Department of Pediatrics, Teikyo University School of Medicine.
Magn Reson Med Sci. 2024 Apr 1;23(2):153-160. doi: 10.2463/mrms.mp.2022-0140. Epub 2023 Feb 7.
Despite the usefulness of blood oxygenation level-dependent (BOLD) MRI in assessing glomerulonephritis activity, its relationship with histological findings remains unclear. Because glomerulonephritis presents multiple complex injury patterns, analysis of each pattern is essential. We aimed to elucidate the relationship between the histological findings of the kidney and BOLD MRI findings in mesangial proliferative glomerulonephritis.
Children under 16 years of age diagnosed with mesangial proliferative glomerulonephritis by kidney biopsy at our university hospital between January 2013 and September 2022 were included in this study. Cortical and medullary spin relaxation rate (R2*) values were measured using BOLD MRI at 3T within two weeks before and after the kidney biopsy. The R2* values, including the fluctuations with low-dose oxygen administration, were retrospectively examined in relation to the cortical (mesangial proliferation, endothelial cell proliferation, crescent, sclerosis, and fibrosis) and medullary findings (fibrosis).
Sixteen times kidney biopsies were performed for glomerulonephritis during the study period, and one patient was excluded because of comorbidities; the remaining 14 patients included six boys with a mean age of 11.9 ± 3.5 years at the BOLD examination. None of the patients had medullary fibrosis. Among the kidney tissue parameters, only sclerosis showed a significant correlation with R2* values: medulla with R2* values under atmospheric pressure (r = 0.53, P < 0.05) and cortex with the rate of change in R2* values with low-dose oxygen administration (r = -0.57, P < 0.03). In the multiple regression analysis, only sclerosis was an independent contributor to the change in R2* values with oxygen administration in the cortex (regression coefficient -0.109, P < 0.05).
Since the R2* values reflect histological changes in the kidney, BOLD MRI may facilitate the evaluation of mesangial proliferative glomerulonephritis, potentially reducing the patient burden.
尽管血氧水平依赖（BOLD）MRI 在评估肾小球肾炎活动度方面非常有用，但它与组织学发现之间的关系仍不清楚。由于肾小球肾炎表现出多种复杂的损伤模式，因此分析每种模式都很重要。我们旨在阐明系膜增生性肾小球肾炎的肾脏组织学发现与 BOLD MRI 发现之间的关系。
本研究纳入了 2013 年 1 月至 2022 年 9 月期间在我们大学医院因肾脏活检诊断为系膜增生性肾小球肾炎的 16 岁以下儿童。在肾脏活检前两周内，使用 3T 的 BOLD MRI 测量皮质和髓质的自旋弛豫率（R2*）值。回顾性分析了 R2*值（包括低氧给药时的波动）与皮质（系膜增生、内皮细胞增生、新月体、硬化和纤维化）和髓质（纤维化）之间的关系。
研究期间共进行了 16 次肾脏活检以诊断肾小球肾炎，其中 1 例因合并症而被排除；其余 14 例患者包括 6 名男孩，在进行 BOLD 检查时的平均年龄为 11.9 ± 3.5 岁。没有患者有髓质纤维化。在肾脏组织学参数中，只有硬化与 R2值呈显著相关：在大气压下的髓质（r = 0.53，P < 0.05）和皮质的低氧给药时 R2值变化率（r = -0.57，P < 0.03）。在多元回归分析中，只有硬化是皮质氧给药时 R2*值变化的独立影响因素（回归系数-0.109，P < 0.05）。
由于 R2*值反映了肾脏的组织学变化，因此 BOLD MRI 可能有助于评估系膜增生性肾小球肾炎，从而可能减轻患者的负担。
