实时三维超声造影在判断移植肾动脉数目及监测动脉并发症中的应用

Value of Real-time Three-dimensional Contrast-Enhanced Ultrasound in Detecting the Amount of Renal Artery and Arterial Vascular Complication of Renal Allograft

【目的】探讨实时三维超声造影(3D-CEUS)在评估移植肾肾动脉(RA)数目及动脉性血管并发症(VC)中的应用。【方法】回顾性分析30例移植肾患者的二维超声造影(2D-CEUS)及实时3D-CEUS图像。以CT血管成像(CTA)、数字减影血管成像(DSA)或手术记录作为诊断参考标准,分别比较2D-CEUS(方法 1)及2D-CEUS联合实时3D-CEUS(方法 2)在肾动脉(RA)数目及动脉性VC的诊断水平及诊断信心。采用χ2检验对比两种方法诊断RA数目的诊断符合率进行;采用Mc Nemar检验及χ2检验比较两种方法的敏感性(Sen)、特异性(Spe)、准确性(ACC);采用秩和检验比较二者的诊断信心。【结果】1)评价移植肾RA的28例患者中,16例为单支RA,9例为2支RA,>2支RA有3例。两种方法对单支RA评价之间的差异无统计学意义(P=0.347),但对≥2支RA的诊断符合率的差异具有统计学意义(P=0.031),诊断符合率为41.67%(方法1)及75.00%(方法 2)。2)30例患者中,24例不存在VC,确诊移植肾动脉狭窄(TRAS)2例,动脉血栓2例,肾内动静脉瘘1例,局灶性梗死1例。方法 1及方法 2诊断移植肾动脉性VC的Sen、Spe、ACC分别为66.67%、87.50%、83.33%及83.33%、91.67%、90.00%,两种方法在诊断效能上的差异无统计学意义(P>0.05),但两种方法在诊断信心上的差异具有统计学意义(P=0.019)。【结论】2D-CEUS联合实时3D-CEUS能够提高两支及以上移植肾RA显示率,同时对移植肾动脉性VC具有较高的诊断效能,并可提高诊断信心。

【Objective】 To explore the diagnostic value of real-time three-dimensional contrast-enhanced ultrasound（3D-CEUS）in assessing the amount of renal artery（RA） and detecting arterial vascular complications（VC） in renal allograft. 【Methods】 Twodimensional contrast-enhanced ultrasound.（2D-CEUS）...and real-time 3D-CEUS imaging of 30 allograft patients were analyzed retrospectively. Computed tomography angiography（CTA） / digital subtraction angiography（DSA） / surgery record were set as reference standard, and diagnostic capability and confidence grade of 2D-CEUS（Method 1） and 2D-CEUS combined with real-time 3D-CEUS（Method 2） in detecting the amount of RAs and post-operation arterial VC were compared. The χ2test was used to compare the diagnostic accuracy of RA diagnosis between 2 methods. Mc Nemar and χ2test was used to evaluate differences in sensitivity（Sen）,specificity（Spe）, accuracy（ACC） in graft arterial VC between 2 methods. Rank sum test was used to assess difference between 2methods in diagnostic confidence grade. 【Results】 1. Evaluation of amount RA 16 of 28 patients have single RA, two RA in 9, 2RAin3cases. There was a significant difference between 2 methods in displaying two or more RA（P = 0.031）. 2.Diagnostic capability and confidence in arterial VC 24 of 30 cases have no VC, transplant renal artery stenosis（TRAS） was confirmed in 2 cases, arterial thrombosis in 2 cases, one case with intra-renal arteriovenous fistula, focal infarction in 1 case. Sen, Spe, ACC of diagnosis in arterial VC were 66.67%, 87.50%, 83.33%（method 1） and 83.33%, 91.67%, 90.00%（method 2）（P 0.05）. There was a significant difference in diagnostic confidence between 2 methods in arterial VC（P = 0.019）. 【Conclusion】 Real-time 3D-CEUS combined with 2D-CEUS might improve ≥2RAs displaying and arterial VC detecting, moreover, it would increase confidence in diagnosis.