基于磁敏感加权成像的终末期肾病患者脑影像特征与认知功能损伤的相关性

doi:10.3969/j.issn.1674-8115.2025.06.011

摘要/Abstract

摘要：

目的·采用磁敏感加权成像（susceptibility-weighted imaging，SWI）评估终末期肾病（end-stage renal disease，ESRD）患者大脑微出血灶的数量、分布，探究SWI所呈现的影像特征与患者认知功能损伤关系。方法·纳入2023年1月—2024年3月在上海交通大学医学院附属第六人民医院行透析治疗>1年的ESRD住院患者。予患者行常规磁共振成像序列检查及SWI检查，记录患者大脑微出血灶的数量，以及其在不同脑区的分布情况。同时，采用蒙特利尔认知评估量表（Montreal Cognitive Assessment，MoCA）对患者的认知功能进行评估。将MoCA≥26分者归为ESRD无认知障碍组，<26分者为ESRD合并认知障碍组。评估患者大脑微出血灶的有无及数量与是否存在认知障碍的关系，探究合并认知障碍的ESRD患者大脑微出血灶在其大脑各区域的分布情况，以及特定脑区大脑微出血灶数量与患者认知损伤程度的相关性。结果·共38例患者纳入研究，其中，ESRD合并认知障碍组16例，ESRD无认知障碍组22例。大脑微出血灶在ESRD合并认知障碍组出现概率更高（14例，占87.50%），而在无认知障碍组出现概率较低（12例，占54.55%），差异有统计学意义（P=0.033）。ESRD合并认知障碍组大脑微出血灶数量更多（106个），且主要分布于双侧皮层及皮层下区（59.43%）和基底节区（19.81%）；无认知障碍组大脑微出血灶数量较少（47个），主要分布于双侧基底节（46.80%）、皮层及皮层下区（40.43%），差异均具有统计学意义（均P<0.05）。合并认知障碍者，皮层及皮层下区微出血灶数量与认知损伤程度呈显著负相关（r=-0.718，P=0.030）。结论·由SWI检出的ESRD患者大脑微出血灶数量及分布与其认知障碍的有无及严重程度存在相关性。通过SWI可以发现ESRD患者大脑微出血灶的形成及分布，进而评估患者认知障碍程度。

关键词: 终末期肾病, 大脑微出血灶, 认知损伤, 磁敏感加权成像

Abstract:

Objective ·To assess the number and distribution of cerebral microbleeds (CMBs) in patients with end-stage renal disease (ESRD) using susceptibility-weighted imaging (SWI), and to explore the relationship between SWI-detected imaging features and cognitive impairment. Methods ·Hospitalized ESRD patients who had received dialysis treatment for more than one year at Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, between January 2023 and March 2024 were included. All patients underwent conventional MRI sequences and SWI scanning. The number and regional distribution of CMBs were recorded. Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA). Patients with MoCA scores ≥26 were classified into the ESRD without cognitive impairment group, and those with scores <26 were placed in the ESRD with cognitive impairment group. The presence and number of CMBs were analyzed in relation to cognitive impairment. The distribution of CMBs in various brain regions was examined, and correlations between the number of CMBs in specific regions and the severity of cognitive impairment were evaluated. Results ·A total of 38 patients were enrolled, including 16 in the ESRD with cognitive impairment group and 22 in the non-impaired group. CMBs were more frequently observed in the cognitively impaired group (14 cases, 87.50%) compared to the non-impaired group (12 cases, 54.55%), with a statistically significant difference (P=0.033). The impaired group had more CMBs (106 in total), primarily located in bilateral cortical and subcortical regions (59.43%) and the basal ganglia (19.81%). In contrast, the non-impaired group had fewer CMBs (47 in total), mainly located in the bilateral basal ganglia (46.80%) and cortical and subcortical regions (40.43%), with all regional distribution differences being statistically significant (both P<0.05). Among those with cognitive impairment, the number of CMBs in the cortical and subcortical areas was significantly negatively correlated with cognitive function (r=-0.718, P=0.030). Conclusion ·The number and distribution of CMBs detected by SWI in ESRD patients are associated with both the presence and severity of cognitive impairment. SWI can be used to identify CMBs formation and localization in ESRD patients, thereby aiding in the assessment of cognitive dysfunction.

Key words: end-stage renal disease (ESRD), cerebral microbleed (CMB), cognitive impairment, susceptibility-weighted imaging (SWI)

中图分类号:

R445.2

顾梁瑞, 颜碧从, 方统磊, 吴金亮. 基于磁敏感加权成像的终末期肾病患者脑影像特征与认知功能损伤的相关性[J]. 上海交通大学学报（医学版）, 2025, 45(6): 760-765.

GU Liangrui, YAN Bicong, FANG Tonglei, WU Jinliang. Correlation between brain imaging features and cognitive impairment in end-stage renal disease patients based on susceptibility-weighted imaging[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2025, 45(6): 760-765.

图/表 4

表1 2组患者一般资料比较

Tab 1 Comparison of general data between the two groups of patients

Characteristic	ESRD with cognitive impairment (n=16)	ESRD without cognitive impairment (n=22)	t/χ²value	P value
Age/year	37.2±7.3	38.8±7.5	1.313	0.242
Gender/n			0.210	0.743
Male	9	14
Female	7	8
Duration of education/year	11.32±2.61	11.88±2.25	-0.219	0.844
Systolic pressure^①/mmHg	152.40±19.61	147.58±13.22	1.840	0.069
Duration of recent dialysis/d	2.6±0.9	2.1±1.3	0.359	0.731

表2 患者不同脑区微出血灶数目比较

Tab 2 Comparison of the number of CMBs in different brain regions of patients

Brain region	CMB in ESRD group with cognitive impairment (n=106)	CMB in ESRD group without cognitive impairment (n=47)	χ²	P value
Cortex and subcortical area/n(%)	63 (59.43)	19 (40.43)	4.74	0.029
Basal ganglion/n(%)	21 (19.81)	22 (46.80)	11.25	0.001
Brainstem/n(%)	7 (6.60)	2 (4.26)	‒	0.440
Cerebellum/n(%)	15 (14.15)	4 (8.51)	‒	0.244

图1 患者不同脑区微出血灶分布的比例Note：A. ESRD with cognitive impairment. B. ESRD without cognitive impairment.

Fig 1 Proportion of CMB distribution in different brain regions of patients

图2 2例患者不同脑区微出血灶的SWI图像Note： A‒C. A 36-year-old female with ESRD who had undergone hemodialysis for 3 years had a few lesions in the right frontal lobe proximal cortex (A), the left frontal subcortex (B) and the right globus pallidus (C). The white arrows show the lesions in each brain region. This patient had no cognitive impairment, with a MoCA score of 28. D‒F. A 41-year-old male with ESRD who had undergone hemodialysis for 1.5 years showed multiple scattered CMBs in the frontal, temporal and occipital lobe (D and F), as well as in the left basal ganglia (E). This patient had cognitive impairment, with a MoCA score of 17.

Fig 2 SWI images of CMBs in different brain regions in two patients

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