超声造影定量分析技术对犬急性肾功能衰竭的评价

QUANTITATIVE ANALYSIS OF CONTRAST-ENHANCED ULTRASOUND IN THE DOG'S ACUTE RENAL FAILURE

目的:通过超声造影(contrast-enhanced ultrasonography,CEUS)定量分析犬造模前及造模后肾实质区血流灌注参数的改变,旨在探讨超声造影定量分析技术在评价犬急性肾功能衰竭中的价值。方法:本实验研究选择15只健康成年雄性犬作为研究对象,经犬后腿多点肌注50%的甘油生理盐水,每千克体重约10m L,建立急性肾功能衰竭的模型。经犬背头静脉团注超声造影剂Sonovue 0.2m L,两侧肾脏造影间隔时间至少15 min,使用GE LOGIQ-E 9超声诊断仪及8 MHz线阵探头,在低机械指数的模式下,于造模前、造模后6 h和造模后24 h分别对犬两侧肾脏进行常规超声及超声造影检查,实时观察犬肾实质区血流灌注情况。造影结束后,开启时间-强度曲线(time-intensity curve,TIC)分析软件,选择与声束垂直的肾实质区为感兴趣区域(region of interest,ROI),并保持ROI的形状、大小、深度和位置不变,根据ROI内造影剂微泡回声信号强度的变化获得TIC曲线及相应的定量参数值,包括曲线上升支斜率(ascending curve,A)、曲线下面积(area under curve,AUC)、曲线峰值强度(peak intensity,PI)、曲线达峰时间(time to peak,TTP)。每次造影前均抽血测量肌酐(serum creatinine,SCr)、尿素氮(blood serum urea nitrogen,BUN)的值。造模后6 h造影结束后随机处死一只犬,取出肾脏进行病理学检查;余犬均于实验结束后全部处死,取出肾脏进行病理学检查。用统计学软件分析比较相同时间段内造影参数值和SCr、BUN的改变情况。结果:(1)造模前曲线上升支斜率(A)、峰值强度(PI)明显高于造模后;造模前达峰时间(TTP)、曲线下面积(AUC)明显低于造模后,差异有统计学意义(P<0.05)。(2)造模后6 h与造模前生化指标相比较,差异无统计学意义(P>0.05),病理变化不明显。(3)造模后24 h与造模前生化指标相比较,差异有统计学意义(P<0.05),病理变化明显。结论:超声造影定量分析技术可以比生化指标更早的反映犬急性肾功能衰竭的血流灌注改变情况并能做出定量评价,有待于越来越多的应用于临床疾病的诊断。

Objective ： To quantitatively assess the parameter aheration of renal cortex blood flow in dogs of before and after injected glycerin with the contrast-enhanced uhrasound.To evaluate the value of contrast-enhanced uhrasound quantitative analysis in diagnosing early renal function changes of dogs.Methods： 15 healthy aduh dogs were the subjects,The dogs model of ARF was established by intramuscular injection of 50%glycerin（10mL/kg） into the hind legs of the dogs.After intravenous bolus injection of 0.2mL Sonovue in dog＇s leg vein.In the pattern of low mechanical index,The conventional ultrasound and Contrast-enhanced ultrasound examinations were perfomled for GE LQGIQ-E 9 ultrasonic diagnostic apparatus and 3.5 MHz convex array probe for both kidneys before injection, 6 hour alter the injection and 24 hour alter the injection.Real time Contrast-enhanced ultrasound of renal cortex blood perthsion of dogs were collected successively.Take advantage of the analysis tunetion of time- intensity curre. Choice the renal cortex which perpendieular to the sound beam to be area-of-interest, keeping the shape, size,depth and position of the ROI unchanged,According to the Sonovue echo sign strength in the area-of-interest get the time-intensity curve.The slope of ascending curve （A）, area under curve（ AUC ）, derived peak intensity （PI） and time to peak （ TTP ） were measured in renal cortex of dogs using time-intensity curve software.The blood serum urea nitrogen（BUN） and serum ereatinine （SCr） level were tested before contrast-enhanced uhrasound. Randomly elected one dog to take the kidney tissue of 6 hours alter the injection of glycerin, and to pathologically examine.the rest of dogs were taken the kidney tissue and examined pathologically alter 24 hours contrast-enhanced ultrasound.In the same time, compared the convert the above parameters and blood test with statistically analyzed software.Results（ 1 ）A, PI before were significantly high the values alter injected glycerin, TTP, AUC before were significantly low the values alter injected glycerin. （2）There was no significant change in histopathologie analysis 6 hours alter the injection of glycerin（P〉0.05） .The pathological change is not obvious. （3）24 hours later, the histopathologie analysis and typical changes can be observed （P〈0.05）. Conclusion：Quantitative analysis of contrast-enhanced ultrasound could monitor the changes of blood perfusion image of the renal cortex of the early renal function changes of dogs than SCr and BUN, has been more and more used in the diagnosis of clinical disease.