本文選題：IgA腎病 + 彌散加權(quán)成像　； 參考：《南昌大學(xué)》2015年碩士論文

【摘要】：目的:1、通過完成健康志愿者腎臟磁共振彌散加權(quán)成像(DWI)及血氧水平依賴(BOLD)成像掃描,建立正常人腎臟ADC值、R2*值參考值范圍及評價(jià)體系。2、測量I~V級IgA腎病患者腎臟ADC值、R2*值,并與正常對照組進(jìn)行兩兩比較,探討DWI聯(lián)合BOLD鑒別IgA腎病不同病理級別的能力。3、分析IgA腎病患者腎臟ADC值、R2*值與其腎小球?yàn)V過率(GFR)、病理Katafuchi積分的相關(guān)性,探討應(yīng)用功能性磁共振評價(jià)IgA腎病腎臟濾過功能和組織病理損害程度的臨床價(jià)值。方法:收集2014年1月~2014年12月南昌大學(xué)第二附屬醫(yī)院腎內(nèi)科經(jīng)腎穿刺活檢、免疫熒光檢查確診為IgA腎病患者35例,平均年齡32歲(17歲~70歲),排除繼發(fā)性IgA沉積疾病及腎萎縮、腎積水、腎結(jié)石等患者。采用99Tcm-DTPA閃爍掃描測定左、右腎的GFR。根據(jù)Lee氏評級系統(tǒng),將IgA腎病分為I~V級。參照Katafuchi評分標(biāo)準(zhǔn),對IgA腎病患者進(jìn)行腎臟病理損害評分。同時(shí),選擇20例健康志愿者作為對照組,平均年齡33歲(20歲~68歲)。所有研究對象均采用3.0T MR掃描儀(GE Singa HDxt GE3.0T)進(jìn)行雙側(cè)腎臟DWI及BOLD成像,使用呼吸門控技術(shù),表面相控陣線圈。受試者在檢查前需停止接受藥物治療、禁食、禁水8小時(shí),呈脫水狀態(tài)。掃描時(shí),先進(jìn)行常規(guī)軸位T1加權(quán)成像(T1WI)、T2加權(quán)成像(T2WI)檢查,后采用單次激發(fā)自旋回波平面成像(SE-EPI)序列進(jìn)行DWI掃描,擴(kuò)散敏感因子b選取500s/mm2;采用多梯度回波(mGRE)序列進(jìn)行BOLD掃描。將掃描的原始數(shù)據(jù)導(dǎo)入工作站進(jìn)行后處理,在腎臟皮髓質(zhì)分界清晰的層面選取感興趣區(qū)(ROI),測量各組腎臟皮、髓質(zhì)的ADC值和R2*值。將數(shù)據(jù)進(jìn)行統(tǒng)計(jì)分析:1、比較腎臟皮髓質(zhì)之間ADC值、R2*值的差異;2、比較對照組與IgA腎病組不同病理級別之間腎臟ADC值、R2*值的差異;3、IgA腎病組分腎皮髓質(zhì)ADC值、R2*值與分腎GFR值之間的關(guān)系;4、IgA腎病組右腎皮髓質(zhì)ADC值、R2*值與腎穿刺活檢病理Katafuchi積分之間的關(guān)系。結(jié)果:最終納入圖像處理:健康對照組20例,iga腎病組i級3例,iii級21例,iv級11例。結(jié)果:1、健康對照組及iga腎病各亞組的腎臟皮質(zhì)adc值均大于髓質(zhì)(p0.05),健康對照組、iga腎病i級、iii級及iv級腎臟皮、髓質(zhì)的adc值(x10-3mm2/s)分別為2.61±0.09vs2.37±0.07、2.57±0.08vs2.19±0.08、2.35±0.12vs2.08±0.06、2.13±0.23vs1.86±0.15。單因素方差分析顯示健康對照組與iga腎病各亞組之間皮、髓質(zhì)adc值均存在統(tǒng)計(jì)學(xué)差異(p0.05)。進(jìn)一步采用最小顯著值差異(lsd)法進(jìn)行兩兩比較,結(jié)果顯示:iga腎病i級組皮質(zhì)adc值與健康對照組之間無統(tǒng)計(jì)學(xué)差異(p0.05),其余任意兩組間腎臟皮、髓質(zhì)adc值均有顯著性差異(p0.05)。2、iga腎病組分腎皮、髓質(zhì)adc值與其gfr值均呈正相關(guān)性(p0.05);iga腎病組的右腎皮、髓質(zhì)adc值與病理katafuchi積分均呈負(fù)相關(guān)性(p0.05)。3、健康對照組及iga腎病各亞組的腎臟髓質(zhì)r2*值均大于皮質(zhì)(p0.05),健康對照組、iga腎病i級、iii級及iv級腎臟皮、髓質(zhì)的r2*值(xhz)分別為16.23±1.15vs31.22±1.44、17.29±0.52vs32.58±0.69、18.60±1.00vs35.25±1.13、19.43±0.80vs38.68±1.64。單因素方差分析顯示健康對照組與iga腎病各亞組之間皮、髓質(zhì)r2*值的差異均有統(tǒng)計(jì)學(xué)意義(p0.05)。用lsd法進(jìn)一步分析:iga腎病i級組皮、髓質(zhì)r2*值與健康對照組之間無統(tǒng)計(jì)學(xué)差異(p0.05),iga腎病iii級、iv級組與對照組之間的任意兩組腎臟皮、髓質(zhì)r2*值均有顯著性差異(p0.05)。4、iga腎病組的分腎皮、髓質(zhì)r2*值與其gfr值均呈負(fù)相關(guān)性(p0.05);iga腎病組的右腎皮、髓質(zhì)r2*值與病理katafuchi積分均呈正相關(guān)性(p0.05)。結(jié)論:1、功能性磁共振成像顯示腎臟皮髓質(zhì)之間adc值、r2*值差異明顯,可以反映皮髓質(zhì)各自的生理效能。2、正常人與iga腎病患者的腎臟adc值、r2*值差異明顯,提示功能性磁共振對檢測腎臟病變有可行性。3、隨著iga腎病級別的加重,腎臟皮髓質(zhì)adc值呈下降趨勢,r2*值呈上升趨勢,提示功能性磁共振對鑒別IgA腎病的分級有一定的臨床價(jià)值。4、隨著IgA腎病GFR的下降,腎臟皮髓質(zhì)ADC值呈下降趨勢,R2*值呈上升趨勢,提示功能性磁共振可用于評價(jià)腎臟的濾過功能。5、隨著IgA腎病病理Katafuchi積分的升高,腎臟皮髓質(zhì)ADC值呈下降趨勢,R2*值呈上升趨勢,提示功能性磁共振對于判斷IgA腎病腎臟病理變化有一定的意義,可以作為評估腎臟病理損害的一種非侵入性方法。
[Abstract]:Objective: 1, by completing the renal magnetic resonance diffusion weighted imaging (DWI) and blood oxygen level dependence (BOLD) imaging scan of healthy volunteers, the renal ADC value of normal human kidney, the range of reference value of R2* value and the evaluation system.2 were used to measure the ADC value and R2* value of the patients with I~V grade IgA nephropathy, and to compare with the normal control group, and to explore DWI United BOLD to identify IgA kidney. The ability of.3 to analyze the renal ADC, R2* value and glomerular filtration rate (GFR) and the correlation of pathological Katafuchi score in IgA nephropathy, and to explore the clinical value of functional MRI for evaluating renal filtration and histopathological damage of IgA nephropathy. Methods: Nanchang University, January 2014, December, second In the Affiliated Hospital, 35 cases of IgA nephropathy were diagnosed by renal biopsy and immunofluorescence. The average age was 32 years old (17 years old ~70). The patients with secondary IgA and renal atrophy, hydronephrosis and kidney stones were excluded. The GFR. of left and right kidney was determined by Lee rating system by 99Tcm-DTPA scintigraphy, and IgA nephropathy was divided into I~V grade. Reference K The atafuchi scoring standard was used to score the renal pathological damage of patients with IgA nephropathy. At the same time, 20 healthy volunteers were selected as the control group, with an average age of 33 years (20 years old). All the subjects were treated with 3.0T MR scanner (GE Singa HDxt GE3.0T) for bilateral kidney DWI and BOLD imaging, and the surface phased array coil was used by the respiratory gated technique. The subjects were required to stop receiving medical treatment, fasting and water prohibition for 8 hours before examination. When scanning, the conventional axial T1 weighted imaging (T1WI), T2 weighted imaging (T2WI) were performed, and then the single excited spin echo plane imaging (SE-EPI) sequence was used for DWI scan, the diffusion sensitivity factor B was selected as 500s/mm2, and multiple gradient echoes (mGR) were used. E) BOLD scan. The scanned original data were introduced into the workstation for post-processing. The region of interest (ROI) was selected at the clear and clear layer of the renal cortex. The renal cortex, the ADC value and the R2* value of the medulla were measured. The data were statistically analyzed. 1, the ADC value, the difference of R2* value between the renal medulla and the renal medulla were compared; and 2, compared with the control group and IgA nephropathy. Group ADC value and R2* value difference between different pathological grades; 3, IgA nephropathy group renal cortex medulla ADC value, R2* value and renal GFR value; 4, IgA nephrotic group right renal cortex medulla ADC value, R2* value and renal biopsy pathology Katafuchi integral. Results: finally included in the image processing: 20 healthy control group, IgA nephrotic group I grade 3 cases The results were as follows: 21 cases of III and 11 cases of grade IV. Results: 1. The renal cortical ADC values in the healthy control group and the IgA nephropathy group were all larger than the medulla (P0.05), the healthy control group, the IgA nephropathy I grade, the III and IV renal cortex and the ADC value of the medulla (x10-3mm2/s) were 2.61 +. The analysis of factor variance showed that there were significant differences in the ADC values of the skin and medulla between the healthy control group and the IgA nephropathy group (P0.05). The difference of the minimum significant difference (LSD) was further compared. The results showed that there was no statistical difference between the ADC value of the I grade group of IgA nephropathy and the healthy control group (P0.05), and the other two groups of renal cortex, The ADC values of the medulla were significantly different (P0.05).2. The renal cortex of the IgA nephropathy group and the ADC value of the medulla were positively correlated with the GFR value (P0.05). The right renal cortex and the medulla ADC value of the IgA nephrosis group were negatively correlated with the pathological katafuchi integral (P0.05).3. The renal medullary values of the healthy control group and the kidney subgroups were all greater than those of the cortex and the healthy control group. IgA nephropathy I, III grade and IV grade renal cortex and r2* value of medulla (XHZ) were 16.23 + 1.15vs31.22 + 1.44,17.29 + 0.52vs32.58 + 0.69,18.60 + 1.00vs35.25 + 1.13,19.43 + variance analysis, which showed that the difference of skin and medullary medullary values between the healthy control group and the kidney subgroups were statistically significant. Method further analysis: there was no statistical difference between the I grade group of IgA nephropathy and the r2* value of medulla and the healthy control group (P0.05), IgA nephropathy III grade, the r2* value of the medulla r2* value of all two groups between the IV group and the control group was significantly different (P0.05).4, the renal cortex of the IgA nephrotic group, the medulla r2* value and the value of the renal medulla were negatively correlated. There was a positive correlation between the right renal cortex and the r2* value of the medulla and the pathological katafuchi score (P0.05). Conclusion: 1, the functional magnetic resonance imaging (fMRI) showed the ADC value between the medulla of the renal cortex, and the difference of r2* value was obvious, which could reflect the physiological efficacy of the medulla,.2, and the ADC value of the renal organs of the normal people and the patients with IgA nephropathy, and the difference of r2* values was obvious, suggesting functional magnetic resonance imaging. The measurement of renal lesions was feasible.3. With the aggravation of IgA nephropathy, the ADC values of renal cortex and medulla were decreasing, and the value of r2* showed an upward trend. It suggested that functional magnetic resonance has a certain clinical value for the differentiation of IgA nephropathy. With the decrease of GFR in IgA nephropathy, the ADC values of renal cortex and medulla are decreasing, and R2* values are on the rise, suggesting that R2* values are on the rise, suggesting the function of the renal medulla, suggesting the function of the renal medulla. Sexual magnetic resonance can be used to evaluate the renal filtration function.5. With the increase of the pathological Katafuchi integral of IgA nephropathy, the ADC value of the renal cortex is declining, and the R2* value is on the rise. It suggests that functional magnetic resonance is of certain significance in judging the pathological changes of kidney in IgA nephropathy. It can be used as a non invasive prescription for evaluating renal pathological damage. Law.

【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】：2015
【分類號】：R692.31

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