George E A, Salimi Z, Wolverson M K, Garvin P J
Department of the Medicine, St. Louis University Medical School, Missouri.
Clin Nucl Med. 1991 Jun;16(6):394-8. doi: 10.1097/00003072-199106000-00002.
The efficacies of two scintigraphic and two sonographic techniques and resultant index values, as markers of renal allograft pathology, were assessed. Index values of 183 combined scintigraphic and sonographic examinations in 47 graft recipients were compared to the pathological diagnosis of transplant biopsies and subsequent clinical outcome. All recipients were studied with baseline imaging techniques postoperatively, again when indicated by predefined clinical criteria, and prior to graft biopsy. The scintigraphic technique involved the calculation of indices of thrombotic activity and cortical graft perfusion. Ultrasound involved determination of the Doppler resistance index of Pourcelot and estimations of graft volume from real time images. A decreased cortical perfusion index was, overall, the most sensitive index of acute or chronic graft pathology, but it lacked specificity. Increased thrombotic and resistance indices were 96% and 86% sensitive for acute vascular rejection and were 82% and 76% specific. Jointly increased thrombotic and resistance indices improved the specificity for acute vascular rejection to 98%. An increase in graft volume of more than 50% over stable values was 100% sensitive and 92% specific for acute interstitial rejection, and 95% specific when paired with a normal thrombotic index. A marked increase in the thrombotic index was 100% sensitive for cyclosporine-induced thrombotic microangiopathy, but only 49% specific. The specificity of a markedly increased thrombotic index for thrombotic microangiopathy improved to 93% when the Doppler resistance index remained normal or was only marginally elevated. None of the scintigraphic or ultrasound indices were helpful for the diagnosis of acute tubular necrosis, chronic rejection, recurrent glomerulopathy, or graft infection.
评估了两种闪烁扫描技术和两种超声技术的效能以及由此产生的指标值，作为同种异体肾移植病理的标志物。将47名移植受者的183次闪烁扫描和超声联合检查的指标值与移植活检的病理诊断及随后的临床结果进行比较。所有受者在术后均采用基线成像技术进行研究，在符合预定义临床标准时再次进行研究，并在移植活检前进行研究。闪烁扫描技术涉及血栓形成活性和皮质移植灌注指标的计算。超声检查包括测定普尔塞洛特多普勒阻力指数，并根据实时图像估计移植体积。总体而言，皮质灌注指数降低是急性或慢性移植病理最敏感的指标，但缺乏特异性。血栓形成指数和阻力指数升高对急性血管排斥反应的敏感性分别为96%和86%，特异性分别为82%和76%。血栓形成指数和阻力指数联合升高可将急性血管排斥反应的特异性提高到98%。移植体积比稳定值增加超过50%对急性间质性排斥反应的敏感性为100%，特异性为92%，与正常血栓形成指数配对时特异性为95%。血栓形成指数显著升高对环孢素诱导的血栓性微血管病的敏感性为100%，但特异性仅为49%。当多普勒阻力指数保持正常或仅略有升高时，血栓形成指数显著升高对血栓性微血管病的特异性提高到93%。闪烁扫描或超声指标均无助于诊断急性肾小管坏死、慢性排斥反应、复发性肾小球病或移植感染。
