[1]闫喆,王春祥,赵滨,等.儿童急性局灶性细菌性肾炎的DWI诊断价值[J].国际放射医学核医学杂志,2018,(4):332-336.[doi:10.3760/cma.j.issn.1673-4114.2018.04.008]
 Yan Zhe,Wang Chunxiang,Zhao Bin,et al.DWI diagnosis of acute focal bacterial nephritis in children[J].International Journal of Radiation Medicine and Nuclear Medicine,2018,(4):332-336.[doi:10.3760/cma.j.issn.1673-4114.2018.04.008]
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《国际放射医学核医学杂志》[ISSN:1673-4114/CN:12-1381/R]

卷:
期数:
2018年第4期
页码:
332-336
栏目:
临床研究
出版日期:
2018-07-25

文章信息/Info

Title:
DWI diagnosis of acute focal bacterial nephritis in children
作者:
闫喆 王春祥 赵滨 李欣
300134, 天津市儿童医院医学影像科
Author(s):
Yan Zhe Wang Chunxiang Zhao Bin Li Xin
Department of Medical Imaging, Tianjin Children’s Hospital, Tianjin 300134, China
关键词:
儿童肾炎细菌感染磁共振成像扩散加权成像
Keywords:
ChildNephritisBacterial infectionsMagnetic resonance imagingDiffusion weighted imaging
DOI:
10.3760/cma.j.issn.1673-4114.2018.04.008
摘要:
目的 分析儿童急性局灶性细菌性肾炎(AFBN)的扩散加权成像(DWI)的影像学表现,并以钆-T1加权像(Gd-T1WI)增强检查为参考标准评估DWI对AFBN的诊断价值。方法 2016年2月至2017年12月经临床确诊为AFBN的患儿26例(男患儿12例、女患儿14例),均行磁共振检查,包括常规磁共振序列(T1WI、T2WI)、DWI及Gd-T1WI增强扫描,以Gd-T1WI增强表现来评定DWI诊断AFBN的灵敏度和特异度。应用Kappa检验和McNemar检验方法统计扫描序列之间的一致性和观察者之间的可重复性。结果 26例患儿中有24例在Gd-T1WI增强图像上表现出楔形低灌注区,21例单侧肾脏受累,3例双侧肾脏受累。26例患儿于DWI图像上均发现阳性结果,其中,23例单侧肾脏受累,3例双侧肾脏受累。病变在DWI上表现为高信号,表现扩散系数的平均值较正常肾组织减低。采用DWI检测病变的灵敏度和特异度分别为100%和92%。DWI与Gd-T1WI具有很好的一致性,对病灶的检测差异无统计学意义(k=0.923,P=0.25)。各观察者应用DWI检测病变具有很好的可重复性(k=0.76)。结论 DWI序列可明确诊断儿童AFBN,尤其是对肾功能不全、不宜使用对比剂者;其影像表现为楔形或片状高信号影,诊断有效性与MRI增强扫描基本一致。
Abstract:
Objective To analyze the diffusion weighted imaging(DWI) manifestations of acute focal bacterial nephritis in children against the reference standard of gadolinium-enhanced T1-weighted imaging(Gd-T1WI). Methods Between February 2016 and December 2017, 26 cases of children (12 males, 14 females) with acute focal bacterial nephritis were examined by magnetic resonance(MR), including routine MR sequence(T1WI, T2WI), DWI, and Gd-T1WI-enhanced scan. The sensitivity and specificity of DWI in the diagnosis of acute focal bacterial nephritis were evaluated by Gd-T1WI-enhanced performance. Kappa test and McNemar test were applied for the calculation of the consistency among scanning sequences and calculation of repeatability among observers. Results Among the 26 children, 24 cases showed a wedge-shaped hypoperfusion area in the enhanced Gd-T1WI images, 21 had unilateral renal involvement, and 3 had bilateral renal involvement. Twenty-six cases had positive results on DWI images, 23 had unilateral renal involvement, and 3 had bilateral renal involvement. The lesions showed high signal on DWI, and the mean apparent diffusion coefficient value is lower than that of the normal renal tissue. The sensitivity and specificity of DWI detection were 100% and 92%, respectively. DWI demonstrated excellent agreement(k=0.923) with Gd-T1WI with no significant difference(P=0.25) in detection of abnormal lesions. All the observers used DWI to detect lesions with excellent reproducibility(k=0.76). Conclusions DWI can be used to diagnose acute focal bacterial nephritis with wedge-shaped or flaky high signal in children. The diagnostic effectiveness of DWI is basically the same as MRI enhanced scan, especially in people with renal insufficiency and inappropriate use of contrast agents.

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备注/Memo

备注/Memo:
收稿日期:2018-04-11。
通讯作者:王春祥,Email:tjchct@163.com
更新日期/Last Update: 2018-07-25