T 映射用于评估肾移植纤维化。
T mapping for assessment of renal allograft fibrosis.
机构信息
Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
出版信息
J Magn Reson Imaging. 2019 Oct;50(4):1085-1091. doi: 10.1002/jmri.26656. Epub 2019 Jan 21.
BACKGROUND
There is an unmet need for noninvasive methods to diagnose and stage renal allograft fibrosis.
PURPOSE
To investigate the utility of T measured with MRI for the assessment of fibrosis in renal allografts.
STUDY TYPE
Institutional Review Board (IRB)-approved prospective.
SUBJECTS
Fifteen patients with stable functional allograft (M/F 9/6, mean age 56 years) and 12 patients with allograft dysfunction and established fibrosis (M/F 6/6, mean age 51 years).
FIELD STRENGTH/SEQUENCE: T imaging at 1.5T using a custom-developed sequence.
ASSESSMENT
Average T in the cortex and medulla was quantified and T repeatability (expressed by the coefficient of variation [CV]) was measured in four patients.
STATISTICAL TESTS
Differences in T values between the 2 groups were assessed using Mann-Whitney U-tests. Diagnostic performance of T for differentiation between functional and fibrotic allografts was evaluated using receiver operating characteristic (ROC) analysis. Spearman correlations of T with Masson's trichrome-stained fractions and serum estimated glomerular filtration rate (eGFR) were assessed.
RESULTS
Higher T repeatability was found for cortex compared with medulla (mean CV T cortex 7.4%, medulla 13.3%). T values were significantly higher in the cortex of fibrotic vs. functional allografts (111.8 ± 17.2 msec vs. 99.0 ± 11.0 msec, P = 0.027), while there was no difference in medullary T values (122.6 ± 20.8 msec vs. 124.3 ± 20.8 msec, P = 0.789). Cortical T significantly correlated with Masson's trichrome-stained fractions (r = 0.515, P = 0.044) and eGFR (r = -0.546, P = 0.004), and demonstrated an area under the curve (AUC) of 0.77 for differentiating between functional and fibrotic allografts (sensitivity and specificity of 75.0% and 86.7%, using threshold of 106.9 msec).
DATA CONCLUSION
Our preliminary results suggest that T is a potential imaging biomarker of renal allograft fibrosis. These results should be verified in a larger study.
LEVEL OF EVIDENCE
1 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2019;50:1085-1091.
背景
目前，临床上需要一种非侵入性的方法来诊断和分期移植肾纤维化。
目的
研究 MRI 测量 T1 值在评估移植肾纤维化中的应用价值。
研究类型
机构审查委员会（IRB）批准的前瞻性研究。
对象
15 例稳定功能的移植肾患者（9 例男性/6 例女性，平均年龄 56 岁）和 12 例移植肾功能障碍且纤维化的患者（6 例男性/6 例女性，平均年龄 51 岁）。
磁场强度/序列：在 1.5T 磁共振仪上使用自主研发的序列进行 T1 成像。
评估
对皮质和髓质的平均 T1 值进行定量分析，并在 4 例患者中测量 T1 值的重复性（用变异系数[CV]表示）。
统计学检验
采用 Mann-Whitney U 检验比较两组间 T1 值的差异。采用受试者工作特征（ROC）分析评估 T1 值鉴别功能正常和纤维化移植肾的诊断效能。评估 T1 值与 Masson 三色染色分数和血清估算肾小球滤过率（eGFR）的 Spearman 相关性。
结果
皮质 T1 值重复性高于髓质（皮质 T1 值的 CV 均值为 7.4%，髓质为 13.3%）。纤维化组移植肾皮质 T1 值明显高于功能正常组（111.8±17.2 msec 比 99.0±11.0 msec，P=0.027），而髓质 T1 值两组间无差异（122.6±20.8 msec 比 124.3±20.8 msec，P=0.789）。皮质 T1 值与 Masson 三色染色分数（r=0.515，P=0.044）和 eGFR（r=-0.546，P=0.004）显著相关，鉴别功能正常和纤维化移植肾的曲线下面积（AUC）为 0.77（阈值为 106.9 msec 时，敏感性和特异性分别为 75.0%和 86.7%）。
数据结论
初步结果提示 T1 值可能是移植肾纤维化的潜在影像学生物标志物。这些结果需要在更大的研究中进一步验证。
证据水平
1 技术功效：阶段 1 J. 磁共振成像 2019；50：1085-1091.
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