摘要
目的分析肾脏IVIM-DWI各参数在糖尿病肾病(DN)各期间的差异,以及与肾小球滤过率(e GFR)、尿白蛋白排泄率(UAER)、肌酐的相关性,探讨IVIM-DWI对早期DN以及早、晚期DN的鉴别诊断效能。方法招募2016年～2018年在本院内分泌住院部确诊2型糖尿病患者52例,男27例,女25例,平均54.58±7.64岁;按简化MDRD公式计算肾小球滤过率(e GFR)并结合UAER进行糖尿病肾病(DN)分期,Ⅰ期19例,Ⅱ期8例,Ⅲ期14例,Ⅳ期11例,进行Philips3.0 T MR双肾轴位(11个b值)IVIM-DWI扫描,测得肾脏皮质D、D*、f值,并比较各期肾病IVIM-DWI对应参数间的差异,以及探讨与肾小球滤过率、UAER、肌酐的相关性。结果IVIM-DWI D值能够敏感反映早期DN肾脏水分子扩散功能减低,并对早期DN(Ⅰ+Ⅱ)期与Ⅲ期的鉴别诊断,有较高准确性。D、D*、f值三者对于Ⅲ期向Ⅳ期进展诊断,有较高的诊断效能(AUC≥0.779)。D、f值与UAER有中度线性关系(r=-0.558～-0.559),与肌酐也有线性关系,但相关度较弱(r=-0.337～-0.449),仅D值与e GFR有着中度相关(r=0.513)。结论 D值在早期DN(Ⅰ+Ⅱ)期与Ⅲ期的区分诊断中,具有较高诊断效能,结合D值、D*、f值可以在DN病程中可起监测及预警作用,为临床准确评估DN分期提供客观依据。
Objective To analyze the diagnostic efficiency of intravoxel incoherent motion diffusion - weighted imaging （IVIM-DW1） parameters of kidneys in various stages of type 2 diabetic nephropathy （DN） in correlation with estimated glomerular filtration rate （eGFR）, urinary albumin excretion rate （UAER）, and serum creatinine. Methods 52 patients with type 2 diabetes （27 men,25 women; average age： 54.58±7.64 years） from 2016 to 2018 were enrolled in the study. eGFR was calculated by simplified modification of diet in renal disease study （MDRD） equation and combined with UAER for DN staging. The double kidney axis IVIM-DWI with lib values was performed using Philips 3 T MR system to measure the values of D, D＊ and f in the renal cortex. These parameters in stage 1 （19 patients）, stage 2 （8）, stage 3 （14）, and stage 4 （11） of DN were compared and the correlation with eGFR, UAER and creatinine were determined. Results The D value o f IVIM-DWI has high sensitivity and accuracy for detecting the decrease of renal water molecular diffusion in the diagnosis of stage 1, 2 and 3 DN. D, D＊ and f values have higher efficiency （AUC〉0.779） for detecting development of stage 3 to stage 4 DN. D, f value and UAER have moderate linear relationship （r=-0.558 to -0.559） and weak linear correlation （r=-0.337 to -0.449） with creatinine. Only the D value has moderate correlation with eGFR （r=0.513）. Conclusion D value has higher diagnostic efficiency in stage 1, 2 and 3 DN. Combined D, D＊, and f values can monitor development of stage 3 to stage 4 DN.
作者
李标达
王丽华
陈小燕
鲁可
伍筱梅
李新春
蒙秋华
LI Biao-da;WANG Li-hua;CHEN Xiao-yan;LU Ke;WU Xiao-mei;LI Xin-chun;MENG Qiu-hua(Department of Radiology,The First Affiliated Hospital of Guangzhou Medical University,Guangdong 510120,China)
出处
《影像诊断与介入放射学》
2018年第4期266-271,共6页
Diagnostic Imaging & Interventional Radiology
基金
广东省科技计划项目(2014A020212353
2016A020215169)
广州医科大学附属第一医院临床应用与转化项目(201512-gyfyy)
关键词
磁共振成像
体素不相干运动
扩散加权成像
糖尿病肾病
Magnetic resonance imaging
Intravoxel incoherent motion
Diffusion weighted imaging
Diabetic nephropathy
作者简介
通信作者：蒙秋华,Email：mengqiuhua@163.com
