肾移植超声检查的新维度：三维超声的应用

New Dimensions in Renal Transplant Sonography: Applications of 3-Dimensional Ultrasound.

作者信息

Frank Susan J, Walter William R, Latson Larry, Cohen Hillel W, Koenigsberg Mordecai

机构信息

1 Department of Radiology, Albert Einstein College of Medicine of Yeshiva University, Montefiore Medical Center, Bronx, NY. 2 NYU Langone Medical Center, New York, NY. 3 Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY.

出版信息

Transplantation. 2017 Jun;101(6):1344-1352. doi: 10.1097/TP.0000000000001206.

DOI:10.1097/TP.0000000000001206

PMID:28291767

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5357201/

Abstract

BACKGROUND

The aim of this study is to demonstrate the usefulness of adding 3-dimensional (3D) ultrasound in evaluation of renal transplant vasculature compared to 2-dimensional (2D) Duplex ultrasound.

METHODS

One hundred thirteen consecutive renal transplant 2D and 3D ultrasound examinations were performed and retrospectively reviewed by 2 board-certified radiologists and a radiology resident individually; each reviewed 2D and then 3D images, including color and spectral Doppler. They recorded ability to visualize the surgical anastomosis and rated visualization on a subjective scale. Interobserver agreement was evaluated. Variant anastomosis anatomy was recorded. Tortuosity or stenosis was evaluated if localized Doppler velocity elevation was present.

RESULTS

The reviewers directly visualized the anastomosis more often with 3D ultrasound ((Equation is included in full-text article.)=97.5%) compared with 2D ((Equation is included in full-text article.)=54.5%) [difference in means (DM) = 43% (95% confidence interval (CI) = 36%-50%) (P < 0.001)]. The reviewers visualized the anastomosis more clearly with 3D ultrasound (P < 0.001) [difference in medians = 0.5, 1.0, and 1.0, (95% CI = 0.5-1.0, 0.5-1.0, and 1.0-1.5)]. Detection of variant anatomy improved with 3D ultrasound by 2 reviewers [DM = 7.1% and 8.9% (95% CI = 1%-13% and 4%-14%, respectively) (P < 0.05)]. There was high interobserver agreement [(Equation is included in full-text article.)= 95.3%, (95% CI = 91.9%-98.7%) regarding anastomosis visualization among reviewers with wide-ranging experience.

CONCLUSIONS

Direct visualization of the entire anastomosis was improved with 3D ultrasound. Three-dimensional evaluation improved detection of anatomic variants and identified tortuosity as the likely cause of borderline localized elevation in Doppler velocity. The data added by 3D ultrasound may obviate confirmatory testing with magnetic resonance angiography or computed tomographic angiography after equivocal 2D ultrasound results.

摘要

背景

本研究的目的是证明与二维（2D）双功超声相比，三维（3D）超声在评估肾移植血管系统中的有用性。

方法

对113例连续的肾移植患者进行2D和3D超声检查，并由2名获得委员会认证的放射科医生和1名放射科住院医师分别进行回顾性分析；每人先查看2D图像，然后查看3D图像，包括彩色和频谱多普勒图像。他们记录观察手术吻合口的能力，并以主观评分法对观察效果进行评级。评估观察者间的一致性。记录变异吻合口的解剖结构。如果出现局部多普勒速度升高，则评估血管迂曲或狭窄情况。

结果

与2D超声（（公式包含在全文中）=54.5%）相比，观察者使用3D超声更常直接观察到吻合口（（公式包含在全文中）=97.5%）[均值差异（DM）=43%（95%置信区间（CI）=36%-50%）（P<0.001）]。观察者使用3D超声观察吻合口更清晰（P<0.001）[中位数差异分别为0.5、1.0和1.0，（95%CI=0.5-1.0、0.5-1.0和1.0-1.5）]。两名观察者使用3D超声对变异解剖结构的检测有所改善[DM分别为7.1%和8.9%（95%CI分别为1%-13%和4%-14%）（P<0.05）]。在经验丰富程度各异的观察者之间，对于吻合口观察的观察者间一致性较高[（公式包含在全文中）=95.3%，（95%CI=91.9%-98.