摘要
目的 探讨5.0T MRI动脉自旋标记和形态学指标对慢性肾脏病(CKD)分期的价值。资料与方法 前瞻性收集2024年1—8月重庆大学附属三峡医院CKD患者95例,均行5.0T MRI常规及动脉自旋标记检查,计算肾血流量(RBF),并进行形态学评估。根据估算肾小球滤过率(eGFR)分为早期CKD组[e GFR 60~89 ml/(min·1.73 m^(2))]和中晚期CKD组[eGFR<59 ml/(min·1.73 m^(2))],并进一步分为1~5期组。比较早期和中晚期CKD患者RBF的差异和不同分期CKD形态学指标的差异。采用二元Logistic回归分析筛选CKD早、中晚期的独立影响因素。采用受试者工作特征曲线评价肾脏RBF、形态学指标对早期CKD的诊断效能。比较1~5期CKD患者RBF的差异,并采用Bonferroni进行两两比较。分析RBF与临床、形态学指标的相关性。结果 在CKD 2、5分期中,影响CKD分期的形态学因素包括肾实质信号、肾皮髓质分界、肾体积、肾包膜(χ^(2)=53.715、73.368、36.488、56.688、35.630、39.499、28.520、32.632,P均<0.001)。在CKD 2分期中,经多变量二分类Logistic回归分析,筛选出独立影响因素包括肾实质信号(P<0.001)、肾皮髓质分界(P=0.021)。早期CKD的双肾RBF均显著高于中晚期CKD(Z=-5.975、-5.885,P均<0.001)。双肾RBF平均值、形态学指标、两者联合诊断早期CKD的曲线下面积分别为0.854、0.932、0.951。在CKD 5分期中,双肾RBF差异有统计学意义(左:H=48.738;右:H=48.102,P均<0.001),并且在非相邻两分期间差异均有统计学意义(P均<0.05)。双肾RBF与肾实质信号、肾皮髓质分界呈正相关(左:r=0.600、0.503;右:r=0.550、0.504,P均<0.001)。结论 5.0T MRI结合动脉自旋标记与形态学评估,可以从功能学和形态学上无创、精准评估CKD患者早期肾损伤,为CKD进一步分期提供依据。
Purpose To explore the value of 5.0T MRI arterial spin labeling and morphological indexes for staging chronic kidney disease(CKD).Materials and Methods Ninety-five patients with CKD in Chongqing University Three Gorges Hospital from January to August 2024 were collected prospectively,all of whom underwent 5.0T MRI routine and arterial spin labeling examination with calculation of renal blood flow(RBF)and morphological evaluation.According to the estimated glomerular filtration rate(eGFR),the patients were categorized into early CKD group[eGFR 60-89 ml/(minꞏ1.73 m^(2))]and intermediate-late CKD group[eGFR<59 ml/(minꞏ1.73 m^(2))]and were further divided into stage 1-5.The differences in RBF between early and intermediate-late CKD patients were compared,and the differences in morphological indexes among different stages of CKD were also analyzed.Binary Logistic regression analysis was used to screen for independent influences on early or intermediate-late CKD staging.Receiver operating characteristic curve was used to evaluate the diagnostic efficacy of RBF values and morphological indexes for early CKD.RBF in CKD stages 1-5 were compared,with Bonferroni pairwise comparisons.The correlation between RBF values and both clinical and morphological indexes were also assessed.Results Whether in CKD stage 2 or 5,morphological factors affecting CKD staging were renal parenchymal signal,renal corticomedullary demarcation,renal volume and renal envelope(χ^(2)=53.715,73.368,36.488,56.688,35.630,39.499,28.520,32.632,all P<0.001).In CKD stage 2,the independent influences screened by multivariate binary Logistic regression analysis were renal parenchymal signal(P<0.001)and renal corticomedullary demarcation(P=0.021).Both renal RBF values in early CKD were significantly higher than that in intermediate-late CKD(Z=-5.975,-5.885,both P<0.001).The areas under the curve for diagnosing early CKD using mean RBF of both kidneys,morphological indexes,and the combination of mean RBF with renal morphological indexes were 0.854,0.932 and 0.951,respectively.RBF values for both kidneys showed statistically significant differences among the five CKD stages(left:H=48.738;right:H=48.102,both P<0.001)and between non-adjacent stages(all P<0.05).Both kidneys RBF values showed a positive correlation with renal parenchymal signal and renal corticomedullary demarcation(left:r=0.600,0.503;right:r=0.550,0.504,both P<0.001).Conclusion The integration of arterial spin labeling and morphological assessment on 5.0T MRI enables a noninvasive and precise functional and morphological evaluation of early renal damage in CKD patients,providing a foundation for subsequent clinical CKD staging.
作者
荣婷
孔俊沣
曾文兵
向绍鑫
冯智超
熊瑛
RONG Ting;KONG Junfeng;ZENG Wenbing;XIANG Shaoxin;FENG Zhichao;XIONG Ying(Department of Radiology,Chongqing University Three Gorges Hospital,Chongqing 404000,China;不详)
出处
《中国医学影像学杂志》
北大核心
2025年第7期717-722,共6页
Chinese Journal of Medical Imaging
基金
重庆市区域医学重点学科建设项目(zdxk202116)。
关键词
肾功能不全
慢性
磁共振成像
动脉自旋标记
超高场强
形态学指标
Renal insufficiency,chronic
Magnetic resonance imaging
Arterial spin labeling
Ultra-high field
Morphological indexes
