Noninvasive assessment of early kidney allograft dysfunction by blood oxygen level-dependent magnetic resonance Imaging
Noninvasive assessment of early kidney allograft dysfunction by blood oxygen level-dependent magnetic resonance Imaging
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DOI：
10.1097/01.tp.0000234815.23630.4a
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发表时间：
2006-09-15
期刊：
影响因子：
6.2
通讯作者：
Becker, Bryan N.
中科院分区：
文献类型：
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作者：
Djamali, Arjang;Sadowski, Elizabeth A.;Becker, Bryan N.
背景血氧水平依赖性（BOLD）磁共振成像（MRI）是一种无创性方法，使用脱氧血红蛋白作为内源性造影剂来评估组织氧的生物利用度。我们假设BOLD-MRI可以准确区分肾移植后早期不同类型的排斥反应。23名患者在移植后的前4个月接受了成像。5例移植物功能正常，18例活检证实急性同种异体移植物功能障碍（急性肾小管坏死[ATN，n=5]和急性排斥反应[n=13]，包括临界排斥反应：n=3; IA排斥反应：n=4; ITA排斥反应：n=6：C4 d（+）排斥反应：n=9）。结果。正常功能的同种异体移植物（R2*=24.3/s +/- 2.3）与急性排斥反应（R2 *= 16.6/s +/-2.1）和ATN（R2*=20.9/s +/- 1.8）相比，平均髓质R2*（MR 2 *）水平（与组织脱氧血红蛋白水平成正比的测量）显著更高（P < 0.05）。在伴有血管损伤的急性排斥反应中观察到最低的MR 2 * 水平，即IIA和C4d（+）。同样，最低的髓皮质R2* 比（MCR 2 *）出现在IIA（1.24 +/- 0.05）和C4d（+）排斥反应（1.26 +/- 0.06）的同种异体移植物中。ROC曲线分析表明，MR 2 * 和MCR 2 * 值能准确区分移植后早期的急性排斥反应。BOLD-MRI显示，在具有活检证实的ATN和急性排斥反应的同种异体移植物中，髓氧生物利用度发生显著变化，这表明这种无创工具可能在移植后早期评估肾功能方面发挥作用。
Background. Blood oxygen level-dependent (BOLD) magnetic resonance imaging (MRI) is a noninvasive method to assess tissue oxygen bioavailability, using deoxyhemoglobin as an endogenous contrast agent. We hypothesized that BOLD-MRI could accurately discriminate different types of rejection early after kidney transplantation.Methods. Twenty-three patients underwent imaging in the first four months posttransplant. Five had normal functioning transplants and 18 had biopsy-proven acute allograft dysfunction (acute tubular necrosis [ATN, n=5] and acute rejection [n=13] including borderline rejection: n=3; IA rejection: n=4; ITA rejection: n=6: C4d(+) rejection: n=9).Results. Mean medullary R2* (MR2*) levels (a measure directly proportional to tissue deoxyhemoglobin levels) were significantly higher in normal functioning allografts (R2*=24.3/s +/- 2.3) versus acute rejection (R2*= 16.6/s +/- 2.1) and ATN (R2*=20.9/s +/- 1.8) (P < 0.05). The lowest MR2* levels were observed in acute rejection episodes with vascular injury i.e. IIA and C4d (+). Similarly, the lowest medullary to cortical R2* ratios (MCR2*) were present in allografts with IIA (1.24 +/- 0.05) and C4d(+) rejection (1.26 +/- 0.06). ROC curve analyses suggested that MR2* and MCR2* values could accurately discriminate acute rejection in the early posttransplant period.Conclusions. BOLD-MRI demonstrated significant changes in medullary oxygen bioavailability in allografts with biopsy-proven ATN and acute rejection, suggesting that there maybe a role for this noninvasive tool to evaluate kidney function early after transplantation.