Bertolotto Michele, Martegani Alberto, Aiani Luca, Zappetti Roberta, Cernic Stefano, Cova Maria Assunta
UCO di Radiologia, Università di Trieste, Ospedale di Cattinara, Strada di Fiume 449, 34149 Trieste, Italy.
Eur Radiol. 2008 Feb;18(2):376-83. doi: 10.1007/s00330-007-0747-2. Epub 2007 Sep 13.
The effectiveness of contrast-enhanced ultrasonography (CEUS) in the evaluation of patients with acute renal infarcts was investigated, using contrast-enhanced helical computed tomography (CT) as the reference imaging procedure. Twenty-seven consecutive patients with acute renal infarcts detected with contrast-enhanced helical CT underwent CEUS. Digital cine-clips of CEUS were evaluated by two independent readers blinded to CT findings. Image quality was rated subjectively on a four-point scale. Then, readers were asked to assign a confidence level in diagnosis of renal infarct at the upper pole, medium portion, and lower pole of each kidney according to a five-degree scale, ranging from definitely absent to definitely present. ROC curve analysis was employed to assess the overall confidence of diagnosis of infarct, and weighted kappa values were calculated to assess inter-reader agreement. The subjective image quality of CEUS was lower than the image quality of CT at the upper poles. However, the diagnostic performance of CEUS was excellent (area under receiver-operator characteristic curve 0.992 +/- 0.006 for reader 1; 0.991 +/- 0.007 for reader 2), with very good inter-reader agreement (weighted kappa value = 0.83). CEUS is a reproducible tool to detect acute renal infarcts in men, with a diagnostic performance approaching that of CT.
以对比增强螺旋计算机断层扫描（CT）作为参考成像方法，研究了超声造影（CEUS）在评估急性肾梗死患者中的有效性。连续27例经对比增强螺旋CT检测出急性肾梗死的患者接受了CEUS检查。两名独立阅片者在不知CT检查结果的情况下对CEUS的数字电影剪辑进行评估。图像质量采用四点量表进行主观评分。然后，要求阅片者根据五级量表，对每个肾脏的上极、中部和下极肾梗死的诊断给出置信度，范围从肯定不存在到肯定存在。采用ROC曲线分析评估梗死诊断的总体置信度，并计算加权kappa值以评估阅片者间的一致性。CEUS在上极的主观图像质量低于CT的图像质量。然而，CEUS的诊断性能极佳（阅片者1的受试者操作特征曲线下面积为0.992±0.006；阅片者2为0.991±0.007），阅片者间一致性非常好（加权kappa值=0.83）。CEUS是一种可重复的检测男性急性肾梗死的工具，其诊断性能接近CT。
