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目的对中远期移植肾行超声造影,总结移植肾慢性排斥反应的成像特征;通过时间-强度曲线(TIC)分析,寻找有助于诊断慢性排斥反应的造影参数。方法使用美国GE公司LOGIQ E9(配备高保真调幅造影成像软件)超声诊断仪,对手术时间>3个月的26例肾移植患者(以血肌酐男性110μmol/L,女性90μmol/L为界分为两组,大于等于界限者经病理证实为慢性排斥反应),用SonoVue造影剂行超声造影,剂量取0.12 mg/kg,实时存储资料,录像回放分析,观察肾实质血流灌注特征。选取感兴趣区域做TIC,分析两组TIC相关参数:皮质峰值强度(A1)、皮质达峰时间(TtoP1)、髓质达峰时间(TtoP2)、皮髓质达峰时间之差(△TtoP)、皮质曲线下面积(Area1)、髓质曲线下面积(Area2)、皮髓质曲线下面积之差(△Area)。结果与移植肾无排斥反应组对比,移植肾慢性排斥反应组造影剂填充强度呈不同程度减低,填充多不均匀,填充时间明显减慢。两组TIC参数除Area2无统计学差异外(P=0.678),其他均有统计学差异(P<0.05),其中A1、△TtoP、Area1及△Area差异最为明显(P<0.01)。结论移植肾慢性排斥反应超声造影影像学特征鲜明,有助于临床诊断;TIC参数A1、△TtoP、Area1及△Area对诊断意义较大。
OBJECTIVE: To evaluate the imaging characteristics of chronic rejection of renal allografts by contrast-enhanced ultrasonography in long-term renal allograft transplantation. To find the imaging parameters that can be used to diagnose chronic allograft rejection by time-intensity curve (TIC) analysis. Methods 26 cases of renal transplant recipients (> 110μmol / L serum creatinine and 90μmol / L female) who were treated by GE GE LOGIQ E9 (equipped with high fidelity AM imaging software) Two groups, no more than the limit of pathological confirmed chronic rejection), with SonoVue contrast agent line ultrasound, the dose taken 0.12 mg / kg, real-time storage of data, video playback analysis to observe renal parenchymal perfusion characteristics. The region of interest (TIC) was selected to analyze the TIC parameters of the two groups: cortical peak intensity (A1), cortical peak time (TtoP1), medulla mass peak time (TtoP2) , Area under the curve of the cortex (Area1), Area under the curve of the medulla (Area2) and area under the curve of the cortex (△ Area). Results Compared with the non-rejection group, the filling intensity of the contrast agent in the chronic rejection group decreased to some degree, the filling was not uniform and the filling time was obviously slowed down. The TIC parameters of the two groups were statistically different (P <0.05) except Area2 (P = 0.678). The difference of A1, △ TtoP, Area1 and △ Area was the most significant (P <0.01). Conclusions The imaging features of chronic allograft rejection by contrast are distinct and helpful for clinical diagnosis. TIC parameters A1, △ TtoP, Area1 and △ Area are of great significance in diagnosis.