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彩色多普勒超声联合超声造影对移植肾动脉狭窄的诊断价值

Diagnostic value of color Doppler ultrasonography combined with contrast-enhanced ultrasound in the diagnosis of transplant renal artery stenosis

  • 摘要:
    目的 探讨彩色多普勒超声(color Doppler ultrasonography,CDUS)血流动力学参数联合超声造影(contrast-enhanced ultrasound,CEUS)定量参数对移植肾动脉狭窄(transplant renal artery stenosis,TRAS)的诊断价值。
    方法 分析2011年9月至2020年5月在复旦大学附属中山医院经DSA或MRA确诊的TRAS患者21例(狭窄组)及同期行肾移植且随访肾功能正常的患者37例(对照组)的CDUS及CEUS资料,比较2组CDUS血流动力学参数及CEUS定量参数的差异,分析上述各个参数与TRAS程度间的相关性,并通过ROC曲线分析上述参数单独及联合应用时诊断TRAS的效能。
    结果 狭窄组主肾动脉PSV、峰值流速后比、皮质RT、髓质RT、皮质TTP及髓质TTP的值均高于或长于对照组,叶间动脉RI低于对照组(P < 0.05);主肾动脉PSV、叶间动脉RI、峰值流速后比、皮质RT、髓质RT、皮质TTP、髓质TTP与TRAS程度均存在中度相关性(r值分别为0.617、-0.409、0.599、0.600、0.518、0.638、0.648),其中叶间动脉RI与狭窄程度负相关,其余超声参数与狭窄程度正相关(P < 0.05)。CDUS血流动力学参数总体灵敏度高于CEUS定量参数,总体特异度低于CEUS定量参数;CEUS定量参数(除髓质RT外)的曲线下面积普遍大于CDUS血流动力学参数。主肾动脉PSV>2.43 m/s及皮质TTP>9.26 s是诊断TRAS的重要参数(P < 0.05),两者联合诊断TRAS的AUC为0.965、准确度为91.40%,高于所有单一参数。
    结论 CDUS及CEUS均可用于诊断TRAS,CDUS血流动力学参数联合CEUS定量参数可提高TRAS诊断的准确度,从而在一定程度上减少CDUS疑诊病例不必要的放射性检查。

     

    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.

     

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