【作者】 林飞飞；

【导师】 刘磊；

【作者基本信息】 中国医科大学 ， 儿科学， 2010， 硕士

【摘要】 目的1、探讨用DWI获得的肾脏表观扩散系数ADC值与婴幼儿先天性肾积水分侧肾小球滤过功能(GFR)的关系；2、探讨肾脏ADC值对评价婴幼儿先天性肾积水单肾功能状态的临床应用价值。方法对30例对照组健康婴幼儿行肾脏DWI检查,最大b值使用500s／mm2、700s／mm2、1000 s／mm2和1500s／mm24种。对四组间肾实质的DWI图像质量评分、肾脏信号强度(SI)、信噪比(SNR)和在ADC图上测量的肾脏ADC值进行比较(随机区组方差分析),P<0.05被认为有统计学意义。46例单侧先天性肾积水婴幼儿同时行1.5T MR DWI(b=0,700s/mm2)和99mTc-DTPA肾动态显像,测量肾门平面肾实质的ADC值并获得肾小球滤过率(GFR),根据GFR把46个肾脏分为肾功能不全代偿组、肾功能不全失代偿组、肾功能衰竭组和尿毒症组。比较对照组正常肾脏、梗阻对侧正常肾脏及四组积水肾脏ADC值的差异有无显著性(完全随机方差分析)、同时比较每两组间ADC值的差异有无显著性(LSD法),并分析肾脏ADC值与分肾GFR的相关性(Pearsons积差相关系数),P<0.05被认为有统计学意义。结果四组b值下对照组肾脏DWI图像质量、SI、SNR及ADC值有显著性差异,b值为700s／mm2时,正常肾脏ADC值约为1.61±0.05×10-3mm2／s。积水肾脏四组间肾脏ADC值的差异有显著性,较正常肾ADC值降低,积水肾脏ADC值与GFR之间存在较好的正相关性(r=0.744)。梗阻对侧肾脏ADC值较正常肾实质降低,与单肾GFR无相关性(r=0.194)。结论1、本研究显示婴幼儿肾脏DWI检查最优b值为700s／mm2,对照组正常肾实质ADC值为1.61±0.05×10-3mm2／s。2、本研究提示婴幼儿先天性肾积水肾脏ADC值较正常肾实质ADC值降低,并与分肾GFR有较好的正相关性,ADC值能够反映积水肾脏的滤过功能,为临床寻找评价单肾功能的无创的新方法提供了一定的参考。3、提示肾脏MR常规及DWI联合检查,有可能同时提供形态和功能方面的信息。更多还原

【Abstract】 ObjectiveTo explore the relationship between ADC values measured from DWI and the glomerular filtration rate(GFR) of infants with congenital hydronephrosis;To explore the value of kidney ADC in evaluating the split renal function of infants congenital hydronephrosis.MethodsThirty healthy infants were examined with renal DWI on a 1.5T MR unit using b values including 500s/mm2、700s/mm2、1000s/mm2 and 1500s/mm2. The picture quality,signal intensities(SI),signal-to-noise ratio(SNR) on DWI were compared with the renal ADC value of normal parenchyma using analysis of variance(ANOVA), P＜0.05.Forty-six infants with congenital hydronephrosis were examined with DWI (b=0,700s/mm2) on a 1.5T MR unit and renal scintigraphy using 99mTc-DTPA.ADC value of the renal hilus section and slip GFR were measured,and the 46 patients were divided into four groups according to the GFR:renal insufficient compensation group, renal insufficient decompansation group, renal functiona depletion group and urinemia group. The renal ADC values between normal control group、obstruction contralateral normal renal and four groups were statistically compared by analysis of variance(ANOVA),and the dependablity between ADC and split GFR were analysed using Pearsons correlation test,.P<0.05. ResultsThere was a statistically significant difference in picture quality、SI、SNR and ADC values of DWI among the four groups at different b values.The ADC values of the normal kidneys were about 1.61±0.05×10-3 mm2/s when b equals 700s/mm2.There was a statistically significant difference between the renal ADC values of four hydronephrotic groups,and the mean ADC values of hydronephrotic groups were significantly lower than that of the normal kidneys. In hydronephrotic kidneys, there was a positive correlation between ADC values and split GFR(r=0.744).The ADC values of the obstruct kidneys were lower than that of the normal ones,and there was no correlation between ADC values and split GFR (r=0.194).ConclusionsIn our study, the optimal b values in evaluating the kidney of healthy infants is 700 s/mm2 and the mean ADC values of the normal infants’kidneys were 1.61±0.05×10-3mm2/s at b=700s/mm2.The mean ADC values of infants’congenital hydronephrotic kidneys were significantly lower than that of the normal kidneys and there was a positive correlation between ADC values and split GFR. The renal ADC values could reflect the renal filtration function of congenital hydronephrosis, and it may become a new way which is no harm to evaluate the split renal functional.MR routine sequence combine with DWI sequence can provide information of the renal functional and morphologic at the same time.更多还原