Magnetic resonance imaging in chronic kidney disease in the clinical application

Title: Magnetic resonance imaging in chronic kidney disease in the clinical application of Authors: Qing-Hai Li Degree-granting units: Fudan University Keywords: magnetic resonance imaging;; diffusion-weighted imaging;; prospective acquisition correction technique;; kidney; chronic kidney disease;; magnetic resonance imaging;; dispersion plus
The right image;; glomerular filtration rate; Neodymium Magnets chronic kidney disease;; magnetic resonance imaging;; diffusion-weighted imaging;; pathology; chronic kidney disease;; magnetic resonance imaging;;
Blood oxygen level-dependent magnetic resonance imaging;; pathology Abstract: The first part Prospective acquisition correction in diffusion-weighted imaging of the kidney clinical studies Purpose:
Explore the use of navigation technology triggered prospective acquisition correction diffusion-weighted imaging (PACE-DWI) in the kidney ADC value measurement repeatability,
And the image signal to noise ratio (SNR) and contrast to noise ratio (CNR) and routine exclusion of air compared to DWI. Methods: 15 healthy volunteers
Conducted a repeat DWI examination (two inspections for the 5-42 day interval), DWI scans are used for each exclusion gas single-shot spin-echo level
Surface echo (SS-SE-EPI) sequence and the use of PACE technology SE-EPI sequence, the choice of five different diffusion gradient factor (b value) of 100,
300,500,800 and 1000 s / mm ~ 2. PACE-DWI ADC value measured in the renal parenchyma of the reproducibility study, using paired t test,
Bland-Altman plot and coherence of analysis; two imaging sequences between the SNR and CNR were compared using Mann-Whitney U test;
Different b values ​​group asked the SNR and CNR were compared using Kruskal-Wallis H test; air exclusion PACE-DWI DWI and ADC values ​​measured by comparison
Using the Wilcoxon paired signed rank test; http://www.everbeenmagnet.com/en/products/110-sintered-neodymium-magnets different b values ​​between the two groups was used to compare ADC values ​​of the Friedman test. Results: The b-value conditions
, The use of PACE-DWI repeat the measured ADC values ​​of kidneys showed no real significant difference (P> 0.05). And in addition to b = 100 s / mm ~ 2 conditions
Addition, PACE-DWI repeat the measured ADC values ​​of renal mean difference of -4.4 × 10 ~ (-5) mm ~ 2 / s ~ 6.3 × 10 ~ (-5) mm ~ 2 / s, a
To limit (mean difference ± 1.96 SD) of ± 28.1 × 10 ~ (-5) mm ~ 2 / s ~ ± 36.4 × 10 ~ (-5) mm ~ 2 / s, repeated measured renal
ADC values ​​between the high consistency (ρ_c = 0.892, P = 0.000). B-value under the same conditions, PACE-DWI images of the SNR and CNR significantly
Exclusion of air above the sequence, there were significant differences (P <0.05); but the exclusion of air, whether DWI or PACE-DWI, with the b value increased, DWI image
The SNR and CNR were decreased, and in the b-value between groups statistically significant difference (P <0.01). In addition, the same b-value conditions
Under, PACE-DWI ADC values ​​measured are higher than the exclusion of air sequence, and in addition to b = 100 s / mm ~ 2 substance under the conditions of the right kidney ADC values, between
There were significant differences (P <0.05); but the exclusion of air, whether DWI or PACE-DWI, ADC values ​​of renal b value increases with a declining trend
And the b-value ADC values ​​between groups were statistically significant differences (P <0.01). Conclusion: PACE-DWI ADC values ​​measured in the kidney
Has good repeatability, and the SNR and CNR were significantly higher than the conventional exclusion of air DWI, suitable for clinical research. However, PACE-DWI and the exclusion of
Gas DWI measured differences between the ADC value. The second part Diffusion-weighted imaging in patients with chronic renal function assessment in clinical
Applied Research Objective: To evaluate diffusion-weighted imaging (DWI) in patients with chronic kidney disease (CKD) stage and sub-clinical assessment of renal function in the price
Value on renal function and renal effects of volume, compared with the prospective acquisition correction triggered navigation technology diffusion-weighted imaging (PACE-DWI) in
Points in the presence of renal function assessment advantage. Methods: 83 cases of CKD patients and 12 healthy volunteers conducted a DWI examination, were collected
With the exclusion of air SS-SE-EPI sequence and the use of PACE technology, SE-EPI sequence, diffusion gradient factor (b value) were 300 s / mm ~ 2 and 800
s / mm ~ 2. Of which 54 cases were also checked isotope renogram, with Gates method of glomerular filtration rate (GFR). Single factor
Analysis of variance to compare the mean ADC renal function in different clinical kidney during renal ADC values ​​and sub-, sub-sub-renal volume and renal volume by the ADC value
Renal function in a different plot points if there are differences between the groups; factors using partial correlation controlling for age analysis and receiver operating curve (ROC) to sub-
Analysis of ADC values ​​of sub-renal, renal volume and renal ADC values ​​of sub-sub-volume product in the value assessment of renal function, and decreased kidney function in the prediction and sub-
Mild decrease in the diagnosis. Results: The mean ADC measured in the kidneys between the groups in all clinical stages were statistically significant differences exist
(P <0.01), with the clinical stage of CKD increased renal function decline, and in the b = 800 s / mm ~ 2, the first and second period and both during the first 3-5
Statistical difference (P <0.05). ADC value and sub-sub-renal kidney GFR positive correlation between the presence of mild to PACE-DWI at b = 800 s / mm ~ 2
, The positive correlation between the two highest (r = 0.471, P = 0.000). PACE-DWI measured with sub-sub-renal ADC values ​​were reduced renal function decline
Trend in the three groups there were significant statistical difference (P <0.01), and to b = 800 s / mm ~ 2 conditions, mild renal function in predicting sub-
Reduce the diagnostic performance of the largest (AUC = 0.780, P = 0.000). In addition, sub-sub-kidney GFR and renal volume low positive correlation between the presence of
(R = 0.470, P = 0.000). ADC values ​​of sub-renal kidney GFR and its sub-volume product of moderate positive correlation between (r = 0.521-
0.550, P = 0.000), and renal function at different points between the two groups were statistically significant differences (P <0.01), mild renal function in predicting sub-
Reduction to further improve the diagnostic performance (AUC = 0.824-0.841, P = 0.000). Conclusion: DWI in CKD stages and sub-clinical renal
To assess the value of certain, especially the use of PACE technology and high b value DWI in the assessment of renal function points, has an advantage, and in the clinic
Renal function decreased slightly off the point there is a certain value. In addition, the volume as factors affecting renal function can not be ignored, combined with ADC
Value and volume measurement of renal kidney function can increase the accuracy of assessment points. The third part Diffusion-weighted imaging evaluation of chronic kidney
Disease clinical pathological damage - Pathology Objective: To evaluate diffusion-weighted imaging (DWI) in patients with chronic kidney disease (CKD) pathological damage assessment
The clinical value, and the use of navigation technology triggered prospective acquisition correction diffusion-weighted imaging (PACE-DWI) whether there are advantages
. Methods: 83 cases of CKD who underwent kidney biopsy cases and 12 healthy volunteers were DWI examination, exclusion of air were used SS-SE
PACE-EPI sequence and the use of technology, SE-EPI sequence, select the b value 300s/mm ~ 2 and 800 s / mm ~ 2. Pathology by two doctors
Health and renal biopsy specimens of the common pathological damage score, as the evaluation criteria for chronic renal pathological damage. Finally, a total of 71 cases of CKD patients and
12 healthy volunteers included in the analysis. Using Pearson correlation analysis, ANOVA and ROC curve analysis of the ADC value in assessing CKD
Pathological damage and moderate to severe pathology in predicting the value of the extent of damage, and to explore whether there are advantages of PACE-DWI; using two independent
Samples t test and ANOVA to compare the different pathological types of CKD and different levels of IgA nephropathy among Lee's ADC value is stored
The difference; using multiple linear regression model affect the ADC value of the preliminary analysis of independent factors. Results: Pathological damage with CKD
The increase, right kidney ADC values ​​showed a downward trend, and pathology of points there were significant negative correlation to PACE-DWI at b = 800 s / mm ~ 2
, The negative correlation between the maximum (r =- 0.632, P = 0.000), and in the prediction of moderate to severe pathological damage in the performance of the largest diagnostic
(AUC = 0.806, P = 0.000). PACE-DWI at b = 800 s / mm ~ 2, the four kinds of pathological types of primary glomerulonephritis ADC values ​​between the stored
Significant difference in the (F = 4.164, P = 0.016), LSD twenty-two analysis showed that glomerulosclerosis was significantly lower than the ADC values ​​of membrane
Nephropathy and focal segmental glomerulonephritis (P <0.05). Lee's grading of IgA nephropathy different ADC values ​​between the groups there is also a significant statistical difference
(P <0.01), LSD pairwise comparison of the results showed that four cases of ADC values ​​were significantly lower than 2 and 3 patients groups (P <0.01). Multi-line
Regression analysis showed that only pathological damage points and ADC values ​​there were significant linear regression relationship (P <0.05), while the right kidney
GFR and between age and ADC values ​​do not exist in linear regression. Conclusion: DWI to a certain extent, reflect the pathological CKD
The extent of damage, and the use of PACE technology and high b value DWI in pathological damage assessment has an advantage, is expected to become a non-invasive evaluation of CKD
Pathological damage, the means of guiding treatment and follow-up. However, the type of DWI in the pathological diagnosis of CKD is limited value, to be further
Research. Part IV 3.OT blood oxygen level-dependent magnetic resonance imaging in chronic kidney disease in a preliminary clinical study
Objective: To investigate 3.0T magnetic resonance imaging blood oxygen level dependent (BOLD-MRI) is the largest TE timing of kidney R_2 ~ * values ​​are measured
There is influence, and a preliminary study of renal oxygenation in CKD condition assessment of the value. Methods: Magnetic resonance in GE 3.0T Signa HDx
Scanner, in 13 healthy volunteers and 61 cases who underwent renal biopsy in patients with CKD had BOLD-MRI, multi-gradient reunion back
Wave sequence, respectively 6 and 12 echo echo chain chain, TE time was 2.8-22.4 ms and 2.8-45.9 ms. Finally, 13 cases of health
Health volunteers and 44 cases of CKD patients included in the analysis, in which a total of 39 cases of CKD patients had renal pathological damage score, 20 patients were simultaneously
Check the isotope GFR. Jointly by two radiologists for image analysis, histogram analysis method, the image points R_2 ~ *
Do not measured in different conditions, the maximum time TE renal cortex and medulla of R_2 ~ * values, and using using the Wilcoxon signed rank test to compare paired
Whether there are differences between the two. For patients with CKD, only measuring 6 echo chain under the conditions of renal cortex and medulla of R_2 ~ * values. Paper pulp normal kidney
Quality R_2 ~ * values ​​compared using the Wilcoxon paired signed rank test; using 6-echo echo-chain and 12 chain 3.0T BOLD-MRI in
Measuring renal cortex and medulla R_2 ~ * whether there are differences between the comparison, using paired t test, Bland-Altman plot and consistency of the relevant sub-
Analysis; normal control group between the two groups with CKD renal cortex and medulla R_2 ~ * mean comparisons, using Mann-Whitney U test; different renal
Able during clinical renal cortex and medulla R_2 ~ * mean comparison, using single-factor analysis of variance; points kidney R_2 ~ * kidney GFR and its sub-phase
Correlation with pathological damage analysis and correlation analysis points to ask, using spearman correlation analysis. Results: R_2 ~ * Color
Map, normal kidney cortex and medulla is relatively clear boundaries, showing the color gradually from the cortex to the medulla from blue to green, yellow, red over
Crossing changes. Kidney medulla R_2 ~ * significantly higher than the cortex, there were significant between the two statistical difference (P <0.01). 6 echo chain (
Maximum TE: 22.4 msec) and 12 echo chain (maximum TE: 45.9 msec) conditions, measured around the renal cortex and medulla R_2 ~ * values ​​between
Do not exist significant differences (P> 0.05). Also, different echo chain conditions, repeated measured renal cortex and medulla R_2 ~ * average
Difference of -0.3 sec ~ (-1), consistency limits (mean difference ± 1.96 SD) of -1.9 ~ 1.4 sec ~ (-1), repeated measured renal cortical and medullary
Quality R_2 ~ * values ​​with high consistency (pc = 0.983, P = 0.000). CKD group, renal cortex and medulla R_2 ~ * is significantly higher than average
Normal control group, there were significant between the two statistical difference (P <0.01). With increasing clinical stage of renal function, renal medulla R_2 ~ * mean
Was gradually increasing trend, and there are significant differences between the groups (P <0.05). LSD pairwise comparison of the results showed that the normal control group and 2
-4 Significant differences exist in the period (P <0.05). In addition, the sub-renal medullary R_2 ~ * kidney GFR values ​​and points are significantly negative correlation
(R =- 0.415, P = 0.008), and pathological damage points there were significant positive correlation (r = 0.450, P =- 0.004). Conclusion:
In the 3.0T BOLD-MRI examination, using six echo chain (the largest TE 22.4 msec) will be able to meet the kidneys R_2 ~ * value measurements, and can
Enough to reflect the presence of hypoxia in CKD, the kidney is expected to provide an assessment of oxygenation status of non-invasive means. Degree Year: 2009