摘要
目的探讨功能性磁共振成像在老年人糖尿病肾病(DN)诊断中的应用价值。方法前瞻性选取温州市中心医院2020年5月至2023年5月收治的老年DN患者80例为观察组,同期健康志愿者80例为对照组,所有纳入对象均通过功能性磁共振血氧水平依赖成像(BOLD-MRI)和基于体素内不相干运动成像(IVIM-DWI),检测DN患者估算肾小球滤过率(eGFR)水平,通过受试者工作特征曲线(ROC曲线)评估功能性磁共振成像对DN的诊断价值,采用Pearson相关性分析DN患者成像参数与eGFR水平的关系。结果观察组BOLD参数髓质、皮质表观横向弛豫率(R2*)值均高于对照组(t=7.99、3.50,均P<0.001);髓质R2*值诊断DN发生的ROC曲线下面积为0.885,高于皮质R2*值诊断曲线下面积的0.734(Z=2.24,P<0.05);观察组肾脏皮髓质IVIM参数纯扩散系数(D值)、灌注分数(f值)均低于对照组(t=8.73、11.24、6.59、9.52,均P<0.05);皮质D值、f值诊断DN发生的ROC曲线下面积为0.893、0.911,高于髓质D值、f值诊断曲线下面积的0.808、0.793(Z=1.99、2.14,均P<0.05);Pearson相关性分析结果显示DN患者eGFR水平与肾脏皮髓质BOLD参数肾髓质R2*值、皮质R2*值均呈负相关(r=-0.31、-0.48,均P<0.05),与髓质以及皮质D值、f值均呈正相关(r=0.48、0.44、0.39、0.33,均P<0.05)。结论功能磁共振BOLD-MRI、IVIM-DWI成像可从肾脏氧合、灌注、水分子弥散等不同方面反映DN患者肾脏改变,早期诊断老年糖尿病患者肾损害,无创性观察患者肾脏功能改变。
Objective To explore the application value of functional magnetic resonance imaging in the diagnosis of elderly diabetic nephropathy.Methods A total of 80 older adult patients with diabetic nephropathy admitted at Wenzhou Central Hospital between May 2020 and May 2023 and 80 healthy volunteers were prospectively enrolled as observation group and control group respectively.All subjects underwent examinations of blood oxygen level dependent-functional magnetic resonance imaging(BOLD-MRI)and intravoxel incoherent motion diffusion-weighted imaging(IVIM-DWI)to detect estimated glomerular filtration rate(eGFR).The diagnostic value of functional magnetic resonance imaging in patients with diabetic nephropathy was evaluated by receiver operating characteristic(ROC)curves.The relationship between imaging parameters and eGFR level in patients with diabetic nephropathy was analyzed by Pearson correlation analysis.Results The apparent spin-spin relaxation(R2*)values of the medulla and cortex in the observation group were greater than those in the control group(t=7.99,3.50,P<0.05).The area under the ROC curve(AUC)of medulla R2*in the diagnosis of diabetic nephropathy was greater than that of cortex R2*(0.885 vs.0.734,Z=2.24,P<0.05).The IVIM pure diffusion coefficient(D value)and perfusion fraction(f value)of renal medulla and cortex in the observation group were lower than those in the control group(t=8.73,11.24,6.59,9.52,P<0.05).AUC values of cortex D and f in the diagnosis of diabetic nephropathy were 0.893 and 0.911 respectively,greater than those of medulla D and f(0.808 and 0.793 respectively;Z=1.99,2.14,P<0.05).The results of Pearson correlation analysis showed that eGFR level was negatively correlated with BOLD R2*of renal medulla and cortex(r=-0.31,-0.48,P<0.05),while positively correlated with D and f of medulla and cortex(r=0.48,0.44,0.39,0.33,P<0.05).Conclusion BOLD-MRI and IVIM-DWI can reflect renal changes in patients with diabetic nephropathy from different aspects such as renal oxygenation,perfusion and water m
作者
王晓韩
谢宾
张一帆
Wang Xiaohan;Xie Bin;Zhang Yifan(Department of Radiology,Wenzhou Central Hospital,Wenzhou 325000,Zhejiang Province,China;Department of Nephrology,Wenzhou Central Hospital,Wenzhou 325000,Zhejiang Province,China)
出处
《中国基层医药》
CAS
2024年第5期729-733,共5页
Chinese Journal of Primary Medicine and Pharmacy
基金
浙江省温州市基础性科研项目(Y2020789)。
关键词
糖尿病肾病
磁共振成像
肾髓质
肾皮质
肾小球滤过率
Diabetic nephropathy
Magnetic resonance imaging
Kidney medulla
Kidney cortex
Glomerular filtration rate
