慢性肾脏病：体素内不相干运动扩散加权成像的病理和功能评估。
Chronic kidney disease: Pathological and functional evaluation with intravoxel incoherent motion diffusion-weighted imaging.
机构信息
Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Medical Imaging, Shanghai, P.R. China.
Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, P.R. China.
出版信息
J Magn Reson Imaging. 2018 May;47(5):1251-1259. doi: 10.1002/jmri.25861. Epub 2017 Sep 21.
BACKGROUND
Because chronic kidney disease (CKD) is a worldwide problem, accurate pathological and functional evaluation is required for planning treatment and follow-up. Intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) can assess both capillary perfusion and tissue diffusion and may be helpful in evaluating renal function and pathology.
PURPOSE
To evaluate functional and pathological alterations in CKD by applying IVIM-DWI.
STUDY TYPE
Prospective study.
SUBJECTS
In all, 72 CKD patients who required renal biopsy and 20 healthy volunteers.
FIELD STRENGTH
1.5T.
ASSESSMENT
All subjects underwent IVIM-DWI of the kidneys, and image analysis was performed by two radiologists. The mean values of true diffusion coefficient (D), pseudo diffusion coefficient (D*), and perfusion fraction (f) were acquired from renal parenchyma. Correlation between IVIM-DWI parameters and estimated glomerular filtration rate (eGFR), as well as pathological damage, were assessed.
STATISTICAL TESTS
One-way analysis of variance (ANOVA), paired sample t-test and Spearman correlation analysis.
RESULTS
The paired sample t-test revealed that IVIM-DWI parameters were significantly lower in medulla than cortex for both patients and controls (P < 0.01). Regardless of whether eGFR was reduced, ANOVA revealed that f values of renal parenchyma were significantly lower in patients than controls (P < 0.05). Spearman correlation analysis revealed that there were positive correlations between eGFR and D (cortex, r = 0.466, P < 0.001; medulla, r = 0.491, P < 0.001), and between eGFR and f (cortex, r = 0.713, P < 0.001; medulla, r = 0.512, P < 0.001). Negative correlations were found between f and glomerular injury (cortex, r = -0.773, P < 0.001; medulla, r = -0.629, P < 0.001), and between f and tubulointerstitial lesion (cortex, r = -0.728, P < 0.001; medulla, r = -0.547, P < 0.001).
DATA CONCLUSION
IVIM-DWI might be feasible for noninvasive evaluation of renal function and pathology of CKD, especially in detection of renal insufficiency at an early stage.
LEVEL OF EVIDENCE
1 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2018;47:1251-1259.
背景
由于慢性肾脏病（CKD）是一个全球性问题，因此需要准确的病理和功能评估来规划治疗和随访。体素内不相干运动扩散加权成像（IVIM-DWI）可以评估毛细血管灌注和组织扩散，可能有助于评估肾功能和病理。
目的
应用 IVIM-DWI 评估 CKD 的功能和病理变化。
研究类型
前瞻性研究。
受试者
共 72 例需要肾活检的 CKD 患者和 20 名健康志愿者。
场强
1.5T。
评估
所有受试者均行肾脏 IVIM-DWI 检查，由 2 名放射科医生进行图像分析。从肾实质获得真实扩散系数（D）、假性扩散系数（D*）和灌注分数（f）的平均值。评估 IVIM-DWI 参数与估算肾小球滤过率（eGFR）以及病理损伤之间的相关性。
统计检验
单因素方差分析（ANOVA）、配对样本 t 检验和 Spearman 相关分析。
结果
配对样本 t 检验显示，患者和对照组的肾髓质 IVIM-DWI 参数均明显低于皮质（P<0.01）。无论 eGFR 是否降低，ANOVA 均显示肾实质的 f 值在患者中明显低于对照组（P<0.05）。Spearman 相关分析显示，eGFR 与 D 呈正相关（皮质，r=0.466，P<0.001；髓质，r=0.491，P<0.001），与 f 呈正相关（皮质，r=0.713，P<0.001；髓质，r=0.512，P<0.001）。f 与肾小球损伤呈负相关（皮质，r=-0.773，P<0.001；髓质，r=-0.629，P<0.001），与肾小管间质病变呈负相关（皮质，r=-0.728，P<0.001；髓质，r=-0.547，P<0.001）。
数据结论
IVIM-DWI 可能是一种用于评估 CKD 肾功能和病理的非侵入性方法，特别是在早期检测肾功能不全方面。
证据水平
1 技术功效：第 3 阶段 J. 磁共振成像 2018；47：1251-1259。
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