超声造影分析正常移植肾皮质不同部位微循环灌注特点的研究

目的利用超声造影观测正常移植肾皮质不同部位的微循环灌注特征。方法入选病例为肾移植时间1年以上的20例患者,均知情同意,经随访证实移植肾功能均正常。常规超声检查结束后,采用声诺维团注法超声造影技术对移植肾实质微循环血流灌注进行实时监测,并利用Sono Liver定量分析软件进行分析。选择移植肾同一切面包膜下肾皮质(外层皮质,ROI1)、弓形动脉上方肾皮质(近髓皮质,ROI2)、中层皮质(ROI3)以及肾外皮下组织(参考区,ROIc)4个感兴趣区,获得相应的时间—强度曲线(TIC曲线)及定量参数:上升时间(RT)、达峰时间(TTP)和峰值强度(IMAX)。分析移植肾三个感兴趣区的微循环灌注特征。结果 TIC曲线显示:近髓皮质处最早开始显影,灌注强度迅速上升,迅速下降至一定灌注强度并缓慢消退;外层皮质最后显影,最早到达灌注峰值,并迅速下降至一定强度后缓慢消退;中层皮质介于两者之间。时间—强度定量参数:参考区、外层皮质、中层皮质和近髓皮质的RT分别为(25.29±12.75)s、(9.72±2.43)s、(10.45±2.55)s及(10.92±2.69)s;TTP分别为(35.88±19.07)s、(13.52±4.34)s、(13.73±4.47)s及(14.18±4.53)s;IMAX分别为(100.00±0)%、(1132.82±1170.93)%、(2032.93±2444.65)%及(2403.92±2981.03)%。参考区与皮质内3个感兴趣区的参数比较,差异有统计学意义(P0.05);外层皮质、中层皮质及近髓皮质的RT、TTP及IMAX呈逐渐增大之势,但差异无统计学意义(P﹥0.05)。结论超声造影能为临床监测移植肾的状况提供一种新的思路和方法。

Evaluation of normal transplanted kidney cortical microcirculatory perfusion with contrast-enhanced ultrasonography

Objective To evaluate the characteristics of normal transplanted kidney cortical microcirculatory perfusion with contrast-enhanced ultrasonography （CEUS）.nethods Twenty patients with normal transplanted kidney for more than one year were enrolled in the study. After traditional ultrasound examination, CEUS was performed to monitor the transplanted kidney cortical microcirculatory perfusion. The dynamic images of CEUS were analyzed off-line with the quantitative software. Four regions of interest （ROI）, including subcapsular renal cortex （ROI1）, juxtamedullary cortex （ROI3）, middle cortex （ROI2） and extrarenal subcutaneous tissue （ROIc）, were chosen at the same section. The time-intensity curve （TIC） and some quantitative parameters, including rise time （RT）, time-to-peak （TIP） and maximum intensity （IMAX）, were obtained. Quantitative analysis of the normal transplanted kidney cortical microcirculatory perfusion was performed between different ROIs.Results Microbubbles rapidly entered the kidney cortex from inner cortex to middle cortex and outer cortex. Meantime, it arrived to the peak of perfusion quickly, and descended rapidly to certain intensity, then had delayed washout. The RT of ROIc, ROI1,ROI2 and ROI3 was （25.29±12.75）s,（9.72±2.43 ）s,（ 10.45±2.55 ）s and （ 10.92±2.69）s, respectively. The TIP was （35.88±19.07）s,（ 13.52± 4.34）s, （ 13.73 ±4.47 ）s and （ 14.18 ±4.53 ）s, respectively. The IMAX was （ 100.00±0）%, （ 1132.82 ±1170.93 ）%, （2032.93±2444.65 ）% and （2403.92±2981.03）%, respectively. There was significant difference of RT,TTP and IMAX bertween ROle and other ROIs（P 〈 0.05）. RT,TTP and IMAX had a trend to increase from ROI1,ROI2 to ROI3, but there was no significant difference （P 〉 0.05）.Conclusion CEUS provides a new approach for evaluating transplant renal cortical perfusion.