用多值扩散MRI提前发现移植肾纤维化，不依赖肾功能下降
Detecting Early Kidney Allograft Fibrosis with Multi-b-value Spectral Diffusion MRI
- 采用多b值扩散MRI结合谱扩散分析，探测早期纤维化
- 在肾功能正常者中检测纤维化准确率AUC达0.72，优于传统指标
- 适合关注移植肾长期健康的临床医生和研究者
肾移植后纤维化是慢性肾病（CKD）的标志，预示功能衰退与移植物失功。本研究在两家中心开展前瞻性研究，评估谱扩散MRI是否可检测移植肾早期及轻中度纤维化。对99例患者进行多b值DWI（b=0,10,30,50,80,120,200,400,800 mm²/s）后处理，使用谱扩散、IVIM和ADC分析。通过Mann-Whitney U检验和Spearman相关性分析影像参数与病理的关系，以五折交叉验证的单变量和多变量逻辑回归评估诊断效能。质量控制包括4名健康志愿者扫描和19例双人独立评估。患者平均年龄50±13岁，男性64例，女性35例；其中IFTA=0者39例，IFTA=2者22例，IFTA=4者20例，IFTA=6者18例；eGFR≤45 mL/min/1.73m²者46例，平均eGFR为47.5±21.3 mL/min/1.73m²。谱扩散在eGFR>45 mL/min/1.73m²的正常/稳定人群检测纤维化（IFTA>0）具有显著能力，AUC(95%CI)=0.72(0.56,0.87)，p=0.007；对轻中度纤维化（IFTA=2–4）的检测也有效，AUC=0.65(0.52,0.71)，p=0.023；ADC同样表现良好，AUC=0.71(0.54,0.87)，p=0.013。而eGFR、移植时间、移植物大小均无法有效预测。24/40个扩散参数的观察者间一致性>0.50。结果表明，谱扩散MRI可在肾功能未下降前识别轻中度纤维化，是一种有前景的早期监测手段。
原文摘要 · Abstract (English)
Kidney allograft fibrosis is a marker of chronic kidney disease (CKD) and predicts functional decline, and eventual allograft failure. This study evaluates if spectral diffusion MRI can help detect early development and mild/moderate fibrosis in kidney allografts. In a prospective two-center study of kidney allografts, interstitial fibrosis and tubular atrophy (IFTA) was scored and eGFR was calculated from serum creatinine. Multi-b-value DWI (bvalues=[0,10,30,50,80,120,200,400,800mm2/s]) was post-processed with spectral diffusion, intravoxel incoherent motion (IVIM), and apparent diffusion coefficient (ADC). Connection between imaging parameters and biological processes was measured by Mann-Whitney U-test and Spearman's rank; diagnostic ability was measured by five-fold cross-validation univariate and multi-variate logistic regression. Quality control analyses included volunteer MRI (n=4) and inter-observer analysis (n=19). 99 patients were included (50$\pm$13yo, 64M/35F, 39 IFTA=0, 22 IFTA=2, 20 IFTA=4, 18 IFTA=6, 46 eGFR<=45mL/min/1.73m2, mean eGFR=47.5$\pm$21.3mL/min/1.73m2). Spectral diffusion detected fibrosis (IFTA>0) in patients with normal/stable eGFR>45ml/min/1.73m2 [AUC(95$\%$CI)=0.72(0.56,0.87),p=0.007]. Spectral diffusion detected mild/moderate fibrosis (IFTA=2-4) [AUC(95$\%$CI)=0.65(0.52,0.71),p=0.023], as did ADC [AUC(95$\%$CI)=0.71(0.54,0.87),p=0.013)]. eGFR, time-from-transplant, and allograft size could not. Interobserver correlation was >0.50 in 24 out of 40 diffusion parameters. Spectral diffusion MRI showed detection of mild/moderate fibrosis and fibrosis before decline in function. It is a promising method to detect early development of fibrosis and CKD before progression.
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