多参数功能磁共振成像与组织病理学分析评估慢性肾脏病间质纤维化。
Evaluation of interstitial fibrosis in chronic kidney disease by multiparametric functional MRI and histopathologic analysis.
机构信息
Department of Radiology, Zhongshan Hospital, Shanghai Institute of Medical Imaging, Fudan University, 180, Fenglin Road, Shanghai, 200032, People's Republic of China.
Department of Nephrology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, People's Republic of China.
出版信息
Eur Radiol. 2023 Jun;33(6):4138-4147. doi: 10.1007/s00330-022-09329-7. Epub 2022 Dec 11.
OBJECTIVES
To investigate the diagnostic value of functional MRI to assess renal interstitial fibrosis in patients with chronic kidney disease (CKD).
METHODS
We prospectively recruited 80 CKD patients who underwent renal biopsies and 16 healthy volunteers to undergo multiparametric functional MRI examinations. The Oxford MEST-C classification was used to score the interstitial fibrosis. The diagnostic performance of functional MRI to discriminate interstitial fibrosis was evaluated by calculating the area under the receiver operating characteristic (ROC) curves.
RESULTS
IgA nephropathy (60%) accounted for the majority of pathologic type in the CKD patients. Apparent diffusion coefficient (ADC) from diffusion-weighted imaging (DWI) was correlated with interstitial fibrosis (rho = -0.73). Decreased renal blood flow (RBF) derived from arterial spin labeling (rho = -0.78) and decreased perfusion fraction (f) derived from DWI (rho = -0.70) were accompanied by increased interstitial fibrosis. The T1 value from T1 mapping correlated with interstitial fibrosis (rho = 0.67) (all p < 0.01). The areas under the ROC curve for the discrimination of ≤ 25% vs. > 25% and ≤ 50% vs. > 50% interstitial fibrosis were 0.87 (95% confidence interval, 0.78 to 0.94) and 0.93 (0.86 to 0.98) by ADC, 0.84 (0.74 to 0.91) and 0.94 (0.86 to 0.98) by f, 0.93 (0.85 to 0.98) and 0.90 (0.82 to 0.96) by RBF, and 0.91 (0.83 to 0.96) and 0.77 (0.66 to 0.85) by T1, respectively.
CONCLUSIONS
Functional MRI parameters were strongly correlated with the interstitial fibrosis of CKD. Therefore, it might a powerful tool to assess interstitial fibrosis of CKD noninvasively.
KEY POINTS
• In CKD patients, the renal cortical ADC value decreased and T1 value increased significantly compared with healthy volunteers. • Functional MRI revealed significantly decreased renal perfusion in CKD patients compared with healthy volunteers. • The renal cortical ADC, f, RBF, and T1 values were strongly correlated with the interstitial fibrosis of CKD.
目的
探讨功能磁共振成像（functional MRI）评估慢性肾脏病（CKD）患者肾间质纤维化的诊断价值。
方法
前瞻性纳入 80 例接受肾活检的 CKD 患者和 16 名健康志愿者进行多参数功能磁共振成像检查。采用牛津 MEST-C 评分系统对间质纤维化进行评分。通过计算受试者工作特征（ROC）曲线下面积评估功能 MRI 鉴别间质纤维化的诊断性能。
结果
IgA 肾病（60%）是 CKD 患者最常见的病理类型。弥散加权成像（DWI）的表观弥散系数（ADC）与间质纤维化相关（rho=-0.73）。动脉自旋标记（ASL）衍生的肾血流减少（rho=-0.78）和 DWI 衍生的灌注分数（f）减少（rho=-0.70）与间质纤维化程度增加相关。T1 映射的 T1 值与间质纤维化相关（rho=0.67）（均 p<0.01）。ADC 对≤25%与>25%和≤50%与>50%间质纤维化的鉴别诊断的 ROC 曲线下面积分别为 0.87（95%置信区间，0.78 至 0.94）和 0.93（0.86 至 0.98），f 分别为 0.84（0.74 至 0.91）和 0.94（0.86 至 0.98），RBF 分别为 0.93（0.85 至 0.98）和 0.90（0.82 至 0.96），T1 分别为 0.91（0.83 至 0.96）和 0.77（0.66 至 0.85）。
结论
功能 MRI 参数与 CKD 的间质纤维化具有很强的相关性。因此，它可能是一种评估 CKD 间质纤维化的强大工具。
关键要点
CKD 患者的肾皮质 ADC 值较健康志愿者明显降低，T1 值明显升高。
与健康志愿者相比，功能 MRI 显示 CKD 患者的肾灌注明显减少。
肾皮质 ADC、f、RBF 和 T1 值与 CKD 的间质纤维化密切相关。
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