对比增强超声在肾移植患者中急性肾盂肾炎的诊断。

Diagnosis of acute pyelonephritis by contrast-enhanced ultrasonography in kidney transplant patients.

机构信息

Department of Nephrology, AOU Policlinico-Vittorio Emanuele Catania, Italy.

出版信息

Nephrol Dial Transplant. 2011 Feb;26(2):715-20. doi: 10.1093/ndt/gfq417. Epub 2010 Jul 20.

DOI:10.1093/ndt/gfq417

PMID:20659906

Abstract

BACKGROUND

Diagnostic imaging of acute pyelonephritis (APN) in renal transplanted patients is an important clinical issue. While conventional ultrasonography (US) has a limited diagnostic role, contrast-enhanced computer tomography and magnetic resonance imaging (MRI) represent the gold standard diagnostic tests. However, nephrotoxicity of either iodinated or paramagnetic contrast medium limits their use, especially in patients with kidney disease. Contrast-enhanced US (CEUS) may detect poorly perfused parenchymal renal areas, a useful feature in the diagnosis of APN. The aim of this study was to evaluate the diagnostic value of CEUS in APN compared with MRI as the reference test.

METHODS

From a pool of 389 kidney transplant patients, we prospectively recruited 56 patients with clinical suspicion of APN of the transplanted kidney. They underwent both CEUS and MRI, performed in a blinded manner by two different operators. Sensitivity, specificity, accuracy, positive and negative predictive values, and K statistics were calculated.

RESULTS

Thirty-seven out of 56 patients (66.1%) resulted positive for APN with the reference test, gadolinium-enhanced MRI. Thirty-five out of these 37 patients showed positive results for APN with CEUS, and 19 patients showed negative results for APN with both MRI and CEUS: sensitivity 95% (CI 82-99), specificity 100% (CI 83-100), accuracy 96% (CI 88-99), positive predictive value 100% (CI 90-100), negative predictive value 90% (CI 71-97) and K statistics 0.92 (P<0.01).

CONCLUSIONS

Our results suggest, for the first time, the feasibility of CEUS, a low-cost and low-risk diagnostic procedure, in the diagnosis of APN in kidney transplant patients.

摘要

背景

对肾移植患者急性肾盂肾炎（APN）的诊断性影像学检查是一个重要的临床问题。虽然传统的超声检查（US）的诊断作用有限，但增强计算机断层扫描和磁共振成像（MRI）是金标准的诊断测试。然而，碘或顺磁性造影剂的肾毒性限制了它们的使用，特别是在有肾脏疾病的患者中。对比增强超声（CEUS）可检测到灌注不良的实质肾区，这是诊断 APN 的一个有用特征。本研究旨在评估 CEUS 在诊断肾移植患者 APN 中的诊断价值，并将其与 MRI 作为参考测试进行比较。

方法

从 389 例肾移植患者中，我们前瞻性地招募了 56 例有移植肾 APN 临床怀疑的患者。他们接受了 CEUS 和 MRI 检查，由两位不同的操作人员以盲法进行。计算了敏感性、特异性、准确性、阳性和阴性预测值以及 K 统计量。

结果

以参考测试（钆增强 MRI）为标准，56 例患者中有 37 例（66.1%）诊断为 APN。这 37 例患者中有 35 例 CEUS 检查结果为 APN 阳性，19 例 MRI 和 CEUS 检查结果均为 APN 阴性：敏感性 95%（CI 82-99），特异性 100%（CI 83-100），准确性 96%（CI 88-99），阳性预测值 100%（CI 90-100），阴性预测值 90%（CI 71-97）和 K 统计量 0.92（P<0.01）。