超声造影在移植肾动脉狭窄诊断及疗效监测中的应用

Contrast-enhanced ultrasonography for diagnosis and therapeutic effect monitoring of transplant renal artery stenosis

目的:探讨超声造影(CEUS)定量分析对成人移植肾动脉狭窄(TRAS)的诊断价值,及其判断血管介入治疗疗效的应用。方法:选择广州医科大学附属第三医院肾移植术后考虑为TRAS的患者34例,经计算机断层扫描血管造影(CTA)明确诊断,分为TRAS组(18例)和对照组(16例)。回顾性分析两组患者临床诊治资料及超声造影参数。结果:CEUS诊断TRAS为18例(16例经CTA确诊),灵敏度为88.9%、特异度为87.5%。CEUS定量分析显示,与对照组相比,TRAS组在达峰时间、绝对达峰时间及平均渡越时间明显延长,曲线下面积增大(P<0.05),且与估算肾小球滤过率呈负相关(P<0.001)。TRAS组的8例患者因重度狭窄、移植肾微循环灌注不良而行血管介入术,术后CEUS参数明显改善;其他10例因CEUS示移植肾微循环灌注好,采用药物保守治疗。随访12个月以上,所有患者移植肾灌注良好,移植肾功能稳定。结论:CEUS可以直观评估TRAS狭窄程度及定量分析移植肾的微循环灌注,是辅助诊断及评估TRAS疗效的可靠方法。

Objective:To explore the application of quantitative analysis of contrast-enhanced ultrasound(CEUS) for diagnosis and therapeutic effect monitoring in adult patients with transplant renal artery stenosis(TRAS). Methodology:34 patients who were considered as TRAS after renal transplantation in our hospital were selected. The diagnosis was confirmed by computed tomography angiography(CTA), patients were divided into TRAS group(n=18) and control group(n=16). The clinical data and ultrasonic parameters of the two groups were analyzed retrospectively. Results:TRAS was diagnosed by CEUS in 18 cases, of which 16 cases were confirmed by CTA at the same time. The sensitivity and specificity of CEUS in the diagnosis of TRAS were 88.9% and 87.5%. CEUS quantitative analysis showed that the time to peak, absolutely time to peak and mean-transit time in TRAS group were prolonged, the area under the curve increased, and negatively correlated with estimated glomerular filtration rate(P<0.001). 8 patients in TRAS group underwent vascular intervention because of severe stenosis and poor microcirculation perfusion of transplanted kidney, CEUS parameters improved after operation. While CEUS revealed good micro-circulation perfusion of the graft in the other 10 patients and they received conservative therapies only. During the follow-up of more than 12 months, all the patients had relative good renal allograft perfusion and stable renal function. Conclusion:CEUS can directly evaluate the degree of TRAS and quantitatively analyze the microcirculation perfusion of transplanted kidney.It is a reliable method for auxiliary diagnosis and follow-up the therapeutic effect of TRAS.