Fu Jia, Lin Zhiyong, Zhang Bihui, Meng Xiaoyan, Qiu Jianxing, Yang Min, Zou Yinghua
Department of Radiology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China; Department of Radiology, Peking University First Hospital, Beijing, China.
Department of Radiology, Peking University First Hospital, Beijing, China.
Magn Reson Imaging. 2025 Apr;117:110329. doi: 10.1016/j.mri.2025.110329. Epub 2025 Jan 22.
To explore the potential of Intravoxel Incoherent Motion Diffusion (IVIM) and Arterial Spin Labeling (ASL) in predicting the short-term effectiveness of post-revascularization for severe atherosclerotic renal artery stenosis.
A retrospective analysis of 88 cases from October 2018 to February 2023 was conducted. Patients were divided into Responder and Non-Responder groups based on renal function outcomes at their last follow-up. Clinical data were compared between the groups, and preoperative functional MRI images were analyzed. ROIs were outlined for the affected and both kidneys. Measurements included ASL-derived renal blood flow (RBF), IVIM's pseudo-diffusion coefficient (D*), perfusion fraction (f), true diffusion coefficient (D), and the conventional apparent diffusion coefficient (ADC).Multivariate logistic regression identified independent clinical predictors of benefit, and a clinical prediction model was developed. Model performance was assessed using Receiver Operating Characteristic (ROC) curves and Decision Curve Analysis(DCA) curves.
In the training cohort of 54 non-responders and 34 responders, no quantitative parameters of bilateral kidneys showed statistical significance in predicting Responders (all p > 0.05). Pre-treatment eGFR, presence of diabetes, and the D value of the affected kidney were identified as independent factors for predicting short-term treatment effectiveness. The combined clinical-functional imaging model yielded a higher AUC at 0.796 (95 % CI: 0.690-0.897). Decision curve analysis further confirmed the better net benefit of combined model.
Beyond clinical characteristics, functional MRI had the potential to predict response of stenting for severe atherosclerotic renal artery stenosis.
探讨体素内不相干运动扩散成像（IVIM）和动脉自旋标记成像（ASL）预测重度动脉粥样硬化性肾动脉狭窄血管重建术后短期疗效的潜力。
对2018年10月至2023年2月的88例患者进行回顾性分析。根据患者最后一次随访时的肾功能结果将其分为反应者组和无反应者组。比较两组间的临床资料，并分析术前功能磁共振成像图像。在患侧肾脏和双侧肾脏勾勒出感兴趣区（ROI）。测量指标包括ASL衍生的肾血流量（RBF）、IVIM的伪扩散系数（D*）、灌注分数（f）、真实扩散系数（D）以及传统的表观扩散系数（ADC）。多因素逻辑回归确定获益的独立临床预测因素，并建立临床预测模型。使用受试者操作特征（ROC）曲线和决策曲线分析（DCA）曲线评估模型性能。
在由54例无反应者和34例反应者组成的训练队列中，双侧肾脏的定量参数在预测反应者方面均无统计学意义（所有p>0.05）。治疗前估算肾小球滤过率（eGFR）、糖尿病的存在以及患侧肾脏的D值被确定为预测短期治疗效果的独立因素。联合临床功能成像模型的曲线下面积（AUC）更高，为0.796（95%CI：0.690-0.897）。决策曲线分析进一步证实联合模型的净获益更好。
除临床特征外，功能磁共振成像有潜力预测重度动脉粥样硬化性肾动脉狭窄支架置入术的反应。
