收稿日期: 2022-06-13
网络出版日期: 2022-08-17
Study on blood oxygen level-dependent magnetic resonance imaging for the assessment of early renal hypoxia in chronic kidney disease
Received date: 2022-06-13
Online published: 2022-08-17
目的:探讨肾脏血氧水平依赖(blood oxygen level-dependent,BOLD)磁共振成像(magnetic resonance imaging,MRI)评估慢性肾病(chronic kidney disease, CKD)早期肾缺氧的价值。方法:52例CKD患者(CKD组)和年龄、性别匹配的52名健康体检者(对照组)接受冠状面BOLD-MRI检查,分别测量肾脏皮、髓质R2*值。同时检测CKD患者的血清肌酐水平,运用Cockcroft-Gault公式计算获得估算肾小球滤过率,按照美国肾脏病基金会公布的肾脏病生存质量指导指南将CKD患者分为1~5期。比较对照组与CKD组、各CKD分期亚组间的肾脏皮质、髓质R2*值间的差异。结果:CKD组及对照组肾脏的髓质R2*值明显高于皮质R2*值(P<0.05)。CKD组[(16.40±2.47)/s]及CKD 1期组[(16.55±2.12)/s]、CKD 4期组[(16.48±2.95)/s]、CKD 5期组[(13.99±2.21)/s]的肾髓质R2*值均低于对照组[(18.17±2.38)/s](P<0.05)。结论:肾脏BOLD-MRI检查可发现CKD 1期患者肾髓质R2*值的下降变化,提示BOLD成像对慢性肾病早期肾髓质缺氧变化敏感,可用于CKD早期肾功能损害的诊断。
关键词: 慢性肾病; 血氧水平依赖磁共振成像; R2*值; 缺氧
黄娟, 朱晓雷, 李晓, 陈克敏, 严福华, 徐学勤 . 血氧水平依赖磁共振成像评估早期慢性肾病肾缺氧的研究[J]. 诊断学理论与实践, 2022 , 21(03) : 385 -389 . DOI: 10.16150/j.1671-2870.2022.03.016
Objective: To evaluate value of blood oxygen level-dependent (BOLD) magnetic resonance imaging (MRI) for early renal hypoxia assessment in chronic kidney disease(CKD). Methods: Fifty-two patients with CKD and 52 age- and sex-matched health volunteers underwent BOLD MRI of the kidneys. Serum creatinine (sCr) levels and estimated GFR (eGFR) were collected. The patients were classified into 5 stages according to the National Kidney Foundation′s Kidney Disease Outcomes Quality Initiative. Difference in R2*s were compared between patients and volunteers and among different stages of CKD. Results: In patients with CKD and volunteers, R2* of renal medulla was higher than that of renal cortex (P<0.05). Compared with those of volunteers, medulla R2*s in patients with CKD were significantly lower [(16.40 ± 2.47)/s vs (18.17± 2.38)/s, P<0.05]. There were no differences in cortical R2*s among CKD stages and volunteers (P>0.05). However, medullar R2*s were lower in patients with CKD1 [(16.55 ± 2.12)/s], CKD4 [(16.48 ± 2.95)/s], or CKD5 [(13.99 ± 2.21)/s] than those in volunteers [(18.17± 2.38)/s] (P<0.05). Conclusions: BOLD MRI is sensitive to renal medullary hypoxia, and which is helpful for diagnosing early stage of CKD.
[1] | Ene-Iordache B, Perico N, Bikbov B, et al. Chronic kidney disease and cardiovascular risk in six regions of the world (ISN-KDDC): a cross-sectional study[J]. Lancet Glob Health, 2016, 4(5):e307-e319. |
[2] | Niendorf T, Pohlmann A, Arakelyan K, et al. How bold is blood oxygenation level-dependent (BOLD) magnetic reso-nance imaging of the kidney? Opportunities, challenges and future directions[J]. Acta Physiol (Oxf), 2015, 213(1):19-38. |
[3] | Fine LG, Norman JT. Chronic hypoxia as a mechanism of progression of chronic kidney diseases: from hypothesis to novel therapeutics[J]. Kidney Int, 2008, 74(7):867-872. |
[4] | Michaely HJ, Metzger L, Haneder S, et al. Renal BOLD-MRI does not reflect renal function in chronic kidney disease[J]. Kidney Int, 2012, 81(7):684-689. |
[5] | Yin WJ, Liu F, Li XM, et al. Noninvasive evaluation of renal oxygenation in diabetic nephropathy by BOLD-MRI[J]. Eur J Radiol, 2012, 81(7):1426-1431. |
[6] | Inoue T, Kozawa E, Okada H, et al. Noninvasive evaluation of kidney hypoxia and fibrosis using magnetic resonance imaging[J]. J Am Soc Nephrol, 2011, 22(8):1429-1434. |
[7] | Khatir DS, Pedersen M, Jespersen B, et al. Evaluation of renal blood flow and oxygenation in CKD using magnetic resonance imaging[J]. Am J Kidney Dis, 2015, 66(3):402-411. |
[8] | National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification[J]. Am J Kidney Dis, 2002, 39(2 Suppl 1):S1-266. |
[9] | Li LP, Halter S, Prasad PV. Blood oxygen level-dependent MR imaging of the kidneys[J]. Magn Reson Imaging Clin N Am, 2008, 16(4):613-625, viii. |
[10] | Zhang R, Wang Y, Chen F, et al. Noninvasive evaluation of renal oxygenation in primary nephrotic syndrome with blood oxygen level dependent magnetic resonance ima-ging: Initial experience[J]. J Int Med Res, 2015, 43(3):356-363. |
[11] | Piskunowicz M, Hofmann L, Zuercher E, et al. A new technique with high reproducibility to estimate renal oxygenation using BOLD-MRI in chronic kidney disease[J]. Magn Reson Imaging, 2015, 33(3):253-261. |
[12] | Khatir DS, Pedersen M, Jespersen B, et al. Reproducibi-lity of MRI renal artery blood flow and BOLD measurements in patients with chronic kidney disease and healthy controls[J]. J Magn Reson Imaging, 2014, 40(5):1091-1098. |
[13] | Li X, Xu X, Zhang Q, et al. Diffusion weighted imaging and blood oxygen level-dependent MR imaging of kidneys in patients with lupus nephritis[J]. J Transl Med, 2014, 12:295. |
[14] | Thoeny HC, Zumstein D, Simon-Zoula S, et al. Functio-nal evaluation of transplanted kidneys with diffusion-weighted and BOLD MR imaging: initial experience[J]. Radiology, 2006, 241(3):812-821. |
[15] | Luo F, Liao Y, Cui K, et al. Noninvasive evaluation of renal oxygenation in children with chronic kidney disease using blood-oxygen-level-dependent magnetic resonance imaging[J]. Pediatr Radiol, 2020, 50(6):848-854. |
[16] | Kang DH, Kanellis J, Hugo C, et al. Role of the microvascular endothelium in progressive renal disease[J]. J Am Soc Nephrol, 2002, 13(3):806-816. |
[17] | Prasad PV. Evaluation of intra-renal oxygenation by BOLD MRI[J]. Nephron Clin Pract, 2006, 103(2):c58-c65. |
[18] | Eckardt KU, Bernhardt WM, Weidemann A, et al. Role of hypoxia in the pathogenesis of renal disease[J]. Kidney Int Suppl, 2005(99):S46-S51. |
[19] | Nangaku M. Hypoxia and tubulointerstitial injury: a final common pathway to end-stage renal failure[J]. Nephron Exp Nephrol, 2004, 98(1):e8-e12. |
[20] | Nangaku M. Chronic hypoxia and tubulointerstitial injury: a final common pathway to end-stage renal failure[J]. J Am Soc Nephrol, 2006, 17(1):17-25. |
[21] | Rossi C, Artunc F, Martirosian P, et al. Histogram analysis of renal arterial spin labeling perfusion data reveals differences between volunteers and patients with mild chronic kidney disease[J]. Invest Radiol, 2012, 47(8):490-496. |
[22] | Gloviczki ML, Glockner JF, Crane JA, et al. Blood oxygen level-dependent magnetic resonance imaging identifies cortical hypoxia in severe renovascular disease[J]. Hypertension, 2011, 58(6):1066-1072. |
[23] | Neugarten J. Renal BOLD-MRI and assessment for renal hypoxia[J]. Kidney Int, 2012, 81(7):613-614. |
[24] | Pei XL, Xie JX, Liu JY, et al. A preliminary study of blood-oxygen-level-dependent MRI in patients with chro-nic kidney disease[J]. Magn Reson Imaging, 2012, 30(3):330-335. |
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