Jiang B, Wan J Y, Tian Y Y, Xu R, Ma J L, Li J, Yu Y X, Hu L K, Hu C H, Zhu M
Department of Radiology, the First Affiliated Hospital of Soochow University, Suzhou 215006, China.
Department of Urology, the First Affiliated Hospital of Soochow University, Suzhou 215006, China.
Zhonghua Yi Xue Za Zhi. 2024 Jan 23;104(4):276-281. doi: 10.3760/cma.j.cn112137-20230726-00095.
To explore the feasibility and application value of arterial spin labeling (ASL) in evaluating the degree of renal fibrosis after kidney transplantation. This is a cross-sectional study. Renal transplant recipients who received treatment at the First Affiliated Hospital of Soochow University from December 2021 to December 2022 were enrolled. All participants underwent ASL scan, and the values of renal cortical renal blood flow (RBF) were measured through post-processing software. The participants were divided into different groups according to the Banff interstitial fibrosis score (ci score) of the transplanted kidneys, and then relevant indicators were compared. One-way analysis of variance was conducted to compare the differences in renal cortical RBF among the groups. Spearman correlation analysis was employed to investigate the association between renal cortical RBF and ci score of the transplanted kidney. Receiver operating characteristic curve was used to analyze the diagnostic effectiveness of renal cortical RBF and laboratory indicators for distinguishing varying degrees of fibrosis in transplanted kidneys. The Delong test was utilized to compare the area under the curve (AUC). A total of 60 patients (42 males and 18 females) were included in the study, with a mean age of (44.6±10.8) years. All patients were divided into 4 groups: ci0 group (ci score=0, 11 cases), ci1 group (ci score=1, 21 cases), ci2 group (ci score=2, 20 cases), and ci3 group (ci score=3, 8 cases). With an increase in the degree of fibrosis in the transplanted kidney, there was a corresponding decrease in the renal cortical RBF value. The differences in renal cortical RBF values among the 4 groups were statistically significant[ci0 group: (214.9±28.5) ml·(100 g)·min; ci1 group: (181.7±29.3) ml·(100 g)·min; ci2 group: (158.8±39.2) ml·(100 g)·min; ci3 group: (123.1±27.2) ml·(100 g)·min; =14.02, <0.001]. The renal cortical RBF was moderately negatively correlated with the ci score (=-0.644, <0.001). The AUC for discriminating between ci0 and ci1-3 of renal cortical RBF and 24-hour urine protein was 0.881 (95%: 0.772-0.950) and 0.680 (95%: 0.547-0.795), respectively. The AUC for renal cortical RBF was significantly higher than that for 24-hour urine protein (=0.047). The renal cortical RBF can distinguish between ci0-1 and ci2-3, as well as ci0-2 and ci3, with the corresponding AUC value of 0.796 (95%: 0.673-0.889) and 0.900 (95%: 0.795-0.963), respectively. ASL can quantitatively assess renal blood perfusion in transplanted kidneys and demonstrates high operational efficacy in distinguishing varying degrees of fibrosis in the transplanted kidneys.
探讨动脉自旋标记（ASL）在评估肾移植术后肾纤维化程度中的可行性及应用价值。本研究为横断面研究。选取2021年12月至2022年12月在苏州大学附属第一医院接受治疗的肾移植受者。所有参与者均接受ASL扫描，并通过后处理软件测量肾皮质肾血流量（RBF）值。根据移植肾的Banff间质纤维化评分（ci评分）将参与者分为不同组，然后比较相关指标。采用单因素方差分析比较各组间肾皮质RBF的差异。采用Spearman相关性分析探讨肾皮质RBF与移植肾ci评分之间的关联。利用受试者工作特征曲线分析肾皮质RBF及实验室指标对区分移植肾不同程度纤维化的诊断效能。采用Delong检验比较曲线下面积（AUC）。本研究共纳入60例患者（男42例，女18例），平均年龄为（44.6±10.8）岁。所有患者分为4组：ci0组（ci评分=0，11例）、ci1组（ci评分=1，21例）、ci2组（ci评分=2，20例）和ci3组（ci评分=3，8例）。随着移植肾纤维化程度的增加，肾皮质RBF值相应降低。4组间肾皮质RBF值差异有统计学意义[ci0组：（214.9±28.5）ml·（100g）·min；ci1组：（181.7±29.3）ml·（100g）·min；ci2组：（158.8±39.2）ml·（100g）·min；ci3组：（123.1±27.2）ml·（100g）·min；F=14.02，P<0.001]。肾皮质RBF与ci评分呈中度负相关（r=-0.644，P<0.001）。肾皮质RBF及24小时尿蛋白鉴别ci0与ci1 - 3的AUC分别为0.881（95%CI：0.772 - 0.950）和0.680（95%CI：0.547 - 0.795）。肾皮质RBF的AUC显著高于24小时尿蛋白（Z=0.047）。肾皮质RBF可区分ci0 - 1与ci2 - 3以及ci0 - 2与ci3，相应的AUC值分别为0.796（95%CI：0.673 - 0.889）和0.900（95%CI：0.795 - 0.963）。ASL可定量评估移植肾的肾血流灌注，并在区分移植肾不同程度纤维化方面具有较高的操作效能。
