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Diagnostic value of color Doppler ultrasonography combined with contrast-enhanced ultrasound in the diagnosis of transplant renal artery stenosis
Received:January 02, 2021  Revised:April 13, 2021  Click here to download the full text
Citation of this paper:ZOU Zi-ran,YANG Ping,FAN Yun-ling,HE Wan-yuan,WANG Wen-ping.Diagnostic value of color Doppler ultrasonography combined with contrast-enhanced ultrasound in the diagnosis of transplant renal artery stenosis[J].Chinese Journal of Clinical Medicine,2021,28(4):629-634
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Author NameAffiliationE-mail
ZOU Zi-ran Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai 200032, China  
YANG Ping Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai 200032, China  
FAN Yun-ling Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai 200032, China  
HE Wan-yuan Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai 200032, China he.wanyuan@zs-hospital.sh.cn 
WANG Wen-ping Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai 200032, China
Shanghai Institute of Medical Imaging, Shanghai 200032, China 
 
Abstract:Objective: To explore the clinical value of hemodynamic parameters of color Doppler ultrasonography (CDUS) combined with quantitative parameters of contrast-enhanced ultrasound (CEUS) in the diagnosis of transplant renal artery stenosis (TRAS). Methods: Twenty-one patients with TRAS diagnosed by the digital subtraction angiography (DSA) or magnetic resonance angiography (MRA) were selected as stenosis group, and another 37 patients with stable transplant renal function who underwent kidney transplantation at the same time were included in the control group. The CDUS and CEUS images of these patients were analyzed retrospectively. The differences of the CDUS hemodynamic parameters such as the peak systolic velocity (PSV) in the main renal artery, the ratio of the PSV in the main renal artery to that in the interlobar arteries, and the resistant index (RI) in the interlobar arteries, and the CEUS quantitative analysis parameters such as the rising time (RT), time to peak (TTP) of interestive regions in renal allograft cortex and medulla were compared between the two groups. The correlation between the above-mentioned ultrasound parameters and the degree of renal artery stenosis was analyzed and the receiver operator characteristic curve (ROC) was used to compare the efficacy of the above parameters used alone and in combination in diagnosing TRAS. Results: The main renal artery PSV, the ratio of the main renal artery PSV to that in the interlobar arteries, and the RT and TTP of the renal allograft cortex and medulla in the stenosis group were significantly higher or longer than those in the control group, and the interlobular artery RI was lower than that in the control group (P<0.05). Each ultrasound parameter was moderately correlated with the degree of renal artery stenosis, the r values of the main renal artery PSV, the interlobular artery RI, the ratio of the main renal artery PSV to the interlobar arteries PSV, cortex RT, medulla RT, cortex TTP, and medulla TTP were 0.617, -0.409, 0.599, 0.600, 0.518, 0.638, and 0.648, respectively. Among them, the interlobular artery RI was negatively correlated with the degree of stenosis, and the remaining ultrasound parameters were positively correlated with the degree of stenosis (P<0.05). Compared with CEUS quantitative parameters, CDUS hemodynamic parameters had high sensitivity and low specificity in totality. The area of the curve of CEUS quantitative parameters were generally higher than that of CDUS hemodynamic parameters except for the medulla RT. The PSV in the main renal artery higher than 2.43 m/s and the TTP of renal allograft cortex higher than 9.26 s were important in the diagnosis of TRAS (P<0.05). The AUC and accuracy of the combination of the above two paramenters in the diagnosis of TRAS were 0.965 and 91.40%, respectively, which was higher than the diagnostic efficacy of any single parameter. Conclusions: Both CDUS and CEUS parameters can be used to diagnose TRAS, and the combination of the two methods can improve the diagnostic accuracy of TRAS and reduce unnecessary radioactive examination.
keywords:transplant renal artery stenosis  color Doppler ultrasonography  contrast-enhanced ultrasonography
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