Quantitative evaluation of acute renal transplant dysfunction with low-dose three-dimensional MR renography.
Quantitative evaluation of acute renal transplant dysfunction with low-dose three-dimensional MR renography.
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DOI：
10.1148/radiol.11101664
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发表时间：
2011-09
期刊：
影响因子：
19.7
通讯作者：
A. Yamamoto;Jeff L Zhang;H. Rusinek;H. Chandarana;P. Vivier;J. Babb;T. Diflo;D. John;J. Benstein;L. Barisoni;D. Stoffel;V. Lee
中科院分区：
文献类型：
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作者：
A. Yamamoto;Jeff L Zhang;H. Rusinek;H. Chandarana;P. Vivier;J. Babb;T. Diflo;D. John;J. Benstein;L. Barisoni;D. Stoffel;V. Lee
目的：前瞻性评估定量低剂量三维磁共振（MR）肾造影术（mri）鉴别急性移植物功能障碍原因的能力。材料和方法本研究符合hipaa标准，经机构审查委员会批准，并获得书面知情同意。在2001年12月至2009年5月期间，纳入了60例肾脏移植患者（男性41例，女性19例，平均年龄49岁，年龄范围22-71岁）。31例功能正常，29例因急性排斥反应（n = 12）、急性肾小管坏死（n = 8）、慢性排斥反应（n = 6）或药物毒性（n = 3）而出现急性功能障碍。在1.5 T下进行磁共振成像，三维梯度回波成像。采用多室肾模型，计算肾小球滤过率（GFR）和示踪剂对血管室（MTT(a)）、小管室（MTT(T)）和收集系统室（MTT(C)）的平均传递时间（MTT）。还导出了全肾的MTT(MTT(K) = MTT(A) + MTT（T) + MTT(C)）和各隔室的分数MTT(MTT(A)/MTT(K)， MTT(T/K) = MTT(T)/MTT(K)， MTT(C/K) = MTT（C)/MTT(K)）。将这些参数在不同研究组的患者中进行比较。采用协方差分析进行统计分析。结果急性功能障碍组GFR和MTT(K)分别为36.4 mL/min±20.8和177.1秒±46.8，与正常功能组65.9 mL/min±27.6和140.5秒±51.8，差异均有统计学意义（P < 0.001和P = 0.004）。急性排斥反应组的MTT(A/K)（平均12.7%±2.9）明显高于功能正常组（平均8.3%±2.2,P < 0.001）和ATN组（平均7.1%±1.4,P < 0.001）。ATN组的MTT(T/K)（平均83.2%±9.2）明显高于功能正常组（平均72.4%±10.2,P = 0.031）和急性排斥反应组（平均69.2%±6.1,P = 0.003）。结论采用多室示踪动力学肾模型分析低剂量MR肾造影有助于无创区分肾移植后急性排斥反应和ATN。
PURPOSE To assess prospectively the ability of quantitative low-dose three-dimensional magnetic resonance (MR) renography to help identify the cause of acute graft dysfunction. MATERIALS AND METHODS This HIPAA-compliant study was approved by the institutional review board, and written informed consent was obtained. Between December 2001 and May 2009, sixty patients with transplanted kidneys (41 men and 19 women; mean age, 49 years; age range, 22-71 years) were included. Thirty-one patients had normal function and 29 had acute dysfunction due to acute rejection (n = 12), acute tubular necrosis (ATN) (n = 8), chronic rejection (n = 6), or drug toxicity (n = 3). MR renography was performed at 1.5 T with three-dimensional gradient-echo imaging. With use of a multicompartment renal model, the glomerular filtration rate (GFR) and the mean transit time (MTT) of the tracer for the vascular compartment (MTT(A)), the tubular compartment (MTT(T)), and the collecting system compartment (MTT(C)) were calculated. Also derived was MTT for the whole kidney (MTT(K) = MTT(A) + MTT(T) + MTT(C)) and fractional MTT of each compartment (MTT(A/K) = MTT(A)/MTT(K), MTT(T/K) = MTT(T)/MTT(K), MTT(C/K) = MTT(C)/MTT(K)). These parameters were compared in patients in the different study groups. Statistical analysis was performed by using analysis of covariance. RESULTS There were significant differences in GFR and MTT(K) between the acute dysfunction group (36.4 mL/min ± 20.8 [standard deviation] and 177.1 seconds ± 46.8, respectively) and the normal function group (65.9 mL/min ± 27.6 and 140.5 seconds ± 51.8, respectively) (P < .001 and P = .004). The MTT(A/K) was significantly higher in the acute rejection group (mean, 12.7% ± 2.9) than in the normal function group (mean, 8.3% ± 2.2; P < .001) or in the ATN group (mean, 7.1% ± 1.4; P < .001). The MTT(T/K) was significantly higher in the ATN group (mean, 83.2% ± 9.2) than in the normal function group (mean, 72.4% ± 10.2; P = .031) or in the acute rejection group (mean, 69.2% ± 6.1; P = .003). CONCLUSION Low-dose MR renography analyzed by using a multicompartmental tracer kinetic renal model may help to differentiate noninvasively between acute rejection and ATN after kidney transplantation.