Multi-Parametric Evaluation of Chronic Kidney Disease by MRI: A Preliminary Cross-Sectional Study.
Multi-Parametric Evaluation of Chronic Kidney Disease by MRI: A Preliminary Cross-Sectional Study.
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DOI：
10.1371/journal.pone.0139661
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发表时间：
2015
期刊：
影响因子：
3.7
通讯作者：
Sprague SM
中科院分区：
文献类型：
--
作者：
Prasad PV;Thacker J;Li LP;Haque M;Li W;Koenigs H;Zhou Y;Sprague SM
目前慢性肾脏病（CKD）的临床分类并不完美，可能高估了疾病进展的患病率和风险。正在寻找新的标志物来识别那些有进展风险的人。这项初步研究评估了基于磁共振成像的标记物识别CKD早期变化的可行性。59例受试者（22例健康受试者，7例无肾脏疾病的贫血受试者，30例CKD受试者）参加了研究。采用3D容积成像、血氧水平依赖（BOLD）和扩散MRI采集数据。静脉注射呋塞米20 mg后重复BOLD MRI采集。与健康受试者相比，CKD患者的肾实质体积较低（329.6±66.4 vs. 257.1±87.0 ml，p<0.005），皮质R2* 值较高（19.7±3.2 vs. 23.2±6.3 s−1，p = 0.013）（表明缺氧水平较高）和对呋塞米的反应较低（6.9±3.3 vs. 3.1±7.5 s-1，p = 0.02）。所有三个参数均与估计的肾小球滤过率（eGFR）显著相关。当年龄和性别匹配时，CKD和健康对照组之间的皮质R2* 和肾脏体积仍显示出显著差异。最有趣的观察结果是少数受试者（8/29）导致CKD平均值增加。与其他受试者相比，这些受试者之间的皮质R2* 差异非常显著，并且具有较大的效应量（Cohen d = 3.5）。虽然高度提示，但未来的研究可能需要验证这种较高水平的缺氧是否指示疾病进展。扩散MRI显示CKD和健康对照组之间无差异。这些数据表明，BOLD MRI可用于识别与CKD相关的缺氧增强，初步观察结果与CKD疾病进展的慢性缺氧模型一致。纵向研究是必要的，以进一步验证这些发现，并评估其预测价值。
The current clinical classification of chronic kidney disease (CKD) is not perfect and may be overestimating both the prevalence and the risk for progressive disease. Novel markers are being sought to identify those at risk of progression. This preliminary study evaluates the feasibility of magnetic resonance imaging based markers to identify early changes in CKD. Fifty-nine subjects (22 healthy, 7 anemics with no renal disease, 30 subjects with CKD) participated. Data using 3D volume imaging, blood oxygenation level dependent (BOLD) and Diffusion MRI was acquired. BOLD MRI acquisition was repeated after 20 mg of iv furosemide. Compared to healthy subjects, those with CKD have lower renal parenchymal volumes (329.6±66.4 vs. 257.1±87.0 ml, p<0.005), higher cortical R2* values (19.7±3.2 vs. 23.2±6.3 s−1, p = 0.013) (suggesting higher levels of hypoxia) and lower response to furosemide on medullary R2* (6.9±3.3 vs. 3.1±7.5 s−1, p = 0.02). All three parameters showed significant correlation with estimated glomerular filtration rate (eGFR). When the groups were matched for age and sex, cortical R2* and kidney volume still showed significant differences between CKD and healthy controls. The most interesting observation is that a small number of subjects (8 of 29) contributed to the increase in mean value observed in CKD. The difference in cortical R2* between these subjects compared to the rest were highly significant and had a large effect size (Cohen’s d = 3.5). While highly suggestive, future studies may be necessary to verify if such higher levels of hypoxia are indicative of progressive disease. Diffusion MRI showed no differences between CKD and healthy controls. These data demonstrate that BOLD MRI can be used to identify enhanced hypoxia associated with CKD and the preliminary observations are consistent with the chronic hypoxia model for disease progression in CKD. Longitudinal studies are warranted to further verify these findings and assess their predictive value.