Chen S N, Wang Y C, Feng Y L, Gao Y T, Ju S S
Medical School of Southeast University, Nanjing 210009, China.
Zhonghua Yi Xue Za Zhi. 2018 Jan 30;98(5):346-351. doi: 10.3760/cma.j.issn.0376-2491.2018.05.006.
To evaluate the application value of intravoxel incoherent motion (IVIM) and diffusion tensor imaging (DTI) in detecting early-stage diabetic nephropathy and to assess the damage of ralated renal function. A total of 52 patients with type 2 diabetes diagnosed in Zhongda Hospital were collected from April 2016 to May 2017 and were assigned to DM group (diabetes without nephropathy, =32) and DN group (diabetes with nephropathy, =20) according to detection of microalbuminuria, a cohort of healthy recipients were included as control group (=27) in the meantime. All of the subjects underwent IVIM and DTI examination. The cortical and medullary parameters[IVIM: perfusion fraction f, tissue diffusivity D, pseudodiffuvisity D(*;) DTI: fractional anisotropy FA, apparent diffusion coefficient ADC, principal diffusivities (λ1, λ2, λ3)]were obtained respectively and were compared among groups. The relationship between MRI related parameters and estimated glomerular filtration rate (eGFR) were statistically investigated; and diagnostic performance of IVIM and DTI in discriminating DM and DN group was evaluated by receiver operating characteristic analysis. The cortical and medullary f, D values in DN group were lower than those in DM group and control group (=17.32, 15.69, 6.71, 10.94, all <0.05). D values of all subjects showed positive correlations with eGFR (cortex =0.518, medulla =0.538, both <0.05). The diagnostic efficiency of cortical f values to discriminate diabetes and diabetic nephropathy was 0.817, the cut-off value was 0.205. The medullary FA value in DM group was lower than that in control group ((0.371±0.051 vs 0.423±0.043, =4.188, <0.05); and the medullary FA value in DN group (0.315±0.062) was lower than that in control and DM group (=25.08, <0.05). The medullary λ3 values in DM group and DN group were all significantly higher than that in control group (=7.86, <0.05). The diagnostic efficiency of medullary FA values to discriminate diabetes and diabetic nephropathy was 0.763, the cut-off value was 0.344. IVIM and DTI can reflect the abnormal perfusion and diffusion during early-stage diabetic nephropathy and have the potential value to assess the damage of ralated renal function.
评估体素内不相干运动(IVIM)和扩散张量成像(DTI)在早期糖尿病肾病检测中的应用价值,并评估相关肾功能损害情况。收集2016年4月至2017年5月在中大医院确诊的52例2型糖尿病患者,根据微量白蛋白尿检测结果分为糖尿病无肾病组(DM组,n = 32)和糖尿病肾病组(DN组,n = 20),同时纳入一组健康受试者作为对照组(n = 27)。所有受试者均接受IVIM和DTI检查。分别获取皮质和髓质参数[IVIM:灌注分数f、组织扩散系数D、伪扩散系数D*;DTI:分数各向异性FA、表观扩散系数ADC、主扩散率(λ1、λ2、λ3)],并进行组间比较。对MRI相关参数与估计肾小球滤过率(eGFR)之间的关系进行统计学研究;通过受试者工作特征分析评估IVIM和DTI鉴别DM组和DN组的诊断性能。DN组皮质和髓质的f、D值均低于DM组和对照组(F = 17.32、15.69、6.71、10.94,均P < 0.05)。所有受试者的D值与eGFR均呈正相关(皮质r = 0.518,髓质r = 0.538,均P < 0.05)。皮质f值鉴别糖尿病和糖尿病肾病的诊断效能为0.817,截断值为0.205。DM组髓质FA值低于对照组((0.371±0.051 vs 0.423±0.043,t = 4.188,P < 0.05);DN组髓质FA值(0.315±0.062)低于对照组和DM组(F = 25.08,P < 0.05)。DM组和DN组髓质λ3值均显著高于对照组(F = 7.86,P < 0.