弥散张量成像在肾移植后急性排斥反应和慢性移植肾肾病中的应用。
The Use of Diffusion Tensor Imaging in the Identification of Acute Rejection and Chronic Allograft Nephropathy After Renal Transplantation.
机构信息
Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China.
Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, China.
出版信息
J Magn Reson Imaging. 2024 Jun;59(6):2082-2088. doi: 10.1002/jmri.29042. Epub 2023 Oct 9.
BACKGROUND
Identifying the cause of renal allograft dysfunction is important for the clinical management of kidney transplant recipients.
PURPOSE
To evaluate the diagnostic efficiency of diffusion tensor imaging (DTI) for identifying allografts with acute rejection (AR) and chronic allograft nephropathy (CAN).
STUDY TYPE
Prospective.
SUBJECTS
Seventy-seven renal transplant patients (aged 42.5 ± 9.5 years), including 29 patients with well-functioning stable allografts (Control group), 25 patients diagnosed with acute rejection (AR group), and 23 patients diagnosed with chronic allograft nephropathy (CAN group).
FIELD STRENGTH/SEQUENCE: 1.5 T/T2-weighted imaging and DTI.
ASSESSMENT
The serum creatinine, proteinuria, pathologic results, and fractional anisotropy (FA) values were obtained and compared among the three groups.
STATISTICAL TEST
One-way analysis of variance; correlation analysis; independent-sample t-test; intraclass correlation coefficients and receiver operating characteristic curves. Statistical significance was set to a P-value <0.05.
RESULTS
The AR and CAN groups presented with significantly elevated serum creatinine as compared with the Control group (191.8 ± 181.0 and 163.1 ± 115.8 μmol/L vs. 82.3 ± 20.9 μmol/L). FA decreased in AR group (cortical/medullary: 0.13 ± 0.02/0.31 ± 0.07) and CAN group (cortical/medullary: 0.11 ± 0.02/0.27 ± 0.06), compared with the Control group (cortical/medullary: 0.15 ± 0.02/0.35 ± 0.05). Cortical FA in the AR group was higher than in the CAN group. The area under the curve (AUC) for identifying AR from normal allografts was 0.756 and 0.744 by cortical FA and medullary FA, respectively. The AUC of cortical FA and medullary FA for differentiating CAN from normal allografts was 0.907 and 0.830, respectively. The AUC of cortical FA and medullary FA for distinguishing AR and CAN from normal allografts was 0.828 and 0.785, respectively. Cortical FA was able to distinguish between AR and CAN with an AUC of 0.728.
DATA CONCLUSION
DTI was able to detect patients with dysfunctional allografts. Cortical FA can further distinguish between AR and CAN.
EVIDENCE LEVEL
2 TECHNICAL EFFICACY: Stage 2.
背景
确定肾移植功能障碍的原因对于肾移植受者的临床管理非常重要。
目的
评估扩散张量成像（DTI）在识别急性排斥反应（AR）和慢性移植肾肾病（CAN）的同种异体移植物中的诊断效率。
研究类型
前瞻性。
受试者
77 例肾移植患者（年龄 42.5±9.5 岁），包括 29 例功能良好的稳定同种异体移植物（对照组）、25 例诊断为急性排斥反应（AR 组）和 23 例诊断为慢性移植肾肾病（CAN 组）。
场强/序列：1.5T/T2 加权成像和 DTI。
评估
比较三组患者的血清肌酐、蛋白尿、病理结果和各向异性分数（FA）值。
统计检验
单因素方差分析；相关性分析；独立样本 t 检验；组内相关系数和受试者工作特征曲线。统计显著性设定为 P 值<0.05。
结果
AR 组和 CAN 组的血清肌酐明显高于对照组（191.8±181.0 和 163.1±115.8μmol/L 比 82.3±20.9μmol/L）。AR 组（皮质/髓质：0.13±0.02/0.31±0.07）和 CAN 组（皮质/髓质：0.11±0.02/0.27±0.06）的 FA 值降低，与对照组（皮质/髓质：0.15±0.02/0.35±0.05）相比。AR 组的皮质 FA 高于 CAN 组。皮质 FA 和髓质 FA 鉴别正常移植肾与 AR 的曲线下面积（AUC）分别为 0.756 和 0.744。皮质 FA 和髓质 FA 鉴别 CAN 与正常移植肾的 AUC 分别为 0.907 和 0.830。皮质 FA 和髓质 FA 鉴别 AR 和 CAN 与正常移植肾的 AUC 分别为 0.828 和 0.785。皮质 FA 鉴别 AR 和 CAN 的 AUC 为 0.728。
数据结论
DTI 能够检测到功能障碍的同种异体移植物。皮质 FA 可进一步区分 AR 和 CAN。
证据水平
2 级技术功效。
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