Transplantasyon sonrası erken dönemde renal allograftlerin fonksiyonlarının takibinde difüzyon ağırlıklı görüntülemenin (DAG) kullanılabilirliği
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Dosyalar
Tarih
2016
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Yayıncı
Ege Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Transplantasyon sonrası erken dönemde renal allograftlerin fonksiyonlarının takibinde ve gelişebilecek olası erken komplikasyonların (ATN ve AR gibi) tanısında DAG'nin kullanılabilirliğinin değerlendirilmesi amaçlanmıştır. Yöntem: Ege Üniversitesi Tıp Fakültesi Organ Nakli Kliniği'nde 1998-2016 yılları arasında canlı vericili veya kadaverik olarak yapılan 24 renal transplantasyonlu hasta çalışmaya prospektif olarak alındı. Çalışma grubu olarak Renal transplant uygulanmış klinik ve laboratuar olarak rejeksiyon ve ya akut tübüler nekroz tablosu olan 14 adet hasta hasta grubunda değerlendirildi. Kontrol grubu oluşturulmasında Renal transplant uygulanmış klinik ve laboratuar olarak rejeksiyon ve ya akut tübüler nekroz tablosu olmayan 10 adet hasta kontrol grubunda değerlendirildi. Hastalar işlem öncesinde ayrıntılı şekilde bilgilendirilip, aydınlatılmış onam formları verilerek okumaları sağlandı, işlemler ile ilgili sordukları sorular cevaplandırıldı. Hastalar klinikte yatmakta idi. Randomize olarak seçildi. Radyoloji anabilim dalında böbreklere yönelik difüzyon MR görüntüleme tekniği uygulandı. MR çekim süresi 11 dakika, 56 saniye olarak belirlendi. Aksiyel DAG single shot eko-planar görüntüleme tekniği ile sağlandı. Difüzyon gradient b değerleri 50, 400 ve 800 s/mm2 kullanıldı. Transplante böbrek üst pol, orta kesim ve alt pol düzeylerinden korteks ve medulla kesimlerinden dairesel ROI (region of interest) kullanılarak ADC ölçümleri yapıldı. Çalışmada toplanan verilerin analizi, istatistiksel yazılım paketi SPSS 23 (Statistical Package for the Social Sciences – IBM®) kullanılarak yapıldı. İstatistiksel anlamlılık düzeyini belirlemek için, %95 güven aralığında ve p<0,05 anlamlı kabul edildi. Bulgular: Çalışma kriterlerine uyan 24 Renal Transplantlı hasta çalışmaya dahil edilmiştir. Hasta grubunda yeralan 14 olgunun yaş ortalaması 44,6±13,65 yıl olarak bulunurken, kontrol grubunda yeralan olguların yaş ortalaması ise 41,8±18,3 yıl olarak saptanmıştır. En küçük yaş 14 olurken en büyük yaş 64 olarak bulunmuştur. Çalışma kapsamında yeralan hasta grubu olguların 7'si (%50) kadın hastalardan oluşurken, 7'si (%50) erkekdi. Kontrol grubunda bulunan olguların ise 7'si (%70) kadın hastalardan oluşurken, 3'ü (%30) erkeklerden oluştuğu tespit edildi. Ayrıca hasta grubu olguların 7'si (%50) ve kontrol grubu olguların 4'ü (%40) canlıdan alınan böbrek ile transplant olurken, hasta grubu olguların 7'si (%50) ve kontrol grubu olguların 6'sı (%60) kadavradan alınan böbrek ile transplant yapıldığı tespit edildi. Çalışmamızda hasta grubunda yeralan 14 olgunun idrar protein ortalaması 63,1±51,7olarak bulunurken, kontrol grubunda yeralan olguların idrar protein ortalaması ise 10,3±3,05 olarak saptanmıştır. Bunun yanı sıra hasta grubunda yeralan 14 olgunun eGFR ortalaması 23,31±13,6 olarak bulunurken, kontrol grubunda yeralan olguların eGFR ortalaması ise 65,97±12,3 olarak saptanmıştır. Hasta ve control grupları arasında bütün böbrek pollerinde istatistiksel olarak anlamlı ve kuvvetli bir ilişki saptanmıştır (p<0,05). Klinisyenin ATN ve Red cevapları arasındaki ilişki incelendiğinde; sadece Korteks üst pol ile Medulla Üst polde istatistiksel olarak anlamlı bir ilişki saptanmamıştır (p>0,05). Fakat diğer bütün böbrek pollerinde istatistiksel olarak anlamlı ve kuvvetli bir ilişki saptanmıştır (p<0,05). Sonuç: Çalışmamızda sonucunda, renal transplantasyonlu hastalarda renal kortikal ADC değerleri kontrol grubuna göre azalma göstermektedir. Kantitatif renal DAG incelemesi, renal transplantasyonlu hastalarda renal hasarı belirlemede ve evrelemede yardımcı bir yöntem olabilir.
Objective: It is aimed to evaluate the usefulness of DAG in the diagnosis of possible early complications (such as ATN and AR) following the functions of renal allografts in the early post-transplant period. METHODS: Between 1998 and 2016, 24 patients with renal transplantation who were living donor or cadaveric were studied prospectively at Ege University Medical Faculty Organ Transplantation Clinic. The study group consisted of 14 patients with renal transplantation who underwent clinical and laboratory rejection or acute tubular necrosis. In the control group, 10 patients with Renal transplant were treated clinically and laboratoryly without rejection or acute tubular necrosis. Patients were informed in detail before the procedure and were given informed consent forms and answered questions about the procedures. The patients were in the clinic. Selected as random. Diffusion MR imaging technique was applied to the kidneys in radiology department. The duration of MR exposure was 11 minutes, 56 seconds. The axial DAG single shot is provided with an eco-planar imaging technique. Diffusion gradient b values of 50, 400 and 800 s / mm2 were used. ADC measurements were performed using circular ROI (region of interest) from the cortex and medulla sections of the transplanta renal upper pole, middle pole, and lower pole. Analysis of the data collected in the study was made using statistical software package SPSS 23 (Statistical Package for the Social Sciences - IB ® . To determine the statistical signi icance le el, 95% con idence inter al and p <0.05 were considered significant. Results: Twenty-four renal transplant patients who met the study criteria were included in the study. The mean age o the 14 patients included in the patient group was 44.6 ± 13.65 years, while the mean age o the patients in the control group was 41.8 ± 18.3 years. The youngest age was 14 and the largest age was 64. Seven (50%) of the cases were female and 7 (50%) were male. Of the cases in the control group, 7 (70%) were female and 3 (30%) were male. In addition, 7 (50%) of the patient group and 6 (60%) of the control group were transplanted with the kidney from the living donor, while 7 (50%) of the patient group and 4 (40% It was found that the transplant was made with the kidney taken from cadaver. In our study, urinary protein a erages were ound to be 63,1 ± 51,7 in 14 patients who were included in the patient group whereas urinary protein averages in the control group were found to be 10,3 ± 3,05. In addition, the EGFR mean o 14 patients included in the patient group was ound to be 23.31 ± 13.6, while the EGFR average of the patients in the control group was ound to be 65.97 ± 12.3. There was a statistically signi icant and strong correlation between all patients and control groups in all kidney poles (p <0.05). When the relationship between the clinician's ATN and Red answers is examined; Only a statistically significant relation was not found between cortex upper pole and Medulla upper pole (p> 0,05). However, there was a statistically significant and strong correlation between all other kidney poles (p <0.05). Conclusion: As a result of our study, renal cortical ADC values in patients with renal transplantation decrease compared to the control group. Quantitative renal DAG screening may be helpful in identifying and staging renal injury in renal transplant patients.
Objective: It is aimed to evaluate the usefulness of DAG in the diagnosis of possible early complications (such as ATN and AR) following the functions of renal allografts in the early post-transplant period. METHODS: Between 1998 and 2016, 24 patients with renal transplantation who were living donor or cadaveric were studied prospectively at Ege University Medical Faculty Organ Transplantation Clinic. The study group consisted of 14 patients with renal transplantation who underwent clinical and laboratory rejection or acute tubular necrosis. In the control group, 10 patients with Renal transplant were treated clinically and laboratoryly without rejection or acute tubular necrosis. Patients were informed in detail before the procedure and were given informed consent forms and answered questions about the procedures. The patients were in the clinic. Selected as random. Diffusion MR imaging technique was applied to the kidneys in radiology department. The duration of MR exposure was 11 minutes, 56 seconds. The axial DAG single shot is provided with an eco-planar imaging technique. Diffusion gradient b values of 50, 400 and 800 s / mm2 were used. ADC measurements were performed using circular ROI (region of interest) from the cortex and medulla sections of the transplanta renal upper pole, middle pole, and lower pole. Analysis of the data collected in the study was made using statistical software package SPSS 23 (Statistical Package for the Social Sciences - IB ® . To determine the statistical signi icance le el, 95% con idence inter al and p <0.05 were considered significant. Results: Twenty-four renal transplant patients who met the study criteria were included in the study. The mean age o the 14 patients included in the patient group was 44.6 ± 13.65 years, while the mean age o the patients in the control group was 41.8 ± 18.3 years. The youngest age was 14 and the largest age was 64. Seven (50%) of the cases were female and 7 (50%) were male. Of the cases in the control group, 7 (70%) were female and 3 (30%) were male. In addition, 7 (50%) of the patient group and 6 (60%) of the control group were transplanted with the kidney from the living donor, while 7 (50%) of the patient group and 4 (40% It was found that the transplant was made with the kidney taken from cadaver. In our study, urinary protein a erages were ound to be 63,1 ± 51,7 in 14 patients who were included in the patient group whereas urinary protein averages in the control group were found to be 10,3 ± 3,05. In addition, the EGFR mean o 14 patients included in the patient group was ound to be 23.31 ± 13.6, while the EGFR average of the patients in the control group was ound to be 65.97 ± 12.3. There was a statistically signi icant and strong correlation between all patients and control groups in all kidney poles (p <0.05). When the relationship between the clinician's ATN and Red answers is examined; Only a statistically significant relation was not found between cortex upper pole and Medulla upper pole (p> 0,05). However, there was a statistically significant and strong correlation between all other kidney poles (p <0.05). Conclusion: As a result of our study, renal cortical ADC values in patients with renal transplantation decrease compared to the control group. Quantitative renal DAG screening may be helpful in identifying and staging renal injury in renal transplant patients.
Açıklama
Anahtar Kelimeler
Renal Transplantasyon, Renal Difüzyon Ağırlıklı Manyetik Rezonans Görüntüleme, Renal Transplantation, Renal Diffusion Weighted Magnetic Resonance Imaging
