在评估肾间质纤维化中，读出分段和常规单次激发 echo-planar 扩散加权成像的比较。
Comparison of readout-segmented and conventional single-shot for echo-planar diffusion-weighted imaging in the assessment of kidney interstitial fibrosis.
机构信息
Division of Radiology, Geneva University Hospitals, University of Geneva, Faculty of Medicine, Geneva, Switzerland.
Division of Nephrology, Geneva University Hospitals, University of Geneva, Faculty of Medicine, Geneva, Switzerland.
出版信息
J Magn Reson Imaging. 2017 Dec;46(6):1631-1640. doi: 10.1002/jmri.25687. Epub 2017 Mar 10.
PURPOSE
To compare readout-segmented echo-planar imaging (EPI) (RESOLVE) to single-shot EPI (ss-EPI) diffusion-weighted imaging (DWI) for the assessment of renal interstitial fibrosis.
MATERIALS AND METHODS
A phantom, eight healthy volunteers (under 30 years to avoid age-fibrosis related) and 27 chronic kidney disease (CKD) patients (scheduled for kidney biopsy) were scanned (at 3T) with ss-EPI and 5-shot RESOLVE DWI (resolution: 2 × 2 × 5 mm , 10 b-values). The cortico-medullary difference for each DW parameter from a monoexponential fit (ΔADC) or, segmented biexponential fit (ΔD, ΔD*, ΔF ) were compared between both sequences. A fibrosis threshold of 40% was defined to separate all 35 subjects into low and high fibrosis groups. The linear relationship between DW parameters and percentage fibrosis (up to 80%) from Masson trichrome was assessed with the Pearson product-moment correlation coefficient. Fisher Z-transform was used for R correlation comparison.
RESULTS
A coefficient of variation between ADCs of 3% was measured between both sequences in the phantom. In healthy volunteers, no significant difference was measured for all DW parameters. Both sequences separated low to high level of fibrosis with a significant decrease of ΔADC (RESOLVE P = 3.1 × 10 , ss-EPI P = 0.003) and ΔD (RESOLVE P = 8.2 × 10 , ss-EPI P = 0.02) in the high level of fibrosis. However, RESOLVE ΔADC had a stronger negative correlation (P = 0.04 for R comparison) with fibrosis than ss-EPI ΔADC (RESOLVE R = 0.65, P = 5.9 × 10 , ss-EPI R = 0.29, P = 8.9 × 10 ). ΔD (RESOLVE) was correlated (moderately) with fibrosis (R = 0.29, P = 9.2 × 10 ); however, ΔD* and ΔF did not show, in our population, a significant correlation with interstitial fibrosis (0.01 < R < 0.08).
CONCLUSION
ΔADC derived from both sequences correlated with fibrosis. ΔADC from RESOLVE showed better correlation with fibrosis than ΔADC from ss-EPI and therefore has potential to monitor CKD.
LEVEL OF EVIDENCE
1 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2017;46:1631-1640.
目的
比较读出分段回波平面成像（EPI）（RESOLVE）与单次激发 EPI（ss-EPI）扩散加权成像（DWI）在评估肾间质纤维化中的应用。
材料与方法
在 3T 扫描仪上对一个体模、8 名健康志愿者（年龄小于 30 岁，以避免与年龄相关的纤维化）和 27 名慢性肾脏病（CKD）患者（计划进行肾活检）进行了 ss-EPI 和 5 次激发 RESOLVE DWI 扫描（分辨率：2×2×5mm，10 个 b 值）。比较两种序列中每个单指数拟合（ΔADC）或分段双指数拟合（ΔD、ΔD*、ΔF）的皮质-髓质差异。将 40%的纤维化阈值定义为将所有 35 名受试者分为低纤维化组和高纤维化组。使用 Pearson 积矩相关系数评估 DWI 参数与 Masson 三色纤维化百分比（高达 80%）之间的线性关系。使用 Fisher Z 变换进行 R 相关比较。
结果
在体模中，两种序列之间 ADC 的变异系数为 3%。在健康志愿者中，两种序列之间所有 DWI 参数均无显著差异。两种序列均能以显著降低的 ΔADC（RESOLVE P=3.1×10-8，ss-EPI P=0.003）和 ΔD（RESOLVE P=8.2×10-8，ss-EPI P=0.02）来区分低纤维化和高纤维化水平。然而，与 ss-EPI ΔADC 相比，RESOLVE ΔADC 与纤维化的负相关性更强（R 比较的 P 值=0.04）（RESOLVE R=0.65，P=5.9×10-8，ss-EPI R=0.29，P=8.9×10-8）。ΔD（RESOLVE）与纤维化呈中度相关（R=0.29，P=9.2×10-8）；然而，在我们的人群中，ΔD*和 ΔF 与间质纤维化无显著相关性（0.01<R<0.08）。
结论
两种序列的 ΔADC 与纤维化相关。与 ss-EPI 相比，RESOLVE 衍生的 ΔADC 与纤维化的相关性更好，因此具有监测 CKD 的潜力。
证据水平
1 技术功效：第 2 阶段 J. Magn. Reson. Imaging 2017；46:1631-1640.
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