超声造影在诊断移植肾术后急性肾小管坏死及急性排异中的应用  

Contrast-enhanced Sonography in the Diagnosis of Acute Tubular Necrosis and Acute Rejection in Kidney Grafts

作　　者：叶争渡[1] 蒋天安[1] 韩飞[2] 刘光军[2] 陈江华[2] 

机构地区：[1]浙江大学附属第一医院超声影像科,杭州市310003 [2]浙江大学附属第一医院肾脏病中心,杭州市310003

出　　处：《中国超声医学杂志》2011年第11期1016-1019,共4页Chinese Journal of Ultrasound in Medicine

基　　金：115国家科技支撑项目资助课题(No.2008BAI60B04)

摘　　要：目的探讨超声造影在诊断移植肾术后急性肾小管坏死及急性排异中的价值。方法对34例移植肾患者(23例功能正常,8例出现功能异常并经移植肾活检诊断为急性肾小管坏死,另有3例患者诊断为急性排异患者)在移植术后2周内同时行常规超声及超声造影检查。常规超声测取移植肾体积、肾动脉及其各级分支阻力指数(RI)和搏动指数(PI),超声造影动态图像利用分析软件获取感兴趣区上升时间(rise time,RT)、达峰时间(time to peak,TTP)等测量指标。结果急性肾小管坏死组患者叶间动脉与肾皮质之间的上升时间差(△RT)和达峰时间差(△TTP)较正常组患者明显延长,以2者为标准诊断急性肾小管坏死特异性均为91.3%时,其敏感性均可达87.5%。以△RT、△TTP为标准的ROC曲线下面积为97.8%,较以RI、PI为标准的ROC曲线下面积86.1%、86.4%明显升高。结论超声造影可客观地反应移植肾急性肾小管坏死及急性排异后移植肾皮质血流灌注情况,较常规能更好的诊断急性肾小管坏死。Objective To investigate the value of contrast-enhanced sonography （CEUS） in the diagnosis of acute tubular necrosis （ATN） and acute rejection （AR）. Methods A total of 34 kidney recipients underwent conventional US and CEUS examinations in 14 days after grafting. 8 patients had acute tubular necrosis （ATN group） ; 23 with normal evolution （as control group） ; another 3 with acute reiectior （AR） . Renal volume were measured with two di- mensional ultrasound. US resist indexes （RI） and pulse indexes （PI） were obtained on main, infrarenal, and arcuate arteries while CEUS analysis was performed both on cortical and interlobar artery using time-intensity curve （TIC） software. The data of renal blood flow perfusion were compared among three groups. Results An increased RI and PI as well as a prolonged ΔRT and ΔTTP were presented in the ATN groups. The area under the ROC curve of ΔRT and ATTP increased from 86. 1% to 97.8% compared with that of RI. Conclusions Microcirulation perfusion changes of kidney grafts with ATN and AR could be detected by CEUS, wich might be superior in the diagnosis of ATN compared with conventional US.

关 键 词：急性肾小管坏死 急性排异 超声造影 时间强度曲线 

分 类 号：R445.1[医药卫生—影像医学与核医学] R699.2[医药卫生—诊断学]