Dong Yi, Wang Wen-Ping, Lin Pan, Fan Peili, Mao Feng
Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China.
Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, China.
Clin Hemorheol Microcirc. 2016;62(3):229-38. doi: 10.3233/CH-151967.
We performed a prospective study to evaluate the value of contrast-enhanced ultrasound (CEUS) in quantitative evaluation of renal cortex perfusion in patients suspected of early diabetic nephropathies (DN), with the estimated GFR (MDRD equation) as the gold standard.
The study protocol was approved by the hospital review board; each patient gave written informed consent. Our study included 46 cases (21 males and 25 females, mean age 55.6 ± 4.14 years) of clinical confirmed early DN patients. After intravenous bolus injection of 1 ml sulfur hexafluoride microbubbles of ultrasound contrast agent, real time CEUS of renal cortex was performed successively using a 2-5 MHz convex probe. Time-intensity curves (TICs) and quantitative indexes were created with Qlab software. Receiver operating characteristic (ROC) curves were used to predict the diagnostic criteria of CEUS quantitative indexes, and their diagnostic efficiencies were compared with resistance index (RI) and peak systolic velocity (PSV) of renal segmental arteries by chi square test. Our control group included forty-five healthy volunteers. Difference was considered statistically significant with P < 0.05.
Changes of area under curve (AUC), derived peak intensity (DPI) were statistically significant (P < 0.05). DPI less than 12 and AUC greater than 1400 had high utility in DN, with 71.7% and 67.3% sensitivity, 77.8% and 80.0% specificity. These results were significantly better than those obtained with RI and PSV which had no significant difference in early stage of DN (P > 0.05).
CEUS might be helpful to improve early diagnosis of DN by quantitative analyses. AUC and DPI might be valuable quantitative indexes.
我们进行了一项前瞻性研究，以估计肾小球滤过率（MDRD方程）作为金标准，评估超声造影（CEUS）在疑似早期糖尿病肾病（DN）患者肾皮质灌注定量评估中的价值。
研究方案经医院伦理委员会批准；每位患者均签署书面知情同意书。我们的研究纳入了46例临床确诊的早期DN患者（男性21例，女性25例，平均年龄55.6±4.14岁）。经静脉团注1ml超声造影剂六氟化硫微泡后，使用2-5MHz凸阵探头连续对肾皮质进行实时CEUS检查。使用Qlab软件绘制时间-强度曲线（TICs）并生成定量指标。采用受试者操作特征（ROC）曲线预测CEUS定量指标的诊断标准，并通过卡方检验将其诊断效率与肾段动脉阻力指数（RI）和收缩期峰值流速（PSV）进行比较。我们的对照组包括45名健康志愿者。P<0.05认为差异具有统计学意义。
曲线下面积（AUC）、派生峰值强度（DPI）的变化具有统计学意义（P<0.05）。DPI小于12且AUC大于1400对DN具有较高的诊断效能，敏感度分别为71.7%和67.3%，特异度分别为77.8%和80.0%。这些结果明显优于RI和PSV，后者在DN早期无显著差异（P>0.05）。
CEUS通过定量分析可能有助于改善DN的早期诊断。AUC和DPI可能是有价值的定量指标。
