超声超分辨率成像评估急性肾损伤患者肾脏微循环的临床价值

The Clinical Value of Ultrasound Super-resolution Imaging in Evaluating Renal Microcirculation in Patients with Acute Kidney Injury

目的:探讨超声超分辨率成像(SRI)技术评估急性肾损伤(AKI)患者肾脏微循环的可行性及临床价值。方法:52例脓毒症患者,依据是否发生AKI分为AKI组(n=32)和无AKI组(对照组,n=20),获取所有对象的肾脏超声及临床资料。经肘静脉推注SonoVue造影剂1.5ml,应用迈瑞Resona A20超声诊断仪采集肾脏造影动态图像2min,分析肾脏灌注的时间-强度曲线(TIC);15min后再次造影,获取肾脏显微血流图,计算包膜下肾皮质微血管密度,分析其与血肌酐的相关性。结果:AKI组与对照组的肾脏形态学无明显差异(P>0.05);AKI组肾皮质的达峰时间及平均渡越时间均较对照组延长(均P<0.01),峰值强度和时间强度曲线下面积均较对照组降低(均P<0.01);AKI组肾皮质微血管密度低于对照组(18.09±6.20%vs 45.56±11.88%,P<0.01),AKI组肾皮质微血管密度与血肌酐呈负相关(r=-0.86,P<0.01)。结论:超声SRI能有效评估AKI患者肾脏微循环,为无创量化评估肾脏微循环提供了新方法。

Objective:To explore the feasibility and clinical value of ultrasound super-resolution imaging(SRI)technology in assessing renal microcirculation in acute kidney injury(AKI)patients.Method:52 patients with sepsis were divided into AKI group(n=32)and without AKI group(control group,n=20).Renal ultrasound and clinical data of all patients were obtained.SonoVue contrast agent(1.5 ml)was injected intravenously through the elbow vein,and Mindray Resona A20 ultrasonic diagnostic system was used to collect dynamic contrast images for 2 min.The time-intensity curve(TIC)of renal perfusion was analyzed.After 15 minutes,CEUS was performed again to obtain the microscopic blood flow map of the kidney.Microvascular density was calculated,and its correlation with blood creatinine was analyzed.Results:There were no significant differences in renal morphology between the AKI group and the control group(P>0.05).The rise time,time to peak,and mean transit time of the renal cortex in the AKI group were all prolonged compared to the control group(all P<0.01),while the peak intensity and the area under the time-intensity curve were lower than those in the control group(all P<0.05).The microvascular density of the renal cortex in the AKI group was lower than that in the control group(18.09±6.20%vs 45.56±11.88%,P<0.01),and the microvascular density in the AKI group showed a negative correlation with blood creatinine(r=-0.86,P<0.01).Conclusion:Ultrasound SRI can effectively assess renal microcirculation in AKI patients.SRI is a new method for non-invasive quantitative evaluation of renal microcirculation.