目的：探讨血氧水平依赖功能磁共振成像(blood oxygen level dependent functional magnetic resonance imaging, BOLD-fMRI)移植肾急性排斥早期诊断价值。材料与方法应用3.0 T BOLD-fMRI序列，扫描专用水模(含氯化锰盐酸混合液小瓶15只)及临床志愿者，临床志愿者扫描包括原位肾51例(A组)、正常移植肾34例(B组)和急性排斥移植肾15例(C组)。应用软件计算水模、肾皮质、髓质(=1000/)值，统计分析水模3次扫描间差异、肾皮质和肾髓质3组间差异、原位肾左右差异、3组肾皮质与髓质间差异。通过受试者工作特征曲线(receiver operating characteristic curve, ROC曲线)评价BOLD-fMRI成像急性排斥移植肾早期诊断效能及确定最佳阈值。结果水模3次扫描间无统计学差异(P＞0.05)；急性排斥肾髓质为(19.36±3.94) Hz，显著低于原位肾(29.73±2.92) Hz和正常移植肾(29.80±2.75) Hz，P＜0.05，但A与B组髓质间及3组肾皮质间无统计学意义(P＞0.05)，以病理为标准，髓质=24.67 Hz为界值，BOLD-fMRI诊断急性排斥移植肾ROC曲线下面积为0.975，敏感性和特异度分别为86.7%和98.5%；原位肾左右侧无统计学意义(P＞0.05)；非急性排斥肾皮髓质间有统计学意义(P＜0.05)，髓质明显高于皮质，而急性排斥肾皮髓质间未显示统计学差异(P＞0.05)。结论 BOLD-fMRI在肾移植急性排斥早期诊断中有重要价值。%Objective: To explore the value of BOLD-fMRI to early diagnose transplanted kidneys with acute rejection. Materials and Methods: Study protocol was approved by local ethics committee; informed consent was obtained. A MR special model which included fifteen vials containing 0–3.2 mM manganese chloride in hydrochloric acid solution, and a total of 100 velunteers were enrolled and divided into three groups, as follows: Group A, 51 cases with healthy kidneys in situ; group B, 34 transplantation with stable renal function for at least 3 months after operating; and group C, 15 iliac renal allografts with early acute rejection from 1 week to 4 weeks after operating. T2W axial/coronal, T1W coronal and a coronal fat-saturated multi-echo GRE with 12 echos (9.2–53.2 ms) were performed on a 3.0 T scanner during normal breathing or breath-holding. CMR tools was used to calculate the value of in MR model vias, renal cortex, medulla respectively after MRI. Receiver operating characteristic (ROC) curve was used to predict the kidneys with early acute rejection and threshold value were identified to discriminate between transplanted kidneys with acute rejection, those with normal function, and healthy native renals. Results: No statistical significances were found for values among repeated scanning on phantom (P>0.05). The value of (Hz) on renal medulla(19.36±3.94) with acute rejection was significantly lower than those of medulla both in group A(29.73±2.92) and B(29.80±2.75) (P0.05), and for on renal cortex among three groups(P>0.05). The value of on medulla was higher than those on cortex both group A and B, moreover no statistical significance was found for between left and right kidney in situ(P>0.05). With a medullary =24.67 Hz as diagnose critical points compared to bilpsy, the sensibility was 86.7%, the specificity was 98.5%, and the accuracy was 0.975 in the prediction of kidneys with early acute rejection. Conclusion: BOLD-fMRI is of important value in the diagnosis of renals with early-stage acute rejection.
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