摘要
目的探讨扩散张量成像（DTI）、血氧水平依赖成像（BOLD）对移植肾急性排异反应（AR）和急性肾小管坏死（ATN）鉴别诊断价值,以期探寻无创、敏感的评价移植肾功能的方法。方法选取2012年5月—2014年3月在天津市第一中心医院进行异体肾移植术后2~3周的患者51例纳入本研究,所有受试者均于Siemens MAGNETOM Trio Tim 3.0T超导磁共振扫描仪进行常规磁共振成像（MR）及脂肪抑制平面回波斜冠状面DTI检查（在6个非共线性方向上施加扩散敏感梯度场,b值为0.300 s/mm^2）及斜冠状面BOLD检查。患者分为三组：移植肾功能正常组、AR组及ATN组,其中AR组与ATN组均经病理穿刺证实。分别测量并计算各组移植肾皮质、髓质的表观扩散系数（ADC）值、各向异性分数（FA）值及表观自旋-自旋弛豫率（R2＊）值,采用单因素方差分析比较移植肾各组间各参数值的差异。采用受试者工作特征曲线（ROC）比较皮髓质ADC值及R2＊值对AR组以及ATN组的鉴别诊断效能并确定最佳诊断阈值。结果与正常组相比,AR组皮质ADC值、髓质ADC值、R2＊值显著下降〔皮质ADC值（×10^-3mm^2/s）：2.31±0.49比2.85±0.28,髓质ADC值（×10^-3mm^2/s）：2.21±0.50比3.07±0.38,R2＊值（1/s）：19.5±3.3比22.7±3.3,均P〈0.05〕。与ATN相比,AR组皮质ADC值、髓质ADC值、R2＊值显著下降〔皮质ADC值（×10^-3mm^2/s）：2.31±0.49比2.85±0.27,髓质ADC值（×10^-3mm^2/s）：2.21±0.50比2.76±0.35,R2＊值（1/s）：19.5±3.3比23.6±2.8,均P〈0.05〕;三组之间皮质、髓质FA值及皮质R2＊值均无明显差异（P〉0.05）。皮质ADC值、髓质ADC值及髓质R2＊值对AR组与ATN组鉴别的最佳诊断阈值分别为2.68×10^-3mm^2/s、2.73×10^-3mm^2/s、21.4/s,其敏感性和特异性均在70%以上,鉴别诊断效能均无明显统计学差异（P〉0.05）。结论 DTI、BOLD能无创、有效鉴别移植肾AR与ATN,其中皮髓质ADC值及髓质R2＊值�
Objective To investigate the value of diffusion-tensor imaging（DTI） and blood oxygen level-dependent（BOLD） in differentiation acute rejection（AR） and acute tubular necrosis（ATN）, and to explore a sensitive, noninvasive strategy of evaluating renal allograft function. Methods A total of 51 renal allograft recipients at 2-3 weeks after transplantation in Tianjin First Center Hospital were included in this study from May 2012 to March 2014 and they were examined using a fat-saturated echo-planar DTI and GRE-BOLD sequence in obliquecoronal orientation at 3.0 Tesla magnetic resonance（MR） imager（diffusion directions = 6,b = 0.300 s/mm^2）. All patients were divided into three groups： normal renal function group, acute rejection group and acute tubular necrosis group, and the AR and ATN groups were confirmed by pathological biopsy. Mean apparent diffusion coefficient（ADC） and mean fractional anisotropy（FA） and apparent spin-spin relaxation rate（R2＊） values of the cortex and medulla were determined separately and comparisons of parameters between the 3 groups were tested by one-way ANOVA analysis. Meanwhile, the receiver operating characteristic（ROC） curves was used to compare the differential diagnostic efficacies of every parameters in AR group and ATN group for determine the best diagnostic threshold. Results Compared with normal group, mean ADC value in cortex, mean ADC value in medulla and medullary R2＊ value of AR group were significantly lower 〔mean ADC value in cortex（×10^-3mm^2/s）：2.31±0.49 vs. 2.85±0.28, mean ADC value in medullar（×10^-3mm^2/s）：2.21±0.50 vs. 3.07±0.38,medullary R2＊ value（1/s）：19.5±3.3 vs. 22.7±3.3,all P 0.05〕. Compared with ATN group, mean ADC value in cortex, mean ADC value in medulla and medullary R2＊ value of AR group were significantly lower 〔mean ADC value in cortex（×10^-3mm^2/s）： 2.31±0.49 vs. 2.85±0.27, mean ADC value in medullar（×10^-3mm^2/s）：2.21±0.50 vs. 2.76±0.35, medullary R2＊value�
出处
《实用器官移植电子杂志》
2016年第4期207-212,共6页
Practical Journal of Organ Transplantation(Electronic Version)
基金
天津市自然科学基金(15KG33)
关键词
扩散张量成像
血氧水平依赖成像
肾移植
急性排异反应
急性肾小管坏死
Diffusion tensor imaging
Blood oxygen level-dependent
Kidney transplantation
Acute rejection
Acute tubular necrosis
