加权 MRI（DWI）在评估肝硬化患者肾功能损害中的应用价值。
回顾性分析 64 例同时行 3T DWI 及肾功能检查的肝硬化患者资料。22 例患者存在中重度肾功能损害（A 组，估算肾小球滤过率[eGFR]＜60ml/min/1.73m²），42 例患者肾功能良好或存在轻度肾功能损害（B 组，eGFR≥60ml/min/1.73m²）。测量双侧肾脏皮髓质表观扩散系数（ADC）。采用 AUC 评估 ADC 对预测 A 组的价值。分析肾脏 ADC 与 eGFR 或血清肌酐的相关性。评估 ADC 测量的可重复性。
A 组患者双侧肾脏皮质及髓质 ADC 均低于 B 组（均 P＜0.05）。在所有患者中，以 ADC 预测 A 组的曲线下面积（AUC）分别为 0.784 和 0.737，皮质和髓质 ADC 均与 eGFR 或血清肌酐呈线性相关（均 P＜0.05）。皮质 ADC 测量的重复性极好（组内相关系数 ICC=0.808），髓质 ADC 测量的重复性良好（ICC=0.692），两者的变异性均＜1.6%。
DWI 可能有助于评估肝硬化患者的肾功能损害。
