Mueller-Peltzer K, Negrão de Figueiredo G, Fischereder M, Habicht A, Rübenthaler J, Clevert D-A
Department of Radiology, Ludwig-Maximilians-University Munich - Grosshadern Campus, Munich, Germany.
Department of Internal Medicine IV, Ludwig-Maximilians-University Munich - Grosshadern Campus, Munich, Germany.
Clin Hemorheol Microcirc. 2018;69(1-2):77-82. doi: 10.3233/CH-189115.
Despite of the more potent immunosuppressive medication, vascular rejection is still a major issue after renal transplantation. Renal biopsy is the gold standard diagnostic to evaluate acute and chronic allograft rejection. As it is an invasive diagnostic there is the risk of complications like haematoma, arteriovenous fistulas, active bleeding or infection. Contrast-enhanced ultrasound is a non-invasive imaging modality that allows visualising renal transplant perfusion.
To analyse the sensitivity and specificity of contrast-enhanced ultrasound (CEUS) compared to biopsy as gold standard in diagnosing vascular rejection in renal transplant patients.
A total of 57 renal transplant recipients with poor renal allograft function with initial diagnostic imaging between 2006 and 2017 were included in the study. Clinical data and imaging studies were analysed retrospectively. The diagnostic accuracy of CEUS in diagnosing vascular rejection of the renal transplant was compared to renal biopsy as gold standard. Out of 57 patients 7 patients showed signs of vascular rejection in biopsy. In 6 out of these 7 patients CEUS described irregularities in renal perfusion suspicious of vascular rejection.
CEUS showed a sensitivity of 85.7%, a specificity of 100%, a positive predictive value (PPV) of 100%, and a negative predictive value (NPV) of 98.0%.
CEUS is a safe, non-nephrotoxic imaging modality for the initial imaging of renal transplant recipients with elevated kidney function parameters suspicious of vascular rejection. Compared to renal biopsy as gold standard CEUS shows a high specificity and PPV in detecting signs of vascular rejection. Since sub-types of vascular rejection with cellular and humoral components with greater risk for allograft loss have been described renal biopsy is inevitable in these cases.
尽管使用了更强效的免疫抑制药物，但血管性排斥反应仍是肾移植后的一个主要问题。肾活检是评估急性和慢性同种异体移植排斥反应的金标准诊断方法。由于它是一种侵入性诊断方法，存在血肿、动静脉瘘、活动性出血或感染等并发症的风险。超声造影是一种非侵入性成像方式，可用于观察肾移植的灌注情况。
分析与作为金标准的活检相比，超声造影（CEUS）在诊断肾移植患者血管性排斥反应中的敏感性和特异性。
本研究纳入了2006年至2017年间57例肾移植受者，这些患者的肾移植功能较差且进行了初始诊断性成像。对临床数据和影像学研究进行回顾性分析。将CEUS诊断肾移植血管性排斥反应的诊断准确性与作为金标准的肾活检进行比较。在57例患者中，7例在活检中显示出血管性排斥反应的迹象。在这7例患者中的6例中，CEUS描述了肾灌注不规则，怀疑有血管性排斥反应。
CEUS的敏感性为85.7%，特异性为100%，阳性预测值（PPV）为100%，阴性预测值（NPV）为98.0%。
对于肾功能参数升高且怀疑有血管性排斥反应的肾移植受者，CEUS是一种安全、无肾毒性的初始成像方式。与作为金标准的肾活检相比，CEUS在检测血管性排斥反应迹象方面具有较高的特异性和PPV。由于已经描述了具有细胞和体液成分且同种异体移植丢失风险更高的血管性排斥反应亚型，在这些情况下肾活检是不可避免的。
