声脉冲辐射力成像结合彩色多普勒血流显像诊断肝移植术后急性排异反应的临床价值

Evaluation of acute rejection after liver transplantation with acoustic radiation force impulse and color Doppler flow imaging

目的探讨声脉冲辐射力成像（acousticradiationforceimpulse，ARFI）技术与彩色多普勒血流显像（colorDopplerflowimaging，CDFI）联合诊断肝移植术后急性排异反应的应用价值。方法采用回顾性研究方法，对在我院进行肝组织活检并经病理确诊为急性排异反应的58例肝移植患者行常规超声检查及CDFI、ARFI检查，主要观察指标为移植肝前后径、门静脉主干平均流速、肝静脉的频谱波形及剪切波速度，并与30例正常人结果进行对照分析。结果与正常对照组比较，急性排异组肝前后径增大，门静脉主干流速减低，肝静脉三相波形消失以及剪切波速度加快，且差异有统计学意义（P=0．000，0．000，0．007，0．000），4个指标与分组之间的相关系数分别为0．478，O．557，0．286，0．483；利用上述4个指标综合诊断肝移植术后急性排异的ROC曲线下面积是0．914。结论利用ARFI和CDFI共同诊断肝移植术后出现急性排异反应具有较高的准确性。

Objective To investigate the value of acoustic radiation force impulse （ARFI） and color Doppler flow imaging （CDFI） in the diagnostic of acute rejection （AR） after liver transplantation. Methods B mode ultrasound,CDFI and ARFI exams were performed on fifty-eight patients who was diagnosed with AR through liver biopsy in our hospital. The liver allograft size, mean velocity of portal vein, hepatic vein spectrum waveform and shear-wave velocity were obtained and compared with the results of 30 healthy subjects as control group. Results Compare to control group, the AR group had a significant increase in liver allograft,decrease in mean velocity of portal vein,the elimination of triphasic wave of hepatic vein,and a significant increase in shear-wave velocity （ P = 0.000,0.000,0.007,0.000, respectively）. The correlation coefficient between four criteria and grouping was 0.478,0.557,0.286,0.483, respectively. The area under ROC curves for diagnosing AR using the four criterias mentioned above was 0.914. Conclusions Combination of CDFI and ARFI in diagnosing of AR after liver transplantation has higher sensitivity and accuracy.