ISSN 1006-298X      CN 32-1425/R

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肾脏病与透析肾移植杂志 ›› 2019, Vol. 28 ›› Issue (2): 101-106.DOI: 10.3969/j.issn.1006-298X.2019.02.001

• 论文 •    下一篇

应用功能磁共振成像评估狼疮性肾炎患者肾功能预后

  

  • 出版日期:2019-04-28 发布日期:2019-05-06

Functional magnetic resonance imaging to evaluate renal function prognosis in lupus nephritis

  • Online:2019-04-28 Published:2019-05-06

摘要:

目的:观察多模态功能磁共振成像(fMRI)技术与狼疮性肾炎(LN)患者肾组织活动性评分(AI)及肾功能的相关性,探索fMRI技术结合病理学改变对LN肾组织损伤程度的评估。
方法:32例经肾活检明确诊断的LN患者,进行fMRI分析,序列包含有体素内不相干运动成像(intravoxel incoherent motion diffusion weighted imaging,IVIMDWI)、弥散张量成像(diffusion tensor imaging,DTI)、血氧水平依赖成像(bloodoxygen level dependent imaging,BOLD)及磁共振弹性成像(magnetic resonance imaging,MRE)。分析记录肾皮质区功能影像序列参数值。分析LN患者基线临床及肾脏病理评分和随访资料。
结果:LN合并急性肾损伤(AKI)患者,IVIM标准表观弥散系数(StandardADC值)低于非AKI患者[(1535±133)×10-6 mm2/s vs (1769±171)×10-6 mm2/s,P<005],DTIFA值也低于后者(0151±003  μm2/ms vs 0181±004 μm2/ms,P<005);DTIFA值与AI和慢性化评分(CI)之间均呈显著负相关性(P<005)。随访6个月时,血清肌酐(SCr)升高>30%的LN患者基线DTIFA值显著低于肾功能稳定组(0164±0031 μm2/ms vs 0195±0065 μm2/ms,P<0001);并且,DTIFA值与SCr升高斜率负相关(R=-054,P<005),且对SCr升高具有一定预测价值(AUC 615%,P<005)。本研究中BOLD及MRE参数与组织AI、CI值和SCr变化斜率之间无显著相关性。
结论:功能影像序列中IVIMDWI及DTI指标的变化,结合肾组织形态学指标,有助于预测LN患者肾功能的变化。

关键词: 狼疮性肾炎, 肾功能, 磁共振成像, 体素内不相干运动, 弥散张量成像

Abstract:

Objective:this study intends to explore the role of functional magnetic resonance imaging combined with histopathological features in predicting the extent of LN tissue damage,by observing the correlation between multimode functional magnetic resonance imaging and renal tissue activity score and the change slope of renal creatinine.
Methodology:32 patients with LN were enrolled. The sequences included intravoxel incoherent motion diffusion imaging (IVIMDWI),diffusion tensor imaging (DTI),bloodoxygenlevel dependent imaging(BOLD) and Magnetic resonance imaging (MRE).The sequence parameters of renal cortical functional imaging were analyzed and recorded Baseline clinicopathological data and followup data for LN patients were analyzed.Acute nephritis tissue activity index (AI); chronic index (CI) is based on renal biopsy histomorphological analysis.
Results:We found that The standADC(1535±133 vs 1769±171,P<005)and FA(0151±003 vs 0181±004,P<005)descended in the AKI subgroup of lupus nephritis. In followup period,FA(0164±0031 vs 0195±0065,P<0001)is much lower in the patients with renal function deterioration,and correlated with the descending slope of serum creatine. The DTIFA had a predictive value for the change of serum(AUC 615%,P<005).We did not found any differences between LN with CKD in BOLD and MRE.
Conclusion:DTIFA and IVIMADC is promising in prediction of renal function.More effort should be paid to monitor renal function prognosis in the future by functional magnetic resonance imaging.

Key words: Lupus nephritis, renal function, magnetic resonance imaging, intravoxel incoherent motion, diffusion tensor imaging