Application value of contrast-enhanced ultrasound in vascular complications of transplanted kidney
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摘要:
目的 评价超声造影(CEUS)在移植肾血管并发症中的应用价值。 方法 回顾性分析临床怀疑有移植肾血管并发症的28例肾移植患者的普通超声和CEUS图像资料, 以CT血管造影(CTA)或数字减影血管造影(DSA)为诊断标准, 分析CEUS在移植肾血管并发症中的诊断价值。 结果 28例患者均未发生造影剂相关不良反应。22例确诊发生血管并发症。CEUS正确诊断血管并发症17例, 漏诊5例移植肾动脉狭窄, 误诊1例移植肾局灶性梗死。CEUS诊断移植肾血管并发症的灵敏度、特异度、阳性预测值、阴性预测值及准确度分别为0.77、1.00、1.00、0.55及0.82。普通超声及CEUS诊断移植肾动脉狭窄的灵敏度、特异度、阳性预测值、阴性预测值及准确度分别为0.37和0.74, 0.89和1.00, 0.88和1.00, 0.40和0.64, 0.54和0.82。两者灵敏度、准确度比较差异均有统计学意义(均为P < 0.05)。 结论 CEUS是诊断移植肾血管并发症的有效手段。 Abstract:Objective To evaluate the application value of contrast-enhanced ultrasound(CEUS)in the diagnosis of vascular complication(VC)of transplanted kidney. Methods Imaging data of conventional ultrasound and CEUS in 28 patients suspected with VC of transplanted kidney were analyzed retrospectively. The results of computed tomography angiography (CTA) or digital subtraction angiography (DSA) were served as the diagnostic standard. The value of CEUS in diagnosing VC of transplanted kidney was analyzed. Results No adverse reaction related to contrast agent was observed in 28 patients during the CEUS examination. And 22 cases with VC were confirmed. VCs were detected correctly by CEUS in 17 cases, but 5 cases with transplant renal artery stenosis(TRAS)were missed and 1 case with focal infarction in transplanted kidney was misdiagnosed. The diagnostic sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of CEUS for VC of transplanted kidney were 0.77, 1.00, 1.00, 0.55 and 0.82, respectively. The diagnostic sensitivity, specificity, PPV, NPV and accuracy of conventional ultrasound and CEUS for TRAS were 0.37 and 0.74, 0.89 and 1.00, 0.88 and 1.00, 0.40 and 0.64, 0.54 and 0.82, respectively. There were significant differences in the sensitivity and accuracy between conventional ultrasound and CEUS (both in P < 0.05). Conclusions CEUS is an effective method for detecting VC of transplanted kidney. -
图 1 移植肾动脉狭窄病例的影像学表现
注：A图为普通超声检查，发现移植肾动脉血流局部成五彩样；B图为CEUS检查，示移植肾上极局灶性充盈缺损(箭头所示)，尖端指向肾门；C图为CEUS检查，示移植肾动脉管径细小(箭头所示)；D图为CTA证实移植肾动脉狭窄(红色箭头)，发现上极实质无灌注(黄色箭头)
Figure 1. Imaging appearance of the patient with transplant renal artery stenosis
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