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  本文選題：擴(kuò)散張量成像 + 血氧水平依賴成像��； 參考：《天津醫(yī)科大學(xué)》2014年碩士論文

【摘要】：目的：探討擴(kuò)散張量成像(DTI)、血氧水平依賴成像(BOLD)對移植腎功能正常、急性排異反應(yīng)(AR)和急性腎小管壞死(ATN)的鑒別診斷價值,以期探尋無創(chuàng)、敏感的評價移植腎功能的方法。 方法：本研究經(jīng)醫(yī)院倫理委員會批準(zhǔn),所有受試者檢查前均簽署了知情同意書。選取2012年5月到2014年3月行異體腎移植術(shù)后2-3周的患者60例納入本研究,所有受試者均于Siemens MAGNETOM Trio Tim3.0T超導(dǎo)磁共振掃描儀行常規(guī)MR、脂肪抑制平面回波斜冠狀面DTI檢查(在6個非共線性方向上施加擴(kuò)散敏感梯度場,b值為0,300s/mm2)及斜冠狀面BOLD檢查。根據(jù)病理穿刺結(jié)果,將患者分為三組：即移植腎功能正常組、AR組及ATN組。分別測量并計算各組移植腎皮質(zhì)、髓質(zhì)的ADC值、FA值及R2*值,采用配對樣本t檢驗(yàn)比較各組皮髓質(zhì)間ADC值、FA值及R2*值的差異,采用單因素方差分析比較各組間移植腎皮質(zhì)、髓質(zhì)ADC值、FA值及R2*值的差異。采用ROC曲線比較皮髓質(zhì)ADC值及R2*值對移植腎功能正常組、AR組以及ATN組的鑒別診斷效能并確定最佳診斷閾值。同時,采用雙變量相關(guān)性分析方法計算Pearson相關(guān)系數(shù)分析腎移植術(shù)后患者移植腎皮、髓質(zhì)R2*值與ADC值之間的相關(guān)性。 結(jié)果：(1)移植腎功能正常組、AR組和ATN組髓質(zhì)FA值均明顯大于皮質(zhì)(P0.01),功能正常組髓質(zhì)ADC明顯小于皮質(zhì)ADC值(P0.05),AR組及ATN組皮、髓質(zhì)間ADC值均無明顯差異(P0.05)； (2)移植腎功能正常組、AR組與ATN組間皮質(zhì)FA值兩兩比較均無明顯差異(P0.05)； (3)移植腎功能正常組、AR組與ATN組間髓質(zhì)FA值兩兩比較均無明顯差異(P0.05)； (4)移植腎功能正常組與ATN組間皮質(zhì)ADC值無明顯差異(P0.05),AR組皮質(zhì)ADC值小于功能正常組與ATN組(P0.05)； (5)移植腎功能正常組與ATN組間髓質(zhì)ADC值無明顯差異(P0.05),AR組髓質(zhì)ADC值小于功能正常組(P0.01),AR組髓質(zhì)ADC值小于ATN組(P0.05)： (6)移植腎功能正常組、AR組和ATN組髓質(zhì)R2*值均明顯大于皮質(zhì)(P0.05)； (7)移植腎功能正常組、AR組與ATN組間皮質(zhì)R2*值兩兩比較均無明顯差異(P0.05)； (8)移植腎功能正常組與ATN組間髓質(zhì)R2*值無明顯差異(P0.05),AR組髓質(zhì)R2*值小于功能正常組及ATN組(P0.05)； (9)皮質(zhì)ADC值、髓質(zhì)ADC值及髓質(zhì)R2*值對功能正常組與AR組鑒別的最佳診斷閾值分別為2.76×10-3mm2/s、2.87×10-3mm2/s、21.4s-1,其敏感性、特異性、陽性預(yù)測值及陰性預(yù)測值均在70%以上；對AR組與ATN組鑒別的最佳診斷閾值分別為2.68×10-3mm2/s、2.74×10-3mm2/s、22.3s-1,其敏感性、特異性、陽性預(yù)測值及陰性預(yù)測值均在70%以上；三個參數(shù)值對移植腎各組的鑒別診斷效能均無明顯統(tǒng)計學(xué)差異(P0.05)； (10)移植腎皮質(zhì)R2*值與皮質(zhì)ADC值之間無明顯的相關(guān)性(r=0.217,P0.05),移植腎髓質(zhì)R2*值與髓質(zhì)ADC值無顯著相關(guān)性(r=0.171,P0.05)。 結(jié)論：DTI、BOLD能無創(chuàng)、有效鑒別移植腎功能正常與AR,以及AR與ATN,其中皮髓質(zhì)ADC值及髓質(zhì)R2*值可作為鑒別診斷指標(biāo)。
[Abstract]:Objective: to investigate the value of diffusion Zhang Liang imaging (DTI) and blood oxygen level dependent imaging (bold) in the differential diagnosis of renal allograft function, acute rejection reaction (AR) and acute tubular necrosis (ATN). Methods: informed consent was signed by all subjects before examination with the approval of the hospital ethics committee. From May 2012 to March 2014, 60 patients who underwent allograft kidney transplantation for 2-3 weeks were included in this study. All the subjects were performed conventional MRs with Siemens Magnetoom Trio Tim3.0T superconducting magnetic resonance scanner, oblique coronal plane of fat suppression echo (applying diffusion-sensitive gradient field (0300s/mm2) in 6 noncollinear directions) and inclined coronal bold. According to the results of pathological puncture, the patients were divided into three groups: AR group and ATN group. The ADC value and R2 * value of renal cortex and medulla of each group were measured and calculated respectively. The difference of ADC value and R2 * value between each group was compared by paired sample t test, and the graft cortex was compared by single factor analysis of variance (ANOVA). Difference of ADC value, FA value and R2 * value in medulla. The value of ADC and R2 * of medulla were compared by ROC curve in the differential diagnosis of AR group and ATN group in normal renal transplantation group and the optimal diagnostic threshold was determined. At the same time, Pearson correlation coefficient was calculated by using bivariate correlation analysis method to analyze the correlation between R2 * value and ADC value of renal graft skin and medulla after renal transplantation. Results: (1) the FA value of medulla in AR group and ATN group was significantly higher than that in cortex group (P0.01). The ADC value of medulla in normal group was significantly lower than that in cortex group (P0.05). There was no significant difference in ADC value between medulla of AR group and ATN group (P0.05). (2) there was no significant difference in FA value of cortex between AR group and); (group (P0.05), and there was no significant difference in FA value between AR group and ATN group in normal renal transplantation group (P0.05). (4) there was no significant difference in ADC value between normal renal transplantation group and ATN group (P0.05). The ADC value of cortex in AR group was lower than that in normal renal transplantation group and ATN group (P0.05). (5) there was no significant difference in ADC value between normal renal transplantation group and ATN group (P0.05). The ADC value of medulla in AR group was lower than that in ATN group (P0.01); (6) the ADC value in AR group and ATN group was lower than that in ATN group (P0.01); (6) the ADC value in AR group and ATN group in normal renal transplantation group was lower than that in ATN group (P0.01). The R2 * value of medulla in group A was significantly higher than that in cortex (P0.05). (7) there was no significant difference in R2 * value between AR group and ATN group (P0.05). (8) there was no significant difference in R2 * value of medulla between normal renal transplantation group and ATN group (P0.05). The medullary R2 * value in AR group was lower than that in normal group and ATN group (P0.05); (9). The best diagnostic threshold for normal group and AR group was 2.76 脳 10 ~ (-3) mm ~ (-2) / s = 2.87 脳 10 ~ (-3) mm ~ (-2) / s ~ (-1) respectively. The sensitivity, specificity, positive predictive value and negative predictive value were all above 70%. The best diagnostic threshold for AR group and ATN group was 2.68 脳 10-3 mm ~ (-2) / s ~ (-1) 2.74 脳 10 ~ (-3) mm ~ (2) 路s ~ (-3) s ~ (-1). The sensitivity, specificity, positive predictive value and negative predictive value of AR group and ATN group were all more than 70%. (10) there was no significant correlation between R2 * value and ADC value (r = 0.217 P 0.05), but there was no significant correlation between R2 * value and ADC value (r = 0.171 P 0.05). Conclusion the differential diagnosis of renal transplantation with normal renal function and AR-AR and ATN is noninvasive. The ADC value of skin medulla and R2 * value of medulla can be used as differential diagnostic index.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R699.2;R445.2

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