磁共振成像获得的肾实质容积和表观扩散系数在轻度、中度和重度糖尿病肾病中的诊断及预后评估价值
Diagnostic and prognostic performance of renal compartment volume and the apparent diffusion coefficient obtained from magnetic resonance imaging in mild, moderate and severe diabetic kidney disease.
作者信息
Zhao Kaixuan, Li Sheng, Liu Yan, Li Qiuling, Lin Huan, Wu Zhigang, Seeliger Erdmann, Niendorf Thoralf, Liu Zaiyi, Wang Wenjian
机构信息
Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China.
出版信息
Quant Imaging Med Surg. 2023 Jun 1;13(6):3973-3987. doi: 10.21037/qims-23-149. Epub 2023 May 4.
BACKGROUND
Diabetic kidney disease (DKD) is the leading cause of end-stage renal disease (ESRD). There are unmet needs for noninvasive diagnosis and prognosis prediction of DKD in clinical practice. This study examines the diagnostic and prognostic value of magnetic resonance (MR) markers of renal compartment volume and the apparent diffusion coefficient (ADC) for mild, moderate, and severe DKD.
METHODS
This study was registered at the Chinese Clinical Trial Registry Center (registration number: ChiCTR-RRC-17012687). Sixty-seven DKD patients were prospectively randomly enrolled and underwent clinical examination and diffusion-weighted magnetic resonance imaging (DW-MRI). Patients with comorbidities that affected renal volumes or components were excluded. Ultimately, 52 DKD patients were included in the cross-sectional analysis. The ADC in the renal cortex (ADC) ADC in the renal medulla (ADC) and difference between ADC and ADC (ΔADC) were measured using a twelve-layer concentric objects (TLCO) approach. Renal compartment volumes of the parenchyma and pelvis were derived from T2-weighted MRI. Due to lost contact or ESRD diagnosed before follow-up (n=14), only 38 DKD patients remained for follow-up (median period =8.25 years) to investigate the correlations between MR markers and renal outcomes. The primary outcomes were the composite of doubling of the primary serum creatinine concentration or ESRD.
RESULTS
ADC presented superior performance in discriminating DKD with normal and declined estimated glomerular filtration rate (eGFR) over ADC, ΔADC and renal compartment volumes with an AUC of 0.904 (sensitivity of 83% and specificity of 91%) and was moderately correlated with the clinical biomarkers eGFR and proteinuria (P<0.05). The Cox survival analysis demonstrated that ADC rather than ΔADC is a predictor of renal outcomes with a hazard ratio of 3.4 (95% CI: 1.1-10.2, P<0.05) independent of baseline eGFR and proteinuria.
CONCLUSIONS
ADC is a valuable imaging marker for the diagnosis and prediction of renal function decline in DKD.
背景
糖尿病肾病（DKD）是终末期肾病（ESRD）的主要原因。临床实践中对DKD的无创诊断和预后预测仍存在未满足的需求。本研究探讨肾实质容积和表观扩散系数（ADC）的磁共振（MR）标志物对轻度、中度和重度DKD的诊断和预后价值。
方法
本研究在中国临床试验注册中心注册（注册号：ChiCTR-RRC-17012687）。前瞻性随机纳入67例DKD患者，进行临床检查和扩散加权磁共振成像（DW-MRI）。排除患有影响肾脏体积或结构的合并症的患者。最终，52例DKD患者纳入横断面分析。采用十二层同心物体（TLCO）方法测量肾皮质ADC（ADC）、肾髓质ADC（ADC）以及ADC与ADC之间的差值（ΔADC）。肾实质和肾盂的肾腔容积由T2加权MRI得出。由于失访或在随访前被诊断为ESRD（n = 14），仅38例DKD患者进行随访（中位随访期 = 8.25年）以研究MR标志物与肾脏结局之间的相关性。主要结局为血清肌酐浓度翻倍或ESRD的复合结局。
结果
在鉴别估算肾小球滤过率（eGFR）正常和下降的DKD方面，ADC的表现优于ADC、ΔADC和肾腔容积，AUC为0.904（敏感性为83%，特异性为91%），且与临床生物标志物eGFR和蛋白尿中度相关（P<0.05）。Cox生存分析表明，ADC而非ΔADC是肾脏结局的预测指标，风险比为3.4（95%CI：1.1 - 10.2，P<0.05），独立于基线eGFR和蛋白尿。
结论
ADC是DKD肾功能下降诊断和预测的有价值的影像学标志物。
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