Johnson C P, Foley W D, Gallagher-Lepak S, Roza A M, Adams M B
Department of Transplant Surgery, Medical College of Wisconsin, Milwaukee.
Surg Gynecol Obstet. 1991 Oct;173(4):279-84.
Color Doppler sonography (CDS) detects changes in renal blood flow that may be useful in evaluating renal transplant dysfunction (RTD). To assess the performance of CDS as a clinical test, we reviewed results from 223 CDS measurements in 130 renal transplant recipients during a 26 month period. Spectral wave forms were characterized by pulsatility index (PI) (maximum frequency shift minus minimum frequency shift divided by mean frequency shift). In 27 individuals with stable renal function, mean PI was 1.80 +/- 0.23 (S.D.). Abnormal PI were subsequently defined as greater than two S.D. more than the mean (PI greater than or equal to 2.3). CDS performed during the early post-transplant period (n = 91) could not differentiate acute tubular necrosis (ATN), obstruction and rejection. Abnormal studies were seen in 35 of 46 instances of ATN and in three of obstruction. In 132 studies done after the postoperative period, CDS became abnormal during rejection episodes in only 45 of 71 instances (sensitivity rate of 63 per cent). When abnormal, CDS was highly suggestive of rejection, however (45 of 49, 92 per cent specificity). Cyclosporine toxicity was not associated with abnormal pulsatility (zero of seven). In 68 instances, CDS and conventional 99mTc DTPA renogram flow studies were performed together within 24 hours. CDS was more sensitive in detecting rejection but the difference did not reach statistical significance (25 of 36 versus 17 of 36). The major advantage of CDS over conventional radionuclide imaging relates to its shorter examination time, lower cost and portable capabilities. CDS will probably become the roentgenologic imaging modality of choice in renal transplantation.
彩色多普勒超声检查（CDS）可检测肾血流变化，这可能有助于评估肾移植功能障碍（RTD）。为了评估CDS作为一项临床检查的性能，我们回顾了130例肾移植受者在26个月期间进行的223次CDS测量结果。频谱波形以搏动指数（PI）（最大频移减去最小频移除以平均频移）为特征。在27例肾功能稳定的个体中，平均PI为1.80±0.23（标准差）。随后将异常PI定义为比平均值高两个标准差以上（PI大于或等于2.3）。移植后早期（n = 91）进行的CDS无法区分急性肾小管坏死（ATN）、梗阻和排斥反应。46例ATN中有35例以及3例梗阻病例的检查结果异常。在术后进行的132项检查中，CDS仅在71例排斥反应发作中的45例出现异常（敏感性为63%）。然而，当出现异常时，CDS高度提示排斥反应（49例中的45例，特异性为92%）。环孢素毒性与搏动异常无关（7例中为0例）。在68例中，CDS和传统的99mTc DTPA肾图血流检查在24小时内一起进行。CDS在检测排斥反应方面更敏感，但差异未达到统计学意义（36例中的25例对36例中的17例）。与传统放射性核素成像相比，CDS的主要优势在于检查时间短、成本低以及便于携带。CDS可能会成为肾移植中首选的放射影像学检查方法。
