移植肾慢性排斥的SonoVue超声造影临床研究

目的观测移植肾慢性排斥的SonoVue超声造影特征,探讨移植肾慢性排斥的SonoVue超声造影诊断指标。方法同种异体移植肾患者36例（功能正常30例,慢性排斥6例）;选用仪器为Siemens公司Sequoia512彩色多普勒超声诊断仪,配备对比脉冲序列造影成像软件;造影剂为SonoVue,剂量选择为0.6-1.0ml;常规超声检查结束后进行超声造影,实时存储图像,回放分析,观测肾实质微循环灌注情况。结果整个造影过程,功能正常移植肾实质呈均匀性增强,包膜下整个肾脏切面被造影剂强回声均匀充填。移植肾发生慢性排斥时,与功能正常移植肾比较,皮质达峰时间延迟,皮质从开始增强到达峰所需时间延长,整个移植肾切面达峰时间延迟;肾脏的增强强度明显不均匀,可见散在的、大小不等、边界不清的低增强区,分布于皮质、髓质及肾窦。结论利用SonoVue进行移植肾的超声造影成像,可以检测出慢性排斥时微循环血流灌注的改变。

Clinical study of chronic rejection of transplant kidney using SonoVue contrast-enhanced ultrasound

Objective To observe the character and establish the diagnosis standard of SonoVue contrast-enhanced ultrasound about chronic rejection of transplant kidney. Methods Thirty-six patients who received transplantation of allogeneic kidney were carried out with SonoVue contrast-enhanced ultrasound, 30 transplant kidneys were normal function and 6 transplant kidneys occurred chronic rejection. The used ultrasound diagnostic instruments included Sequoia512 equipped with contrast software of contrast pulsed sequences (CPS). The used ultrasound contrast agent is SonoVue, dose of agent is 0.6-1.0 ml. The ultrasound contrast imaging was carried out after routine ultrasonography was examined. The images were stored and analyzed by reviewer. The renal microcirculation was analysed. Results During imaging of SonoVue contrast-enhanced ultrasound, the renal parenchyma of normal function was enhanced uniformly, the whole view of normal transplanted kidney was distributed completely with high intensity echo of contrast agent. When chronic rejection of transplant kidney occurred, compared with normal ones, the time of renal cortex intensity reaching apex delayed, the time of cortex from enhancing start to reaching apex prolonged, the renal parenchyma was enhanced asymmetric in evidence, the equirotal, irregular and unclear boundary areas of low intensity enhancing distributed scattered in renal cortex, medulla and sinus. Conclusion The SonoVue contrast-enhanced ultrasound of transplant kidney can find change of microcirculation blood flow perfusion when chronic rejection occurred.