超声造影定量分析诊断移植肾肾小球性病变  

Quantitative analysis of contrast-enhanced ultrasound in renal transplant glomerular disease

作　　者：彭川[1] 黄漾[1] 熊韫祎[2] 王长希[2] 谢晓燕[1] 徐作峰[3] 

机构地区：[1]中山大学附属第一医院超声科,广东广州510080 [2]中山大学附属第一医院器官移植科,广东广州510080 [3]中山大学附属第一医院东院超声科,广东广州510080

出　　处：《影像诊断与介入放射学》2015年第4期294-298,共5页Diagnostic Imaging & Interventional Radiology

基　　金：国家自然科学基金青年科学基金项目(项目编号:81201104)

摘　　要：目的探讨超声造影(CEUS)定量分析在诊断移植肾肾小球性病变中的意义。方法回顾性分析44例移植肾患者的CEUS图像,用TCA定量分析软件拟合实质增强时的平均时间强度曲线(TIC),并输出定量参数。根据镜下是否存在移植肾小球性病变分为病变组及非病变组。比较校正后的峰值强度(PI)、曲线下面积(AUC)、上升段曲线下面积(AUC of wash-in)、下降段曲线下面积(AUC of wash-out)、相对AUC of wash-out及达峰时间(TTP)、平均通过时间(,MTT)等参数及病例资料。采用受试者工作曲线(ROC)评估各参数的诊断效能,并计算最佳临界值及该值的敏感性、特异性。结果排除取材不足的2例,余42例病例根据病理是否存在移植肾小球性病变分为病变组(n=22)及非病变组(n=20)。两组校正PI、校正AUC、校正AUC of wash-in及校正AUC of wash-out等参数之间的差异具有统计学意义(P<0.05)。上述参数的ROC曲线下面积分别为0.902、0.843、0.714及0.791,其诊断移植肾肾小球性病变的最佳临界值分别为≤0.237(敏感性90.9%,特异性83.0%)、≤0.188(敏感性63.6%,特异性100%)、≤0.148(敏感性77.3%,特异性75.0%)、≤0.179(敏感性59.1%,特异性90.0%)。结论校正PI、校正AUC、校正AUC of wash-in及校正AUC of wash-out等参数具有较高的诊断效能,其数值减低可提示移植肾肾小球性病变。Objective To determine the value of quantitative analysis of contrast-enhanced ultrasound （CEUS） in renal transplant glomerular disease. Methods CEUS images of the renal allografts in 44 patients were analyzed retrospectively. Regions of interest were placed in the subcapsular cortex and interlobular arteries of the transplanted kidneys. The average time-intensity curve （TIC） was generated using the TCA software in each patient. Quantitative parameters including the correction peak intensity （PI） ,area under curve（AUC）, AUC of wash-in, AUC of wash-out, the relative value of wash-out AUC and time to peak （TTP）, mean transit time （MTT）as well as clinical characteristics were compared between pathological and non-pathological groups. Analysis of receiver operator characteristic （ROC） curve was performed to calculate area under ROC for transplanted renal glomerular disease, optimal cut-off value, sensitivity, specificity. Results Two patients were excluded due to unclear pathological diagnosis, and 42 patients were divided into pathological group （n=22） and non-pathological group （n=20）. There were significant differences in the correction PI, AUC, AUC of wash-in and AUC of wash-out between the two groups （P〈0.05）. The areas under the ROC curves were 0.902 at optimal cut-off value ≤0.237 with 90.9% sensitivity and 83.0% specificity for the correction PI,0.843 at optimal cut-off value ≤ 0.188 with 63.6% sensitivity and 100.0% specificity for AUC, 0.714 at optimal cut-off value ≤0.148 with 77.3% sensitivity and 75.0% specificity for AUC of wash-in, 0.791 at optimal cut-off value ≤0.179 with 59.1% sensitivity and 90.0% specificity for AUC of wash-out. Conclusion Lower quantitative parameters related to the intensity of enhancement on CEUS may suggest renal allograft glomerular disease.

关 键 词：超声造影 定量分析 移植肾 并发症 血流灌注 肾小球病变 

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]