动态增强MRI与SPECT肾动态显像测定GFR评估肾移植术肾功能的临床价值比较
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摘要
目的比较动态增强MRI(DCE-MRI)与单光子发射计算机断层成像术(SPECT)肾动态显像测定肾小球滤过率(GFR)评估肾移植术肾功能的临床价值。方法选取2015年4月～2018年4月于内蒙古包钢医院接受肾移植术的患者70例为研究对象,分别采用DCE-MRI及S;PECT测定其移植肾GFR(分别为GFR-MRI、GFRSPECT),并与内生肌酐清除率(Ccr)进行比较分析。评估DCE-MRI检测中造影剂的安全性。结果检查测得患者GFR-MRI与Ccr值的偏倚高于GFR-SPECT,30%及50%精确度高于GFR-SPECT,差异有统计学意义(P<0.05);Pearson相关性分析结果显示,GFR-MRI、GFR-SPECT值均与Ccr呈正相关(P<0.05),GFR-MRI与Ccr相关系数高于GFR-SPECT与Ccr相关系数,差异有统计学意义(P<0.05)。通过Bland-Altman分析,GFR-SPECT的95%可信区间为95.49 mL/(min·1.73m2),GFR-MRI的95%可信区间为62.35 mL/(min·1.73m~2),GFR-MRI的可信区间更窄。70例患者中仅2例出现轻微皮疹,且在未经任何治疗的情况下自行好转。结论与SPECT比较,DCE-MRI测得的GFR与Ccr偏倚较大,但与Ccr比较具有更高的精确度、相关性及一致性,可信区间更窄,DCE-MRI能更准确通过测定GFR评估肾移植术肾功能,且具有较高的安全性。
Objective To compare the clinical value of dynamic contrast-enhanced MRI(DCE-MRI) and single photon emission computed tomography(SPECT) renal dynamic imaging of glomerular filtration rate(GFR) measurement in the evaluation of renal function in renal transplantation. Methods A total of 70 recipients who underwent renal transplantation in Baogang Hospital in Inner Mongolia from April 2015 to April 2018 were selected research as objeets. The transplanted renal GFR was measured by DCE-MRI and SPECT(GFR-MRI, GFR-SPECT respectively), and was compared with endogenous creatinine clearance rate(Ccr). The safety of contrast agents was evaluated in DCE-MRI detection.Results The GFR-MRI and Ccr values were more biased than GFR-SPECT, and the accuracy of 30% and 50% were higher than GFR-SPECT, and the difference was statistically significant(P < 0.05). Pearson correlation analysis showed that GFR-MRI and GFR-SPECT values were positively correlated with Ccr(P < 0.05), and GFR-MRI and Ccr correlation coefficients were higher than GFR-MRI and Ccr correlation coefficients, and the difference was statistically significant(P < 0.05). By Bland-Altman analysis, the 95% confidential interval of GFR-SPECT was 95.49 mL/(min·1.73 m~2),and the 95% confidential interval of GFR-MRI was 62.35 mL/(min·1.73 m2), and the confidential interval of GFR-MRI was narrower. Only 2 cases developed mild rash among 70 patients, and improved on their own without any treatment.Conclusion Compared with SPECT, the bias of GFR measured by DCE-MRI and Ccr is larger, but it has higher accuracy, correlation and consistency with Ccr, and has narrower confidential interval. DCE-MRI can more accurately evaluate renal function in renal transplantation through measuring GFR, and it has high safety.
Objective To compare the clinical value of dynamic contrast-enhanced MRI(DCE-MRI) and single photon emission computed tomography(SPECT) renal dynamic imaging of glomerular filtration rate(GFR) measurement in the evaluation of renal function in renal transplantation. Methods A total of 70 recipients who underwent renal transplantation in Baogang Hospital in Inner Mongolia from April 2015 to April 2018 were selected research as objeets. The transplanted renal GFR was measured by DCE-MRI and SPECT(GFR-MRI, GFR-SPECT respectively), and was compared with endogenous creatinine clearance rate(Ccr). The safety of contrast agents was evaluated in DCE-MRI detection.Results The GFR-MRI and Ccr values were more biased than GFR-SPECT, and the accuracy of 30% and 50% were higher than GFR-SPECT, and the difference was statistically significant(P < 0.05). Pearson correlation analysis showed that GFR-MRI and GFR-SPECT values were positively correlated with Ccr(P < 0.05), and GFR-MRI and Ccr correlation coefficients were higher than GFR-MRI and Ccr correlation coefficients, and the difference was statistically significant(P < 0.05). By Bland-Altman analysis, the 95% confidential interval of GFR-SPECT was 95.49 mL/(min·1.73 m~2),and the 95% confidential interval of GFR-MRI was 62.35 mL/(min·1.73 m2), and the confidential interval of GFR-MRI was narrower. Only 2 cases developed mild rash among 70 patients, and improved on their own without any treatment.Conclusion Compared with SPECT, the bias of GFR measured by DCE-MRI and Ccr is larger, but it has higher accuracy, correlation and consistency with Ccr, and has narrower confidential interval. DCE-MRI can more accurately evaluate renal function in renal transplantation through measuring GFR, and it has high safety.
引文
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[13]张蕊,吴焕焕,董峰,等.动态增强MRI肾图评估慢性乙型肝炎早期肾损害的价值[J].放射学实践,2016,31(11):1071-1075.
[14]韩萍萍,李玲,刘杰,等.肾脏深度对肾动态显像测定肾小球滤过率的影响[J].中国医疗设备,2017,32(6):66-69.
[15]王艾博,边杰.DCE-MRI原理及临床应用情况[J].中国临床医学影像杂志,2016,27(6):435-438.
[16]Eikefjord E,Andersen E,Hodneland E,et al.Quantification of Single-Kidney Function and Volume in Living Kidney Donors Using Dynamic Contrast-Enhanced MRI[J].AJR Am J Roentgenol,2016,207(5):1022-1030.
[17]张蕊,吴焕焕,董峰,等.动态增强MRI肾图评估慢性乙型肝炎早期肾损害的价值[J].放射学实践,2016,31(11):1071-1075.
[18]Peperhove M,Vo Chieu VD,Jang MS,et al.Assessment of acute kidney injury with T1 mapping MRI following solid organ transplantation[J].Eur Radiol,2018,28(1):1-7.
[19]Jiang K,Tang H,Mishra PK,et al.Measurement of Murine Single-Kidney Glomerular Filtration Rate Using Dynamic Contrast-Enhanced MRI[J].Magn Reson Med,2017,79(6):2935-2943.
[20]Kanakia S,Toussaint J,Kukarni P,et al.Safety and Efficacy of A High Performance Graphene-Based Magnetic Resonance Imaging Contrast Agent for Renal Abnormalities[J].Graphene Technol,2016,1(1/4):1-12.
[21]张艳辉,张宏岩,张海禄,等.新型Gd基T2造影剂的制备和应用[J].波谱学杂志,2017,34(3):302-310.
[2]You S,Ma X,Zhang C,et al.Determination of single-kidney glomerular filtration rate(GFR)with CT urography versus renal dynamic imaging Gates method[J].Eur Radiol,2017,28(3):1-8.
[3]Tsuda A,Ishimura E,Uedono H,et al.Comparison of the Estimated Glomerular Filtration Rate(eGFR)in Diabetic Patients,Non-Diabetic Patients and Living Kidney Donors[J]Kidney Blood Press Res,2016,41(1):40-47.
[4]Ahmed AM,Qureshi WT,O′neal WT,et al.Incremental prognostic value of SPECT-MPI in chronic kidney disease:Areclassification analysis[J].J Nucl Cardiol,2017,25(5):1658-1673.
[5]周万里,陶俊,张玉东,等.增强磁共振与SPECT肾动态显像评估移植肾肾小球滤过率的对比分析[J].中华器官移植杂志,2017,38(5):272-276.
[6]Rydberg DM,Holm L,Engqvist I,et al.Adverse Drug Reactions in a Tertiary Care Emergency Medicine WardPrevalence,Preventability and Reporting[J].PLoS One,2016,11(9):e0162948.
[7]陈萍.正念认知疗法对终末肾病肾移植患者的生活质量及睡眠状况的作用[J].中国医药导报,2017,14(23):148-151.
[8]Levey AS,Cassandra B,Inker LA.Glomerular filtration rate and albuminuria for d etection and staging of acute and chronic kidney disease in adults:a systematic review[J].JAMA,2015,313(8):837-846.
[9]张方圆,楼鹏程,翁瑜.肌酐公式估算肾小球滤过率与内生肌酐清除率的差异比较[J].浙江预防医学,2017,29(6):646-648.
[10]Tran-Gia J,Schl觔ql S,Lassmann M.Design and Fabrication of Kidney Phantoms for Internal Radiation Dosimetry Using 3D Printing Technology[J].J Nucl Med,2016,57(12):1998-2005.
[11]项希桥.SPECT肾动态显像评估肾功能的临床价值[J].实用临床医药杂志,2017,21(5):212-214.
[12]杜金玲,刘健,蒋卫民,等.高血压中医辨证分型与SPECT测量GFR和估算肾小球率过滤相关性探讨[J].中西医结合心脑血管病杂志,2016,14(24):2871-2873.
[13]张蕊,吴焕焕,董峰,等.动态增强MRI肾图评估慢性乙型肝炎早期肾损害的价值[J].放射学实践,2016,31(11):1071-1075.
[14]韩萍萍,李玲,刘杰,等.肾脏深度对肾动态显像测定肾小球滤过率的影响[J].中国医疗设备,2017,32(6):66-69.
[15]王艾博,边杰.DCE-MRI原理及临床应用情况[J].中国临床医学影像杂志,2016,27(6):435-438.
[16]Eikefjord E,Andersen E,Hodneland E,et al.Quantification of Single-Kidney Function and Volume in Living Kidney Donors Using Dynamic Contrast-Enhanced MRI[J].AJR Am J Roentgenol,2016,207(5):1022-1030.
[17]张蕊,吴焕焕,董峰,等.动态增强MRI肾图评估慢性乙型肝炎早期肾损害的价值[J].放射学实践,2016,31(11):1071-1075.
[18]Peperhove M,Vo Chieu VD,Jang MS,et al.Assessment of acute kidney injury with T1 mapping MRI following solid organ transplantation[J].Eur Radiol,2018,28(1):1-7.
[19]Jiang K,Tang H,Mishra PK,et al.Measurement of Murine Single-Kidney Glomerular Filtration Rate Using Dynamic Contrast-Enhanced MRI[J].Magn Reson Med,2017,79(6):2935-2943.
[20]Kanakia S,Toussaint J,Kukarni P,et al.Safety and Efficacy of A High Performance Graphene-Based Magnetic Resonance Imaging Contrast Agent for Renal Abnormalities[J].Graphene Technol,2016,1(1/4):1-12.
[21]张艳辉,张宏岩,张海禄,等.新型Gd基T2造影剂的制备和应用[J].波谱学杂志,2017,34(3):302-310.
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