Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China.
Department of Radiology, Fuxing Hospital, Capital Medical University, Beijing, 100038, China.
Abdom Radiol (NY). 2021 Apr;46(4):1659-1669. doi: 10.1007/s00261-020-02780-4. Epub 2020 Sep 30.
To investigate the renal microstructure changes and hypoxia changes in type 2 diabetic patients and the relationship between them and glucose using both diffusion-weighted imaging (DWI) and blood oxygenation level-dependent magnetic resonance imaging (BOLD MRI).
After measuring morning fasting blood glucose, DWI and BOLD MRI were performed in 57 patients with type 2 diabetes mellitus (DM group) and 14 healthy volunteers (NC group). According to the fasting blood glucose levels, diabetic patients were divided into a normoglycemic diabetes group (group A), a less hyperglycemic diabetes group (group B) and a more hyperglycemic diabetes group (group C). The renal parenchymal apparent diffusion coefficient (ADC), renal cortical R2* (CR2*), and medullary R2* (MR2*) were measured, and the R2* ratio between the medulla and cortex (MCR) was calculated. To test for differences in ADC, R2*, and MCR among the four groups, the data were analyzed by separate one-way ANOVAs. The correlations between ADC, R2*, and MCR and the clinical index of renal function were analyzed.
Groups B and C had significantly lower ADC values in the renal parenchyma (P = 0.048, 0.002) and significantly higher MR2* and MCR values (P < 0.000, P = 0.001, 0.001, and 0.005, respectively) than the NC group. ADC was negatively correlated with glucose, and MR2*, MCR and glucose showed a weak positive correlation.
DWI and BOLD may indirectly and qualitatively reflect the kidney microstructure status and hypoxia level of diabetic patients at different blood glucose levels to a certain extent, and possibly guide the clinical treatment of diabetic patients with different blood glucose levels.
利用扩散加权成像（DWI）和血氧水平依赖磁共振成像（BOLD MRI）研究 2 型糖尿病患者的肾脏微观结构变化和缺氧变化及其与血糖的关系。
对 57 例 2 型糖尿病患者（DM 组）和 14 例健康志愿者（NC 组）进行空腹血糖测量后，进行 DWI 和 BOLD MRI 检查。根据空腹血糖水平，将糖尿病患者分为血糖正常的糖尿病组（A 组）、血糖较低的糖尿病组（B 组）和血糖较高的糖尿病组（C 组）。测量肾实质表观扩散系数（ADC）、肾皮质 R2*（CR2*）和髓质 R2*（MR2*），并计算髓质与皮质的 R2比值（MCR）。采用单因素方差分析分别检验四组间 ADC、R2和 MCR 的差异。分析 ADC、R2*和 MCR 与肾功能临床指标的相关性。
B 组和 C 组肾实质 ADC 值明显低于 NC 组（P = 0.048，0.002），MR2和 MCR 值明显高于 NC 组（P<0.000，P = 0.001，0.001，0.005）。ADC 与血糖呈负相关，MR2、MCR 与血糖呈弱正相关。
DWI 和 BOLD 可在一定程度上间接、定性地反映不同血糖水平的糖尿病患者肾脏微观结构状态和缺氧程度，可能为指导不同血糖水平的糖尿病患者临床治疗提供依据。
