超声造影定量评估儿童肾积水肾脏血流灌注的应用研究

Quantitative assessment of renal perfusion in children with ureteropelvic junction obstruction through contrast-enhanced ultrasonography

目的探讨超声造影定量评估儿童肾积水肾脏血流灌注变化,以评价其对肾脏功能的诊断效能。方法连续纳入2018年1~4月期间就诊于首都医科大学附属北京儿童医院住院及门诊就诊的共51例单侧肾盂输尿管连接部梗阻(ureteropelvic junction obstruction,UPJO)患儿,其中男42例,女9例;年龄为(6.75±4.14)岁,年龄范围在10个月至14岁。选取所有患儿各自患侧肾脏作为实验组,健侧肾脏为对照组。对全部患儿进行了超声检查、超声造影(contrast-enhanced ultrasonography,CEUS)和利尿性核素肾动态显像检查。通过受试者工作特征曲线下面积(an area under the ROC curve,AUROC)来对超声造影定量分析与利尿性肾图的分肾功能进行评价和比较,评价其诊断效能。结果共51例患儿102侧肾脏绘制CEUS的灌注时间-强度曲线(time-intensity curve,TIC),均显示出不对称的单峰曲线,实验组和对照组可以清楚地区分。实验组的达峰时间(time to peak,TTP)明显延长,曲线上升斜率(the slope of the ascending curve,A)明显降低,与对照组相比差异有统计学意义(P<0.05)。曲线下面积(area under the curve,AUC)、峰值强度(peak intensity,PI)和分肾功能(differential renal function,DRF)之间无显著相关性,但TTP、A和DRF之间的显著相关(P<0.001)。TTP评价DRF绘制的AUROC为0.86。CEUS对UPJO患儿肾脏功能评价,灵敏性和特异性值分别为92.86%和76.14%,临界值为23.459。结论CEUS对儿童UPJO肾脏血流灌注改变、肾功能评价有效性有较高的应用价值,TTP、A可作为评价肾脏功能有效性的重要指标。

Objective To prospectively evaluate the diagnostic value of contrast-enhanced ultrasonography(CEUS)for renal function in children with unilateral ureteropelvic junction obstruction(UPJO).Methods The study protocol was approved by the local ethics committee and written informed consent obtained from parents or guardians.Ultrasonography,CEUS and radioisotopic renography were performed in 51 children.There were 42 boys and 9 girls with a mean age of(6.75±4.14)years.Slope of ascending curve(A),time to peak(TTP),peak intensity(PI)and area under the curve(AUC)were recorded during CEUS.And quantitative data were calculated by the QLAB system software(semiautomated border tracking,Philips Healthcare).Sensitivity and specificity were determined for CEUS and compared with radioisotopic renography.Results A total of 102 kidneys in 51 children were visualized by CEUS.Perfusion time-intensity curve(TIC)of renal cortix demonstrated an asymmetrical single-peak curve in all groups.It could be distinctly distinguished between experimental and control groups.Compared to control group,TTP became markedly prolonged while A declined sharply in experimental group(P<0.05).No significant correlation existed between AUC,PI and differential renal function(DFR).However,correlation coefficients between TTP,A and DFR remained significant(P<0.001).Receiver operating characteristic(ROC)curve of DRF was plotted for TTP with an area under the ROC curve(AUROC)of 0.86.For DFR<40%on CEUS,the values of sensitivity and specificity were 92.86%and 76.14%.Conclusions This preliminary experience represents the first-ever report of evaluating the diagnostic value of CEUS for renal function in UPJO children.And CEUS is a highly sensitive,rapid,non-invasive and cost-effective diagnostic imaging modality for detecting and monitoring renal function.