摘要
目的：探讨血氧水平依赖成像（BOLD）MRI对肾移植术后早期移植肾急性排异反应（AR）和急性肾小管坏死（ATN）的鉴别诊断价值。方法：选取2012年5月-2014年12月于我院行异体肾移植术后2--4周的患者64例,所有受试者均行常规MRI及斜冠状面BOLD检查。根据病理穿刺结果,将患者分为三组,即移植肾功能正常组、AR组及ATN组。分别测量并计算各组移植肾皮质、髓质R2＊值,采用配对样本t检验比较各组皮髓质间R2＊值的差异,采用单因素方差分析比较各组间移植肾皮质、髓质R2＊值的差异。采用ROC曲线比较髓质R2＊值对移植肾功能正常组、AR组以及ATN组的鉴别诊断效能。结果：移植肾功能正常组、AR组和ATN组髓质R2＊值均明显大于皮质（P〈0.05）;移植肾功能正常组、AR组与ATN组间皮质R2＊值两两比较差异无统计学意义（P〉0.05）;AR组髓质R2＊值小于移植肾功能正常组（P=0.002）及ATN组（P=0.004）;移植肾功能正常组与ATN组间髓质R2＊值差异无统计学意义（P〉0.05）。ROC曲线分析显示髓质R2＊值可作为AR的辅助诊断指标,其诊断阈值为21.4/s。结论：BOLD MRI能无创、有效鉴别功能正常移植肾与AR、AR与ATN,其中髓质R2＊值可作为鉴别诊断指标。
Objective： To investigate the value of blood oxygen level dependent （BOLD） MRI in differentiating acute rejection （AR） and acute tubular necrosis （ATN） at the early stage after renal transplantation. Methods：Between May 2012 and December 2014,64 renal allograft recipients 2-4 weeks after transplantation were included in this study,and examined using a routine MR sequence and a GRE BOLD sequence in oblique coronal orientation at a 3.0 Tesla MR scanner. According to the pathological results after renal puncture biopsy, patients were divided into three groups： normal renal function group,AR group and ATN group. R2 values were determined separately for the cortex and the medulla and compared among the 3 groups. Differences in R2 values between the cortex and medulla in each group were compared using paired sample t-test. Differences in R2 values of the cortex and medulla between each group were compared using one-way analysis of variance （ANOVA） test with least significant difference （LSD）. Meanwhile, the receiver operating characteristic （ROC） curves was used to analyze the differential diagnostic efficacies of medullary R2 for renal allografts with different renal functions. P〈0. 05 indicated a statistically significant difference. Results：Mean medullary R2 values were higher than cortical R2 values in all three groups （P〈0.05）. There were no significant differences of mean cortical R2 values among all groups （P〉0.05）. Mean medullary R2＊ values in AR group were lower than in the normal renal function group （P=0. 002） and ATN group （P= 0. 004）,but there were no significant differences between normal renal function group and ATN group （P〉0.05）. ROC curve analyses suggested that medullary R2＊ values could accurately identify AR at the early stage after renal transplantation. The diagnosis threshold was 21.4/s. Conclusion： BOLD MRI could differentiate between al- lograft kidney with normal function and AR, also between AR and ATN noninvasively. Medulla
出处
《放射学实践》
北大核心
2015年第5期525-530,共6页
Radiologic Practice
关键词
血氧水平依赖成像
磁共振成像
肾移植
肾小管坏死
急性
Blood oxygen level-dependent imaging
Magnetic resonance imaging
Kidney transplantation
Kidney tubular necrosis,acute
