弥散张量成像和体素内不相干运动扩散加权成像评估免疫球蛋白 A 肾病患者的临床和病理表现。
The clinical and pathological evaluation of patients with immunoglobulin A nephropathy by diffusion tensor imaging and intravoxel incoherent motion diffusion-weighted imaging.
机构信息
Division of Nephrology, Department of Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China.
Department of Medicine, West China School of Medicine, Sichuan University, Chengdu, Sichuan, 610041, China.
出版信息
Br J Radiol. 2024 Sep 1;97(1161):1577-1587. doi: 10.1093/bjr/tqae132.
OBJECTIVES
To explore the efficacy of diffuse magnetic resonance imaging (MRI) for identifying clinicopathological changes in immunoglobulin A nephropathy (IgAN) patients.
METHODS
The study enrolled IgAN patients and healthy volunteers. IgAN patients were divided into Group 1 [estimated glomerular filtration rate (eGFR) ≥ 90 mL/min/1.73 m2], Group 2 (60 ≤ eGFR < 90 mL/min/1.73 m2), and Group 3 (eGFR < 60 mL/min/1.73 m2). Intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) and diffusion tensor imaging (DTI) were performed via 3.0 T magnetic resonance. Diffuse MRI, clinical, and pathological indicators were collected and analysed. P < .05 was considered statistically significant.
RESULTS
Forty-six IgAN patients and twenty-seven volunteers were enrolled. The apparent diffusion coefficient, diffusion coefficient (D), perfusion fraction (f), and fractional anisotropy (FA) were significantly different among IgAN subgroups and controls. These parameters were positively correlated with eGFR and negatively with creatinine, and inversely correlated with glomerular sclerosis, interstitial fibrosis, and tubular atrophy (all P < .05). They had significantly high area under the curve (AUC) for distinguishing IgAN patients from controls, while FA had the highest AUC in identifying Group 1 IgAN patients from volunteers.
CONCLUSIONS
DTI and IVIM-DWI had the advantage of evaluating clinical and pathological changes in IgAN patients. DTI was superior at distinguishing early IgAN patients and might be a noninvasive marker for screening early IgAN patients from healthy individuals.
ADVANCES IN KNOWLEDGE
DTI and IVIM-DWI could evaluate clinical and pathological changes and correlated with Oxford classification in IgAN patients. They could also identify IgAN patients from healthy populations, while DTI had superiority in differentiating early IgAN patients.
目的
探讨弥散磁共振成像（MRI）在识别免疫球蛋白 A 肾病（IgAN）患者临床病理变化中的作用。
方法
该研究纳入了 IgAN 患者和健康志愿者。IgAN 患者分为三组：第 1 组（估计肾小球滤过率[eGFR]≥90 mL/min/1.73 m2），第 2 组（60≤eGFR<90 mL/min/1.73 m2），第 3 组（eGFR<60 mL/min/1.73 m2）。采用 3.0 T 磁共振进行体素内不相干运动弥散加权成像（IVIM-DWI）和弥散张量成像（DTI）。收集并分析弥散 MRI、临床和病理指标。P<.05 被认为具有统计学意义。
结果
共纳入 46 例 IgAN 患者和 27 名志愿者。IgAN 亚组和对照组之间的表观扩散系数、扩散系数（D）、灌注分数（f）和各向异性分数（FA）均有显著差异。这些参数与 eGFR 呈正相关，与肌酐呈负相关，与肾小球硬化、间质纤维化和肾小管萎缩呈负相关（均 P<.05）。它们在区分 IgAN 患者和对照组方面具有显著的高曲线下面积（AUC），而 FA 在区分 1 组 IgAN 患者和志愿者方面具有最高的 AUC。
结论
DTI 和 IVIM-DWI 具有评估 IgAN 患者临床和病理变化的优势。DTI 更擅长区分早期 IgAN 患者，可能是一种从健康人群中筛选早期 IgAN 患者的非侵入性标志物。
知识进展
DTI 和 IVIM-DWI 可评估 IgAN 患者的临床和病理变化，并与牛津分类相关。它们还可将 IgAN 患者与健康人群区分开来，而 DTI 在区分早期 IgAN 患者方面具有优势。
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