本文關(guān)鍵詞： 彌散張量成像 表觀彌散系數(shù) 各向異性分數(shù) 慢性腎炎 腎腫瘤　出處：《天津醫(yī)科大學(xué)》2014年博士論文　論文類型：學(xué)位論文

【摘要】：一、目的 本研究通過對正常志愿者彌散張量成像研究,評價不同b值對彌散張量成像測量指標(biāo)(ADC值、FA值)和圖像質(zhì)量(SNR、CNR)的影響；評價年齡、性別、測量部位對正常腎臟ADC、FA值的影響。探討慢性腎小球腎炎患者和腎臟占位性病變的彌散張量成像的圖像特點,評估彌散張量成像的測量指標(biāo)在慢性腎小球腎炎早期腎功能損害預(yù)警、腎功能分期評估和腎臟良惡性占位病變的鑒別診斷及其與病理學(xué)改變相關(guān)性的價值。 二、材料與方法 隨機選取60例健康志愿者使用1.5T MRI (Siemens Avanto)行彌散張量成像檢查,掃描平面與腎臟長軸一致,行冠狀面彌散張量成像的序列參數(shù)為：脂肪抑制的ss-EPI序列,GRAPPA并行采集技術(shù),TR1400ms, TE設(shè)為最短82ms,半傅立葉采集6/8,相位編碼方向右左,矩陣128×128,層厚6mm,層間距為0,層數(shù)為10,彌散梯度方向為6,采用呼吸觸發(fā)模式,平均采集次數(shù)為4。b值的選擇分別為0、200s/mm2,0、400s/mm2,0、600s/mm2,0、800s/mm2,0、1000s/mm2,分別測量ADC值、FA值,SNR、CNR,對ADC圖等級評分,比較不同性別、年齡段及腎臟部位對ADC值、FA值的影響。 對75例慢性腎小球腎炎患者,計算估算的腎小球濾過率(estimated glomerular filtration rate,eGFR)并對腎功能分期,比較ADC、FA值與腎功能分期、腎小球硬化面積、腎間質(zhì)纖維面積的相關(guān)性,評價ADC、FA值等測量指標(biāo)在早期腎功能損害的預(yù)警價值。 對連續(xù)收集的70例腎臟占位性病變行彌散張量成像,采用三組b值(0、400) s/mm2、(0、600) s/mm2、(0、800) s/mm2評價,比較彌散張量成像測量指標(biāo)對腎臟占位性病變囊、實性成分的良惡性鑒別的價值,比較不同級別的腎臟透明細胞癌的ADC、FA值及E1值與細胞密度、微血管密度的相關(guān)性。 三、結(jié)果 1.正常志愿者DTI:五組不同的b值獲得的腎實質(zhì)、皮質(zhì)、髓質(zhì)ADC值、SNR比較具有統(tǒng)計學(xué)差異(F值為1846.65、368.93、207.80和951.93,P0.05)；而五組不同的b值獲得的腎實質(zhì)、皮質(zhì)、髓質(zhì)FA值、皮髓質(zhì)信號差比較不具有統(tǒng)計學(xué)差異(F值為0.98、1.07、1.14和1.13,P0.05)。b值為(0、800)s/mm2的ADC圖像滿足診斷要求。腎實質(zhì)與腎皮質(zhì)、髓質(zhì)的ADC值存在相關(guān)性(r=0.91和0.92,P0.01)；腎實質(zhì)與腎皮質(zhì)、髓質(zhì)的FA值存在相關(guān)性(r=0.90和0.88,P0.01)；不同性別、年齡段之間腎臟實質(zhì)ADC、FA值比較均不具有統(tǒng)計差異(P0.05),而腎臟實質(zhì)ADC、FA值隨年齡段的增大逐漸減小；腎臟皮、髓質(zhì)的上、中、下極ADC值、FA值比較均不具有統(tǒng)計學(xué)差異(P0.05),左右側(cè)腎臟比較亦不具統(tǒng)計學(xué)差異(P0.05)。 2.慢性腎小球腎炎患者DTI:慢性腎小球腎炎者的ADC值、FA值伴隨腎功能的下降而降低,不同腎功能分期之間比較,差異均具有統(tǒng)計學(xué)意義(P0.05)。ADC值、FA值與eGFR存在顯著相關(guān)性(r分別為0.89和0.85,P0.05)。ADC值、FA值對區(qū)分CKD Ⅰ期與CKD Ⅱ-Ⅴ期的診斷價值較高,其ROC曲線下面積達0.979和0.946(P0.05)。腎臟皮質(zhì)、髓質(zhì)的FA值與腎小球硬化面積的負相關(guān)性最高(r分別為-0.74,-0.70,P0.05)；腎臟皮質(zhì)、髓質(zhì)ADC值與腎小球硬化面積也顯著負相關(guān),(相關(guān)系數(shù)r分別為-0.65和-0.66,P0.05)。腎臟髓質(zhì)、皮質(zhì)FA值與腎間質(zhì)纖維化面積的負相關(guān)性最高(r分別為-0.76和-0.70,P0.05)；而髓質(zhì)、皮質(zhì)ADC與腎間質(zhì)纖維面積亦存在顯著負相關(guān)(r=-0.68,-0.67,P0.05)。 3.腎臟良惡性占位病變DTI：隨著b值的增大,ADC、E1值減小,而FA值未發(fā)生明顯變化。b值為(0、800) s/mm2時,E1值對腎臟占位病變的實性成分鑒別方面具有最高的診斷價值,ROC曲線下面積為0.923,最佳診斷閾值為1.61×10-3mm2/s,敏感度100%,特異度83.3%；ADC值鑒別囊性部分具有最高的診斷價值,ROC曲線下面積為0.932,最佳診斷閾值為2.76×10-3mm2/s,敏感度100%,特異度83.7%。 低級別腎透明細胞癌的細胞密度為51.73±6.73,高級別腎透明細胞癌的細胞密度為64.87±9.08,兩組比較具有統(tǒng)計學(xué)意義(t=-4.50,P0.05)。ADC、E1、FA值與細胞密度間存在相關(guān)性(r=-0.796,-0.865,-0.730,P0.05)。低級別腎透明細胞癌的微血管密度為49.33±7.76,高級別腎透明細胞癌的微血管密度為61.27±8.45,兩組比較亦具有統(tǒng)計學(xué)意義(t=-4.03,P0.05)。ADC、E1、FA值與微血管密度間亦存在相關(guān)性(r=-0.739,-0.826,-0.761,P0.05)。 四、結(jié)論 本文通過正常人群和腎臟病變患者人群的系列研究,進一步證實了采用臨床型MRI設(shè)備的DTI技術(shù),不僅可應(yīng)用于正常人腎臟結(jié)構(gòu)與功能的評價,而且有助于腎臟慢性疾病腎功能的定量評估和腎臟占位病變良惡性鑒別診斷及病理分級,顯示了良好的臨床應(yīng)用前景。具體結(jié)論如下： 1.腎臟DTI的b值取值范圍為(0,400-800)s/mm2,最佳診斷b值為(0、600)s/mm2;年齡、性別及腎臟不同測量部位等影響因素對ADC、FA值的測量結(jié)果無明顯的影響。 2.ADC、FA值可早期預(yù)警腎功能的損害,有助于評價腎功能的分期以及用于評估與慢性腎衰竭密切相關(guān)的腎小球硬化、腎間質(zhì)纖維化等病理改變。 3.ADC、E1、FA值是鑒別腎臟良惡性占位的重要參數(shù),并可用于評估腎透明細胞癌的細胞密度、微血管密度等病理變化,具有廣泛的應(yīng)用前景。
[Abstract]:First, the purpose
Based on the study of diffusion tensor imaging in normal volunteers, the evaluation of different b values on diffusion tensor imaging measurements (ADC, FA) and image quality (SNR, CNR) effect; evaluation of age, gender, location measurement in normal kidney ADC, the influence of FA. Patients with chronic nephritis and kidney accounted for the image characteristics of lesions by diffusion tensor imaging, diffusion tensor imaging evaluation measure in chronic glomerulonephritis early renal damage in early warning, staging of renal function assessment and differential diagnosis of benign and malignant renal lesions accounted for its value and the pathological changes in correlation.
Two, materials and methods
Randomly selected 60 healthy volunteers using 1.5T MRI (Siemens Avanto) for diffusion tensor imaging. The scanning plane is consistent with the long axis of kidney, coronal sequence parameters of diffusion tensor imaging: ss-EPI fat suppression sequence, GRAPPA parallel acquisition technology, TR1400ms, TE for the shortest 82ms, semi Fu Liye acquisition 6/8, phase encoding the direction of right and left, 128 * 128 matrix, 6mm thickness, layer spacing of 0 layers, 10 diffusion gradient direction is 6, the average number of respiratory triggering mode, acquisition for the selection of 4.b value were 0200s/mm2,0400s/mm2,0600s/ mm2,0800s/mm2,01000s/mm2 and ADC measurements, respectively FA, SNR, CNR, ADC score for the class map, comparison of different gender, age and location of kidney on ADC value and FA value effect.
Of the 75 patients with chronic glomerulonephritis, estimated glomerular filtration rate (estimated, glomerular filtration rate, eGFR) and the staging of renal function, ADC, FA staging and renal function and glomerular sclerosis area, correlation, fiber area between renal evaluation of ADC, FA value measurement index in early renal damage early warning value.
For the continuous collection of 70 cases of renal lesions, diffusion tensor imaging, using three groups of values of B (0400) s/mm2 (0600) s/mm2 (0800) s/mm2 evaluation, comparison of diffusion tensor imaging measurements of lesions on renal cyst, benign and malignant lesions of solid components of the value of renal cell cancer in different levels of the ADC, FA and E1 values and the correlation between cell density and microvessel density.
Three, the result
1. normal volunteers DTI: five groups of different b values of renal parenchyma, the cortex, medulla ADC, SNR was statistically difference (F-measure 1846.65368.93207.80 and 951.93, P0.05); and the five group of different b values of renal parenchyma, the cortex, medulla FA, corticomedular signal is not statistically significant difference (F-measure 0.98,1.07,1.14 and 1.13, P0.05) value of.B (0800) ADC s/mm2 image meets the requirement of diagnosis. Renal parenchyma and renal cortex and medulla of the correlation between ADC value (r=0.91 and 0.92, P0.01); renal parenchyma and renal cortex, medulla FA values are associated (r=0.90 and 0.88, P0.01); gender, age between renal parenchymal ADC, FA value were not statistically difference (P0.05), and renal ADC, FA values increase with age decreased gradually; the renal cortex and medulla, and, under the ADC value, FA value was not statistically significant (P0.05), left and right side kidney There was no statistical difference in the visceral comparison (P0.05).
2. patients with chronic glomerulonephritis DTI: chronic glomerulonephritis and their ADC value, FA value decreased with decreased renal function, different renal function stage between the comparison, the differences were statistically significant (P0.05).ADC, there was a significant correlation between the eGFR and FA values (r = 0.89 and 0.85, P0.05).ADC value, FA value diagnostic value of high differentiated CKD I and CKD II - V period, the ROC area under the curve of 0.979 and 0.946 (P0.05). The renal cortex, medulla FA and glomerular sclerosis area highest negative correlation (r = -0.74, -0.70, P0.05); renal cortex, medulla ADC and glomerular sclerosis the area has a significant negative correlation (correlation coefficient r were -0.65 and -0.66, P0.05). The renal medulla, cortex of the highest FA value and negatively correlated with renal interstitial fibrosis area (r = -0.76 and -0.70, P0.05 and ADC); medulla, cortex and renal interstitial fibrosis area also has a significant negative correlation R=-0.68, -0.67, P0.05.
3. renal benign and malignant lesions of DTI: with the increase of B value, ADC, E1 value decreased, while the FA value did not change significantly.B value (0800) of s/mm2, E1 has the highest diagnostic value of solid component identification of renal occupying lesions. The area under ROC curve is 0.923, the best the diagnostic threshold is 1.61 * 10-3mm2/s, the sensitivity was 100%, specificity was 83.3%; the ADC value of the cystic part of the differential diagnosis value of the highest, ROC area under curve was 0.932, the best diagnostic threshold is 2.76 * 10-3mm2/s, sensitivity 100%, specificity 83.7%.
The low level of renal clear cell carcinoma cell density was 51.73 + 6.73, high-grade renal clear cell carcinoma cell density was 64.87 + 9.08, the two groups was statistically significant (t=-4.50, P0.05).ADC, E1, correlation between the density of cell and FA values (r=-0.796, -0.865, -0.730, P0.05). Microvessel density the low level of renal cell carcinoma was 49.33 + 7.76, the microvessel density of high-grade renal cell carcinoma was 61.27 + 8.45, the two groups were statistically significant (t=-4.03, P0.05).ADC, E1, and correlation with microvessel density between the FA values (r= -0.739, -0.826, -0.761, P0.05).
Four. Conclusion
In this paper, through a series of research in normal subjects and patients with renal disease, confirmed by clinical equipment MRI DTI technology, not only can be used to evaluate the structure and function of normal human kidney, but also contribute to chronic kidney disease renal function assessment and kidney lesions of benign and malignant differential diagnosis and pathological grading, display a good clinical application prospect. The main conclusions are as follows:
1., the b value of kidney DTI was 0400-800 0400-800 s/mm2, and the best diagnosis b value was (0600) s/mm2. There was no significant effect on age, sex and different location of kidney.
2.ADC and FA can early predict renal function damage, help to evaluate the staging of renal function and evaluate pathological changes associated with glomerular sclerosis and interstitial fibrosis, which are closely related to chronic renal failure.
3.ADC, E1 and FA values are important parameters for differentiating benign and malignant kidney, and can be used to evaluate the pathological changes of renal clear cell carcinoma, such as cell density and microvessel density.

【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2014
【分類號】：R445.2;R692.3

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本文編號：1523125