本文選題：腎臟缺氧分數(shù)　切入點：血氧水平依賴磁共振成像　出處：《蘇州大學》2014年碩士論文

【摘要】：目的： 探討利用血氧水平依賴磁共振成像技術測算腎臟缺氧分數(shù)評價慢性腎病的價值。 方法： 本研究選取于2013年3月～2014年2月住院治療的慢性腎病患者32例，分為兩組（CKD1、2期為輕度組共16例，CKD3-5期為中重度組共16例）。并招募健康志愿者13例作為對照組。采用西門子3.0T磁共振進行常規(guī)T1WI、T2WI及mGRE序列BOLD-MRI掃描。由2名有經驗的放射科醫(yī)師各自進行2種不同的方法進行圖像及數(shù)據(jù)計算、分析。方法一為傳統(tǒng)方法，在Siemens Syngo圖像分析軟件上手工選取感興趣區(qū)（ROI），完成數(shù)據(jù)測量并計算得到雙腎皮質、髓質的R2*值。方法二為測算腎臟分數(shù)方法，選取整個腎臟為感興趣區(qū)，利用spin軟件，分析每個體素所對應的R2*值，計算R2*值35sec-1的體素所占全腎體素的百分比（即腎臟缺氧分數(shù)）。采用統(tǒng)計學計算分析(t檢驗、單因素方差分析、組內相關性分析、ROC曲線分析)，比較兩種方法的診斷效能及可重復性。 結果： 1.傳統(tǒng)方法：正常對照組及慢性腎病組髓質R2*值均高于皮質。正常對照組與CKD輕、中重度組髓質R2*值有顯著性差異（髓質F=13.634，P0.05），且R2*值隨CKD嚴重程度加重逐漸增高。正常對照組與CKD輕度組間皮質R2*值無統(tǒng)計學差異（P0.05），正常對照組與CKD中重度組之間及CKD兩組之間皮質R2*值有顯著性差異，，中重度組明顯大于輕度組和正常組。 2.腎臟缺氧分數(shù)方法：正常對照組與CKD輕度、中重度組的腎臟缺氧分數(shù)存在顯著差異（F=60.144,P0.05），中重度組輕度組正常組。 3.利用ROC曲線，對比傳統(tǒng)方法髓質R2*值與腎臟缺氧分數(shù)，腎臟缺氧分數(shù)的敏感性及特異性更高。 4.兩種方法進行重復性分析，腎臟缺氧分數(shù)（重復系數(shù)=0.918）明顯大于髓質R2*值（0.549），腎臟缺氧分數(shù)方法可重復性更好。 結論： 腎臟缺氧分數(shù)較傳統(tǒng)手工選擇ROI測量皮、髓質R2*值診斷敏感性及特異性更高，可重復性更高，更適合應用在CKD的BOLD-MRI圖像分析中，可以更好的評價腎臟的氧化狀態(tài)。
[Abstract]:Objective:. To evaluate the value of oxygen dependent magnetic resonance imaging (MRI) in the evaluation of chronic nephropathy. Methods:. From March 2013 to February 2014, 32 patients with chronic nephropathy were enrolled in this study. The patients were divided into two groups: mild group (n = 16), moderate and severe group (n = 16), and healthy volunteers (n = 13) as control group. Routine T1WI T2WI and mGRE sequence BOLD-MRI scanning were performed with Siemens 3.0T magnetic resonance imaging. Projectists perform two different methods for image and data calculation. Methods: method one is traditional method, the area of interest is selected manually on Siemens Syngo image analysis software, the data is measured and the R2 * value of the renal cortex and medulla is calculated, the second method is to calculate the kidney fraction, and to calculate the R2 * value of the renal cortex and medulla, and to calculate the R2 * value of the renal cortex and medulla. The whole kidney was selected as the region of interest. The R2 * value of each voxel was analyzed by spin software, and the percentage of R2 * 35sec-1 voxel to the whole renin was calculated. Single factor ANOVA, intra-group correlation analysis and ROC curve analysis were used to compare the diagnostic efficacy and repeatability of the two methods. Results:. 1. Traditional method: the medullary R2 * value of normal control group and chronic nephropathy group was higher than that of cortex. There was significant difference in medullary R2 * value between moderate and severe groups (medullary FN 13.634, P0.05, and R2 * increased gradually with the severity of CKD. There was no significant difference in R2 * value between normal control group and mild CKD group (P 0.05), and between normal control group and moderate and severe CKD group). There was significant difference in R2 * value of cortex between the two groups of CKD. The moderate to severe group was significantly larger than that of mild group and normal group. 2.Renal anoxia score: there was significant difference in renal hypoxia score between normal control group and mild CKD, moderate and severe group (P 0.05), and moderate and severe mild group (P 0.05). 3. The sensitivity and specificity of renal hypoxia fraction were higher than that of the traditional method. 3. ROC curve was used to compare the R2 * value of medulla with the anoxic fraction of kidney. 4. The repeatability of the two methods showed that the renal hypoxia fraction (repetition coefficient was 0.918) was significantly higher than the medullary R2 * value (0.549), and the renal hypoxia fraction method was more reproducible than that of the medullary R2 * value. Conclusion:. Compared with the traditional manual selection of ROI, the renal hypoxia fraction has higher diagnostic sensitivity and specificity, higher reproducibility and better evaluation of renal oxidation status in CKD BOLD-MRI image analysis.
【學位授予單位】：蘇州大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R692

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