超声造影诊断胰肾联合移植术后胰腺急性排异反应的价值

The value of contrast-enhanced ultrasound in diagnosis of acute rejection after pancreas transplantation

目的 探讨超声造影诊断胰肾联合移植术后胰腺不同程度急性排异反应的临床价值.方法 对70例胰肾联合移植术后移植胰腺行灰阶、彩色多普勒血流成像（CDFI）及超声造影检查,观察造影剂灌注过程,绘制时间-强度曲线（TIC）.超声造影结果与病理结果进行对照.结果 70例患者中排异组21例,其中轻度组10例,中度组8例,重度组3例;非排异组49例.①灰阶超声及CDFI表现：排异组移植胰腺肿大,实质回声减低不均,动脉血流阻力指数（RI）升高（0.77＆#177;0.05）,与非排异组间RI值（0.74＆#177;0.10）差异有统计学意义（P＜0.05）;依据病理结果将排异组分为轻、中、重度三组后,方差分析结果提示三组间RI值差异无统计学意义（P＞0.05）.②超声造影：与非排异组比较,排异组的达峰时间（TTP）明显延长[（21.7＆#177;4.3）s对（13.0＆#177;2.9）s,P＜0.01],曲线峰圆顿,峰值强度（PI）减低（18.8＆#177;7.9对29.6＆#177;2.4,P＜0.05）;移植胰腺轻、中度排异组间比较,TTP、PI值差异无统计学意义（P＞0.05）,而重度排异组与前两组比较,TTP、PI值差异有统计学意义（P＜0.05）.结论 超声造影技术能够观察移植胰腺血管及实质的灌注并定量分析,是及时诊断胰肾联合移植术后移植胰腺急性排异反应的有效方法.

Objective To investigate the clinical value of contrast-enhanced ultrasound （CEUS） in the diagnosis and grading of acute rejection of the transplanted pancreas after simultaneous pancreas-kidney transplantation.Methods Seventy cases pancreas grafts underwent gray scale ultrasound,color Doppler flow imaging（CDFI） and CEUS examination,the contrast agent perfusion processes were observed,and the parameters of time intensity curves（time-intensity curve,TIC） were calculated.The CEUS results were compared with the pathological findings.Results Twenty-one cases were acute rejection in 70 cases,of which 10 cases were mild,8 cases were moderate and 3 cases were severe;and 49 cases were non-rejection.①Gray scale and CDFI ultrasound：The pancreatic grafts of acute rejection were edema and enlarged,the parenchyma echo were decreased.The artery resistance index（RI） were significant different between acute rejection group and non-rejection group （0.77 ＆#177; 0.05 vs 0.74 ＆#177; 0.10,P 〈0.05）,but there were no significant differences between mild,moderate and severe group （P 〉0.05）.②CEUS：TIC curves showed a significantly longer time to reach peak [TTP,（21.7 ＆#177; 4.3）s vs （13.0 ±177; 2.9） s,P 〈0.01] and significantly reduced peakintensity（PI,18.8 ＆#177; 7.9 vs 29.6 ±177; 2.4,P 〈0.05）.There was no significant difference between the mild and moderate groups （P 〉0.05） but statistically difference was found when the severe group compared with the other two groups （P 〈0.05）.Conclusions CEUS can be used to observe the perfusion of the vascular and parenchyma of the pancreas,the results also can be quantitative analyzed.It is an effective method for the diagnosis of pancreas acute rejection of simultaneous pancreas-kidney transplantation.