本文關(guān)鍵詞： 磁共振成像 腎血流量 年齡 形態(tài)學(xué) 腎小球?yàn)V過率　出處：《大連醫(yī)科大學(xué)》2016年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:使用磁共振動脈自旋標(biāo)記技術(shù)(arterial spin labeling,ASL)與動態(tài)對比增強(qiáng)磁共振(dynamic contrast-enhanced MR,DCE-MR)評估不同年齡腎功能正常人群腎臟皮質(zhì)血流的變化,并分析腎血流灌注與形態(tài)學(xué)、腎功能改變的關(guān)系。探討ASL技術(shù)與DCE-MR評估腎血流灌注的差異。材料與方法:回顧性收集2015年6月至2015年12月間,在本院應(yīng)用GE公司生產(chǎn)的1.5T MR行LAVA四期強(qiáng)化及單激發(fā)快速自旋回波-流動反轉(zhuǎn)恢復(fù)序列(single shot fast spin echo-flow sensitive alternating inversion recovery,SSFSE-FAIR)掃描,且常規(guī)序列[T1WI、T2WI、冠狀位二維穩(wěn)態(tài)采集快速成像序列(two-dimensional fast imaging employing steady state acquisition,2D FIESTA)]確認(rèn)腎臟無明顯病變,MR檢查一周內(nèi)實(shí)驗(yàn)室結(jié)果確認(rèn)腎功能正常的受檢者。將所有受檢者按年齡段分為三組,組1年齡范圍21-40歲,組2年齡范圍41-60歲,組3年齡范圍61-80歲,每組各隨機(jī)抽樣20例進(jìn)行研究。采用冠狀位2D FIESTA序列圖像測量雙腎長度及寬度;采用軸位LAVA增強(qiáng)皮質(zhì)早期圖像測量雙腎皮質(zhì)厚度;采用軸位LAVA-MASK圖像及增強(qiáng)皮質(zhì)期圖像測量雙腎皮質(zhì)信號值,按照增強(qiáng)率(enhancemengt ratio,ER)=(皮質(zhì)期信號值-平掃信號值)/平掃信號值的公式對雙腎皮質(zhì)的皮質(zhì)期ER進(jìn)行計(jì)算;采用FAIR后處理所得灌注圖像測量雙腎皮質(zhì)腎血流量(renal blood flow,RBF);所有數(shù)據(jù)取雙腎均值進(jìn)行最后統(tǒng)計(jì)學(xué)分析。估算腎小球?yàn)V過率(estimated glomerular filtration rate,e GFR)的計(jì)算采用CKD-EPI公式。三組間性別構(gòu)成差異的比較采用卡方檢驗(yàn)(經(jīng)Bonferroni法校正);三組間形態(tài)學(xué)(腎臟皮質(zhì)厚度、長度、寬度)、RBF、ER比較采用方差分析檢定方差齊性,并比較三組間各參數(shù)是否存在總體差異,若方差齊,則采用Bonferroni法進(jìn)行兩兩比較,若方差不齊,則采用Tamhane's T2法進(jìn)行兩兩比較;年齡與各參數(shù)相關(guān)性分析以及RBF與形態(tài)學(xué)各參數(shù)、e GFR之間的相關(guān)性分析采用Spearman相關(guān)、RBF與ER間的相關(guān)性分析,ER與形態(tài)學(xué)各參數(shù)、e GFR之間的相關(guān)性分析采用Pearson相關(guān)。結(jié)果:(1)RBF三組間總體比較差異有統(tǒng)計(jì)學(xué)意義(P=0.005),RBF組1與組3之間差異有統(tǒng)計(jì)學(xué)意義(P=0.004);但ER三組間總體與兩兩比較差異均無統(tǒng)計(jì)學(xué)意義(總體比較P=0.050)。(2)RBF與ER無顯著相關(guān)性(P=0.911),RBF與皮質(zhì)厚度、寬度間有顯著相關(guān)性(P=0.026,0.027),ER與皮質(zhì)厚度有顯著相關(guān)性(P=0.033)。(3)皮質(zhì)厚度、長度、寬度三組間總體比較差異有統(tǒng)計(jì)學(xué)意義,其中皮質(zhì)厚度兩兩比較差異均有統(tǒng)計(jì)學(xué)意義,長度僅組1與組3之間差異有統(tǒng)計(jì)學(xué)意義,寬度組2與組3、組1與組3間差異有統(tǒng)計(jì)學(xué)意義(P0.05)。(4)e GFR三組間總體與兩兩比較時(shí)差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。(5)腎臟皮質(zhì)厚度、長度、寬度、皮質(zhì)RBF、ER以及e GFR均與年齡呈負(fù)相關(guān)。(6)RBF、ER與e GFR之間均無顯著相關(guān)性。結(jié)論:ASL技術(shù)較DCE-MRI對年齡增長導(dǎo)致的腎皮質(zhì)血流的改變更加敏感,并且能夠更好地反應(yīng)隨年齡增長腎血流量與形態(tài)學(xué)改變的相關(guān)性。正常人隨年齡增長,腎血流量減低,腎臟皮質(zhì)厚度變薄。
[Abstract]:Objective: using arterial spin labeling magnetic resonance imaging (arterial spin, labeling, ASL) and dynamic contrast-enhanced magnetic resonance (DCE-MR dynamic contrast-enhanced MR) to assess changes in different age groups with normal renal function of renal cortical blood flow, and the analysis of renal blood perfusion and morphology, the relationship between the change of renal function. The differences of ASL and DCE-MR evaluation of renal perfusion. Materials and methods: retrospectively collected from June 2015 to December 2015 in our hospital, recovery sequence by GE company 1.5T MR LAVA four phases enhanced and single shot fast spin echo (single shot fast spin reverse flow echo-flow sensitive alternating inversion recovery, SSFSE-FAIR) scanning, and conventional sequence [T1WI T2WI, coronal two-dimensional steady-state acquisition fast imaging sequence (two-dimensional fast imaging employing steady state acquisition, 2D FIESTA)] to confirm the kidney Dirty no significant lesions, MR examination within one week of laboratory results confirmed renal function in normal subjects. All subjects were divided into three groups according to age group, 1 age range 21-40 years, 2 age range 41-60 years, 3 age range 61-80 years old, each with a random sample of 20 cases studied. Using coronal renal 2D FIESTA image sequence measuring length and width; the axial LAVA enhanced cortical early image measurement double renal cortical thickness; the axial LAVA-MASK image enhancement and image measurement of double renal cortical phase signal value, in accordance with the enhancement rate (enhancemengt = ratio, ER) (cortical phase value - scan signal signal value) / cortical phase ER scan signal value formula of double renal cortex were calculated; the measurement of renal cortical perfusion images of double renal blood flow by FAIR (renal blood flow, RBF); all data of the two kidneys mean the final statistical analysis. The estimation of renal small (estimated glomerular filtration ball filtration rate rate, e GFR) calculated by CKD-EPI formula. The comparison between the three groups in gender differences in the chi square test (by Bonferroni method; morphological correction) between the three groups (renal cortical thickness, length, width, RBF, ER) were compared using analysis of variance and variance test. The comparison between three groups of parameters are overall difference, if the variance, then Bonferroni method was used to compare 22, if the variance is not homogeneous, using the Tamhane's T2 method was 22; age and analysis of parameters and correlation between RBF and morphological parameters, correlation analysis using Spearman correlation between E GFR and RBF, correlation analysis ER, ER and the parameters of morphology, correlation analysis between E GFR by Pearson. Results: (1) RBF was significant in the three groups (P= 0.005), RBF group 1 and group 3 the difference between the Statistically significant (P=0.004); but there were no significant differences between the three groups and 22 ER overall difference (generally P=0.050). (2) there is no significant correlation between RBF and ER (P=0.911), RBF and cortical thickness, width was significantly correlated (P=0.026,0.027), ER was significantly correlated with cortical thickness (P=0.033). (3) cortical thickness, length and width of the three groups showed statistically significant difference between the cortical thickness of 22, there were significant differences in length, only between group 1 and group 3 had significant difference, the width of group 2 and group 3, statistically significant differences between group 1 and group 3 (P0.05). (4) e GFR between the three groups and 22 overall comparison difference had statistical significance (P0.05). (5) renal cortical thickness, length, width, RBF ER and E GFR cortex, were negatively correlated with age. (6) RBF, between ER and E GFR have no significant correlation. Conclusion: ASL DCE-MRI technology is to guide the growth of the age The change of renal cortex blood flow is more sensitive, and it can better reflect the correlation between renal blood flow and morphological changes with age. In normal persons, the renal blood flow decreases with age, and the thickness of renal cortex becomes thinner.

【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R445.2;R692

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