使用三维动脉自旋标记评估慢性肾脏病患者的肾脏灌注。
Use of Three-Dimensional Arterial Spin Labeling to Evaluate Renal Perfusion in Patients With Chronic Kidney Disease.
机构信息
Department of Radiology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China.
Department of Nephrology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China.
出版信息
J Magn Reson Imaging. 2021 Oct;54(4):1152-1163. doi: 10.1002/jmri.27609. Epub 2021 Mar 26.
BACKGROUND
A noninvasive method for evaluating renal blood flow (RBF) in patients with chronic kidney disease (CKD) may have clinical value in disease staging, management, and prognostication.
PURPOSE
To evaluate effectiveness of three-dimensional pseudocontinuous arterial spin labeling (pCASL) and pulsed arterial spin labeling (PASL) in assessment of cortex and outer medulla (cortex/OM) RBF in CKD patients and healthy volunteers (HVs).
STUDY TYPE
Prospective, in a single institution.
SUBJECTS
A total of 48 CKD patients (stage 1, 2, 3, and 4-5: N = 11, 12, 13, and 12, respectively) and 18 HVs FIELD STRENGTH/SEQUENCE: 3 T, pCASL, and PASL with a three-dimensional hybrid gradient echo/spin echo sequence.
ASSESSMENT
Quality of RBF images derived from pCASL and PASL were evaluated and RBF in cortex/OM measured. Clinical and laboratory data were recorded.
STATISTICAL TESTS
Image quality differences between pCASL and PASL were evaluated with Wilcoxon signed-rank test. For both methods, analysis of variance, followed by Fisher's LSD-t test, was used to determine whether RBF differed between CKD stages and HVs. Pearson correlation coefficients were calculated to assess strength of relationships between cortex/OM RBF and data from clinical and laboratory tests.
RESULTS
Image quality differences were significantly higher in pCASL than PASL in both patients and HVs (both P < 0.05). For pCASL, cortex/OM RBF of patients were significantly lower than those of HVs (P < 0.05). Cortex/OM RBF were higher in S1 and S2 patients than those in S3 and S4-5 (P < 0.05). For PASL, only RBF in cortex of S1 and S2 patients were significantly higher than those of S4-5 (P < 0.05). Good correlations between pCASL RBF and estimated glomerular filtration (eGFR) were found in cortex/OM of patients (rho = 0.796 and 0.798, respectively, both P < 0.05), higher than those between PASL RBF and eGFR (rho = 0.430 and 0.374, respectively, both P < 0.05).
DATA CONCLUSION
Three-dimensional pCASL may potentially be a noninvasive technique to assess renal perfusion in CKD patients in different stages.
LEVEL OF EVIDENCE
1 TECHNICAL EFFICACY: Stage 2.
背景
一种用于评估慢性肾脏病（CKD）患者肾血流（RBF）的无创方法，可能在疾病分期、管理和预后方面具有临床价值。
目的
评估三维伪连续动脉自旋标记（pCASL）和脉冲动脉自旋标记（PASL）在评估 CKD 患者和健康志愿者（HV）的皮质和外髓质（皮质/OM）RBF 中的有效性。
研究类型
前瞻性，单中心。
受试者
共 48 例 CKD 患者（1 期、2 期、3 期和 4-5 期：分别为 11、12、13 和 12 例）和 18 例 HVs
磁场强度/序列：3T，pCASL 和 PASL，采用三维混合梯度回波/自旋回波序列。
评估
评估 pCASL 和 PASL 衍生的 RBF 图像质量，并测量皮质/OM 的 RBF。记录临床和实验室数据。
统计检验
采用 Wilcoxon 符号秩检验评估 pCASL 和 PASL 之间的图像质量差异。对于两种方法，均采用方差分析，然后采用 Fisher's LSD-t 检验，以确定 CKD 分期和 HVs 之间的 RBF 是否存在差异。计算皮质/OM RBF 与临床和实验室检查数据之间的 Pearson 相关系数，以评估它们之间的关系强度。
结果
在患者和 HVs 中，pCASL 的图像质量差异明显高于 PASL（均 P<0.05）。对于 pCASL，患者的皮质/OM RBF 明显低于 HVs（P<0.05）。S1 和 S2 期患者的皮质/OM RBF 高于 S3 和 S4-5 期（P<0.05）。对于 PASL，仅 S1 和 S2 期患者的皮质 RBF 明显高于 S4-5 期（P<0.05）。患者皮质/OM 中的 pCASL RBF 与估算肾小球滤过率（eGFR）之间存在良好的相关性（rho=0.796 和 0.798，均 P<0.05），高于 PASL RBF 与 eGFR 之间的相关性（rho=0.430 和 0.374，均 P<0.05）。
数据结论
三维 pCASL 可能是一种评估不同阶段 CKD 患者肾灌注的无创技术。
证据水平
1 级技术功效：2 级。
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