本文選題：慢性腎病 + 腎小球慮過率　； 參考：《南昌大學(xué)》2014年碩士論文

【摘要】：目的： 對慢性腎病患者進(jìn)行腎臟常規(guī)MRI、DTI及BOLD掃描，，測量腎皮質(zhì)、髓質(zhì)FA值、ADC值及R2*值，與腎小球率過濾進(jìn)行相關(guān)性分析，探討腎臟DTI及BOLD成像在慢性腎病分期及腎功能評估中的價(jià)值。 資料與方法： 收集2012年11月至2013年9月期間經(jīng)我院臨床診斷為慢性腎病的患者54例，其中男性28例，女性26例，年齡23～76歲，平均（45±15）歲。健康志愿者20例，其中男性11例，女性9例，年齡24～64歲，平均（41±12）歲。所有研究對象均接受MRI掃描。 掃描采用3.0T超導(dǎo)磁共振掃描儀（GE，Signa HDXt），8通道TORSO相控陣線圈。先行常規(guī)雙腎MRI掃描，然后行雙腎長軸平行的斜冠狀面DTI及BOLD掃描。所有原始圖像自動導(dǎo)入GE Medical Systems AW4.4工作站，用Functool軟件進(jìn)行后處理及數(shù)據(jù)測量。采用盲法，由兩位年輕影像科大夫，在b值為0s/mm2圖像上，于右側(cè)腎臟手動勾畫皮質(zhì)輪廓作為皮質(zhì)感興趣區(qū)（ROI），選擇近腎門的層面，于腎臟上、中、下極髓質(zhì)各放置1個(gè)橢圓形ROI，求其均值作為髓質(zhì)ROI，分別測量所有受試者腎皮髓質(zhì)FA值及ADC值。同樣的方法于BOLD原始圖上選擇成像質(zhì)量最好的回波圖像上進(jìn)行皮髓質(zhì)R2*值的測量。采用99Tcm-DTPA腎動態(tài)顯像測定單側(cè)腎小球?yàn)V過率。根據(jù)美國腎臟病基金會頒布的腎臟病患者生存質(zhì)量指導(dǎo)（kidney disease outcomes quality initiative，K-DOQI）中關(guān)于慢性腎臟病的定義及分期標(biāo)準(zhǔn)，將54例患者分為四組：A、B、C、D組，分別對應(yīng)于該分期中1、2、3、4~5期，由于4期及5期患者相對較少，因此將兩期合為D組。 結(jié)果： （1）皮、髓質(zhì)MR相關(guān)參數(shù)的比較：對照組、CKD組皮質(zhì)的ADC值均高于髓質(zhì)（P值均＜0.01），對照組、CKD組皮質(zhì)的FA值均低于髓質(zhì)（P值均＜0.01），對照組、CKD組皮質(zhì)的R2*值均低于髓質(zhì)（P值均＜0.01）。 （2）對照組及CKD患者各亞組兩兩比較：對于皮質(zhì)FA值，除對照組與A組、A組與B組、B組與C組，C組與D組比較差異無統(tǒng)計(jì)學(xué)意義（P值均＞0.05），余差異均有統(tǒng)計(jì)學(xué)意義（P值均＜0.05）；對于髓質(zhì)FA值，除對照組與A組比較差異無統(tǒng)計(jì)學(xué)意義外（P值＞0.05），余均有統(tǒng)計(jì)學(xué)意義（P值均＜0.05）。對于皮質(zhì)R2*值：除對照組與A組、A組與B組、C組與D組比較差異無統(tǒng)計(jì)學(xué)意義外，（P值均＞0.05），余差異均有統(tǒng)計(jì)學(xué)意義（P值均＜0.05）；對于髓質(zhì)FA值，除對照組與A組比較差異無統(tǒng)計(jì)學(xué)意義外（P值＞0.05），余均有統(tǒng)計(jì)學(xué)意義（P值均＜0.05）。 （3）所有測量參數(shù)與GFR相關(guān)性分析：皮質(zhì)、髓質(zhì)FA值與腎GFR呈正相關(guān)，其相關(guān)系數(shù)分別為0.408和0.536，P值均＜0.01；皮質(zhì)、髓質(zhì)R2*值與腎GFR呈負(fù)相關(guān)，其相關(guān)系數(shù)分別為-0.547和-0.723，P值均＜0.01。皮質(zhì)及髓質(zhì)ADC值與GFR沒有相關(guān)性（P值均＞0.05）。 結(jié)論： 慢性腎病DTI及BOLD的應(yīng)用中，F(xiàn)A值較ADC值更具有敏感性，F(xiàn)A值及R2*值能在CKD患者的分期診斷中提供有價(jià)值的信息，且皮髓質(zhì)FA值及R2*值與GFR顯示了良好的相關(guān)性，提示CKD患者腎臟DTI及BOLD掃描可用于腎功能狀態(tài)的評估。
[Abstract]:Objective: Renal routine MRII-DTI and BOLD scans were performed in patients with chronic nephropathy. The renal cortex, medulla FA value and R2 * value were measured, and the correlation analysis was made with glomerular filtration. The value of renal DTI and BOLD imaging in the stage of chronic nephropathy and the evaluation of renal function were discussed. Information and methods: From November 2012 to September 2013, 54 cases of chronic nephropathy diagnosed by our hospital were collected, including 28 males and 26 females, aged 2376 years with an average age of 45 鹵15 years. There were 20 healthy volunteers, including 11 males and 9 females, aged 24 to 64 years, with an average age of 41 鹵12 years. All subjects underwent MRI scanning. A 3.0T superconducting magnetic resonance scanner was used to scan the TORSO phased array coil. Routine MRI scans of both kidneys were performed, and then DTI and BOLD scans of oblique coronal plane parallel to the long axis of the two kidneys were performed. All the original images were automatically imported into GE Medical Systems AW4.4 workstation, and the post processing and data measurement were carried out with Functool software. Using the blind method, two young imaging doctors, on 0s/mm2 images with b value, manually delineated the contours of the cortex on the right kidney as the cortical region of interest, and selected the layer near the hilum of the kidney, on the kidney, in the middle. One oval roi was placed in the inferior medulla and the mean value was used as the medullary ROI. The FA value and ADC value of renal medulla were measured respectively. The same method is used to measure the R2 * value of the skin medulla on the best echo image on the BOLD original image. 99Tcm-DTPA renal dynamic imaging was used to measure the unilateral glomerular filtration rate. According to the definition and staging standard of chronic kidney disease in Kidney disease outcomes quality initiation KDOQI issued by the American Nephrology Foundation, 54 patients were divided into four groups: group D: 1: 2, 3 / 4, respectively. Due to the relatively small number of stage 4 and 5 patients, the two stages were divided into D group. Results: Comparison of Mr related parameters of cortex and medulla: the ADC value of cortex in control group was higher than that of medullary P < 0.01, the FA value of cortex in control group was lower than that of medullary P < 0.01, and the value of R2 * in cortex of control group was lower than that of medulla P < 0.01. (2) comparison between the control group and each subgroup of CKD patients: for the cortical FA value, There was no significant difference between C group and D group except control group and A group, A group and B group, and there was no significant difference between C group and D group (P > 0.05). There was no significant difference between control group and group A (P > 0.05), but there was significant difference between control group and group A (P < 0.05). For the cortical R2 * value, there was no significant difference between the two groups except the control group and group A, group A and group B, group C and group D, all P values were more than 0.05, and the remaining differences were all statistically significant (P < 0.05), and for the FA value of medulla, there was no significant difference between the two groups. There was no significant difference between control group and group A (P > 0.05), but there was significant difference between control group and group A (P < 0.05). (3) correlation analysis of all measured parameters with GFR: cortical, medullary FA was positively correlated with renal GFR, and cortical, medullary R2 * was negatively correlated with renal GFR (P < 0.01), and cortical and medullary R2 * were negatively correlated with renal GFR (-0.547 and -0.723 P < 0.01, respectively). There was no correlation between cortical and medullary ADC and GFR (P > 0.05). Conclusion: In the application of DTI and BOLD in chronic nephropathy, FA value and R2 * value are more sensitive than ADC value, which can provide valuable information in staging diagnosis of CKD patients, and the FA value and R2 * value of skin medulla have good correlation with GFR. The results suggest that DTI and BOLD can be used to evaluate renal function in CKD patients.
【學(xué)位授予單位】：南昌大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R445.2;R692

【引證文獻(xiàn)】

相關(guān)碩士學(xué)位論文 前1條

1 姚永杰;DTI、IVIM在糖尿病腎臟疾病中的價(jià)值研究[D];蘭州大學(xué);2016年

本文編號：1838765