磁共振体素内不相干运动成像评价糖尿病肾功能高滤过期的价值

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摘要目的：探讨磁共振体素内不相干运动成像（IVIM-DWI）评价糖尿病早期肾功能高滤过期的可靠性。方法：对温州医科大学附属第二医院育英儿童医院内分泌科12例估算肾小球滤过率（eGFR）≥120 mL·min-1·1.73 m-2的糖尿病患者和12例同期健康志愿者进行研究。采用GE MR750 3.0T磁共振扫描仪、选择11个b值采集IVIM-DWI图像，通过GE工作站内置MADC软件获取ADC、D、DP及PF参数图，对图像勾画ROI获取相关参数值。由2名放射科医师分别独立对获取的所有数据进行组内相关系数（ICC）分析。采用两独立样本t检验比较2组间各参数值差异，并采用Spearman相关分析检验IVIM-DWI参数与eGFR相关性。结果：2组数据具有较好的一致性（ICC=0.764～0.874）。糖尿病组肾脏皮质、髓质ADC值、D值及PF值较健康对照组明显增高（P＜0.05）；肾脏皮质D值与eGFR间存在显著正相关（r=0.581，P＜0.05）。结论：IVIM-DWI扩散参数ADC、D及灌注参数PF可以反映早期糖尿病肾脏高滤期肾功能改变，而灌注参数DP反映高滤期肾功能改变仍存在一定的局限。

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	周永进
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	龚恩惠
	黄小燕
	崔诗浛
	宋佳雯
	刘锟
	严志汉

关键词 ：肾脏, 磁共振成像, 体素内不相干运动, 糖尿病前期, 肾小球滤过率

Abstract：Objective: To investigate whether the intravoxel incoherent motion diffusion weighted imaging (IVIM-DWI) was helpful in assessing renal function changes in early-stage diabetic patients with hyperfiltration. Methods: A total of 12 diabetic patients with eGFR≥120 mL•min-1•1.73 m-2 and 12 healthy controls were included in the study. IVIM-DWI of bilateral kidneys was acquired using 11 b values on a 3.0 T MR scanner. The diffusion coefficient of apparent diffusion coefficient (ADC), pure molecular diffusion (D), perfusion-related pseudo-diffusion coefficient (DP) and perfusion fraction (PF) of the renal cortex and medullawere calculated from IVIM-DWI maps of the two groups. Two radiologists independently analyzed all imaging data. Intra-class correlation coefficients (ICCs) and group comparisons by two-sided t-test were made between the two groups. Relationship between IVIM-DWI parameters and eGFR was examined by Spearman correlation test.Results: Inter-observer agreement was “good” (ICC=0.764-0.874) for all parameters. Mean renal cortex and medulla ADC, D and PF value of diabetic patients were significantly higher than healthy controls (P<0.05). There was a significant linear correlation between renal cortex D value and eGFR level (r=0.581, P<0.05). Conclusion: It is indicated that ADC, D and PF value could detect the renal changes of water molecular diffusion and microcirculation perfusion in diabetic kidneys which may emerge as glomerular hyperfiltration that occurs in early-stage diabetic kidneys. However, it is still a challenge for DP value to reflect microcirculation perfusion changes.

Key words： kidney magnetic resonance imaging intravoxel incoherent motion prediabetic state glomerular filtration rate

收稿日期: 2018-01-18

基金资助:浙江省卫生厅一般研究计划项目（2014KYA145）；温州市科技局公益性科技计划项目（Y20170813）。

通讯作者: 严志汉，教授，Email：zhihanyan@hotmail.com。

作者简介: 周永进（1988-），男，湖北监利人，硕士生。

链接本文:

https://xb.wmu.edu.cn/CN/ 或 https://xb.wmu.edu.cn/CN/Y2018/V48/I5/366

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