超声造影在诊断同种异体移植肾慢性排斥反应中的应用  

Diagnosis of chronic rejection of allogenic transplanted kidneys by ultrasonic contrast

作　　者：刘好田[1] 李嫚[1] 于国放[2] 门同义[3] 王建宁[3] 郝淑倩[4] 曹淑娟[1] 

机构地区：[1]山东大学附属千佛山医院超声诊疗科,济南250014 [2]山东大学附属省立医院超声科,济南250021 [3]山东大学附属千佛山医院泌尿外科,济南250014 [4]山东大学附属千佛山医院病理科,济南250014

出　　处：《山东大学学报（医学版）》2012年第8期108-111,115,共5页Journal of Shandong University:Health Sciences

基　　金：山东省自然科学基金(ZR2011HL024)

摘　　要：目的对中远期移植肾行超声造影,总结移植肾慢性排斥反应的成像特征;通过时间-强度曲线(TIC)分析,寻找有助于诊断慢性排斥反应的造影参数。方法使用美国GE公司LOGIQ E9(配备高保真调幅造影成像软件)超声诊断仪,对手术时间>3个月的26例肾移植患者(以血肌酐男性110μmol/L,女性90μmol/L为界分为两组,大于等于界限者经病理证实为慢性排斥反应),用SonoVue造影剂行超声造影,剂量取0.12 mg/kg,实时存储资料,录像回放分析,观察肾实质血流灌注特征。选取感兴趣区域做TIC,分析两组TIC相关参数:皮质峰值强度(A1)、皮质达峰时间(TtoP1)、髓质达峰时间(TtoP2)、皮髓质达峰时间之差(△TtoP)、皮质曲线下面积(Area1)、髓质曲线下面积(Area2)、皮髓质曲线下面积之差(△Area)。结果与移植肾无排斥反应组对比,移植肾慢性排斥反应组造影剂填充强度呈不同程度减低,填充多不均匀,填充时间明显减慢。两组TIC参数除Area2无统计学差异外(P=0.678),其他均有统计学差异(P<0.05),其中A1、△TtoP、Area1及△Area差异最为明显(P<0.01)。结论移植肾慢性排斥反应超声造影影像学特征鲜明,有助于临床诊断;TIC参数A1、△TtoP、Area1及△Area对诊断意义较大。Objective To examine chronic rejection（CR） features of transplanted kidneys under ultrasonic contrast and find valuable parameters for CR diagnosis by analyzing time intensity curve（TIC）.Methods 26 patients who took kidney transplantation more than 3 months before were selected and divided into no-rejection and CR groups according to a plasma creatinine standard of 110 μmol/L（males） and 90 μmol/L（females）.The patients with a higher creatinine were pathologically proved to have CR.LOGIQ E9 from GE Company was taken and Sonovue contrast was administered intravenously with a dose of 0.12 mg/kg to examine kidney perfusion.Interested parts of ultrasonic performance in the two groups were selected to draft TIC and the following parameters were analyzed： cortex peak strength（A1）,cortex peak time（TtoP1）,medulla peak time（TtoP2）,difference between TtoP1 and TtoP2（△TtoP）,cortex area under TIC（Area1）,medulla area under TIC（Area2） and difference between Area1 and Area2（△Area）.Results CR transplanted kidneys had a lower filling strength and slower filling speed than others.Except in Area2（P=0.678）,significant differences were found in the other parameters between the two groups（P0.05）,especially in A1,△TtoP,Area1 and △Area（P0.01）.Conclusion Ultrasonic contrast on CR transplanted kidneys has characteristic features.Parameters A1,△TtoP,Area1 and △Area are valuable for CR diagnosis.

关 键 词：移植肾 慢性排斥反应 超声造影 时间-强度曲线 峰值强度 达峰时间 

分 类 号：R699.2[医药卫生—泌尿科学]