超谐波声学造影评价移植肾急性排异血流灌注的实验研究

Experimental study on blood perfusion of acute rejection in renal allograft with ultraharmonic contrast imaging

目的探讨应用超谐波声学造影和声学密度定量(AD)技术,定量评价异体移植肾急性排异反应时皮质血流灌注的价值.方法建立犬异体移植肾急性排异模型,分别于术后第 1、3、5、7、9、11 d共6个时间点,采用经静脉声学造影和AD技术检查移植肾,测定肾皮质造影后峰值密度(PI)、曲线下面积(AUC)、降支减半时间(HT)及平均通过时间(MTT)等有关灌注参数,并同时进行穿刺活检.结果造影后发生急性排异反应的移植肾皮质灌注不良,出现充盈缺损区.移植肾术后 5～11 d,随着急性排异反应的逐渐加重,灌注参数PI、AUC、HT及MTT逐渐下降,50%清除斜率逐渐增加,与术后 1 d比较差异均有显著性意义(P<0.05).结论超谐波声学造影结合AD技术,用于评价移植肾急性排异反应时皮质血流灌注是一安全、有效的方法,具有良好的应用前景.

Objective To evaluate the value of using ultraharmonic contrast imaging（UHCI） and acoustic densitometry（AD） technique to quantify cortex blood perfusion of acute rejection in renal allograft. Methods The canine models with acute renal allograft rejection were established. The examinations of renal allograft were performed by intravenous contrast ultrasound and AD technique on the days 1,3,5,7,9,11 after transplantation, some parameters related to perfusion such as peak intensity（PI）, the area under the curve（AUC）, the half time of descending（HT） and the mean transit time（MTT） of renal cortex were measured, and the graft biopsies were done simultaneously. Results The cortex of renal allograft with acute rejection showed nonenhancing defects after contrast agent injection. From 5 to 11 days after transplantation, the PI, AUC, HT, MTT of renal cortex were increasingly decreased, and the 50% wash-out slope was increasingly increased; furthermore, there were significant differences between those of the first day of post-operation（ P 〈0.05）. Conclusions Combination of UHCI and AD is a safe, efficient technology for assessing cortex blood perfusion of acute rejection in renal allograft,and is valuable for application.