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首页> 外文期刊>Nephrology, dialysis, transplantation: official publication of the European Dialysis and Transplant Association - European Renal Association >Improved diagnosis of early kidney allograft dysfunction by ultrasound with echo enhancer--a new method for the diagnosis of renal perfusion.
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Improved diagnosis of early kidney allograft dysfunction by ultrasound with echo enhancer--a new method for the diagnosis of renal perfusion.

机译：超声与回声增强剂改善对早期同种异体肾功能不全的诊断-一种诊断肾脏灌注的新方法。

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BACKGROUND: Conventional ultrasound parameters such as the resistance index (RI) are only of limited use in the diagnosis of early allograft dysfunction. We, therefore, performed a prospective study to compare the value of ultrasound contrast media (USCM) with conventional US in the diagnosis of early allograft dysfunction. METHODS: A total of 48 consecutive kidney recipients underwent US examination after USCM administration 4-10 days after transplantation. Arterial inflow was determined in the interlobar artery and renal cortex using time-intensity curve (TIC) software. The difference in time-to-peak intensity between these two vascular territories was determined, and a perfusion quotient (PQ) was defined as the ratio of TIC increase of interlobar artery to renal cortex. Three patients with segmental loss of renal perfusion demonstrated by Doppler US were excluded. RESULTS: Nineteen patients had an uneventful clinical course (control group); PQ was 1.2 +/- 0.4. Seven patients with a large perirenal haematoma, without rejection had an increased PQ (P < 0.05) and a prolonged time difference (P < 0.05). Based on clinical and histological criteria, the remaining patients were classified as acute tubular necrosis (ATN) (n = 7), non-vascular rejection (n = 7) or vascular rejection (n = 5). RI determination could not discriminate these groups. Patients with ATN (PQ = 1.6 +/- 0.7) or non-vascular rejection (PQ = 1.1 +/- 0.6) had a lower PQ than patients with vascular rejection (PQ = 2.2 +/- 0.8, P < 0.05). The time difference in all three subgroups was longer compared with controls. CONCLUSIONS: USCM might be superior in the diagnosis of early kidney allograft dysfunction compared with conventional US by means of RI determination. Perirenal haematoma, ATN and vascular rejection are associated with characteristic changes of the TIC.
机译：背景：常规的超声参数（例如阻力指数（RI））仅在诊断同种异体早期功能障碍中用途有限。因此，我们进行了一项前瞻性研究，以比较超声造影剂（USCM）与常规US在早期同种异体移植功能障碍诊断中的价值。方法：在移植后4-10天进行USCM给药后，总共48位连续的肾脏接受者接受了US检查。使用时间强度曲线（TIC）软件确定小叶间动脉和肾皮质的动脉流入。确定了这两个血管区域之间的峰时强度差异，并将灌注商（PQ）定义为小叶间动脉与肾皮质TIC的增加比率。排除了多普勒超声证实的三例肾灌注不全的患者。结果：19例患者的临床过程平稳（对照组）; PQ为1.2 +/- 0.4。七名大肾周血肿但无排斥反应的患者PQ升高（P <0.05），时间差延长（P <0.05）。根据临床和组织学标准，将其余患者分为急性肾小管坏死（ATN）（n = 7），非血管排斥（n = 7）或血管排斥（n = 5）。 RI确定无法区分这些组。 ATN（PQ = 1.6 +/- 0.7）或非血管排斥（PQ = 1.1 +/- 0.6）患者的PQ低于血管排斥（PQ = 2.2 +/- 0.8，P <0.05）。与对照组相比，所有三个亚组的时间差都更长。结论：通过RI测定，USCM在诊断早期同种异体肾功能不全方面优于常规美国。周围性血肿，ATN和血管排斥反应与TIC的特征改变有关。

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