Bassaganyas Clara, Ventura-Aguiar Pedro, Sapena Victor, Soler-Perromat Juan Carlos, Darnell Anna, Soler-Perromat Alexandre, Cuatrecasas Miriam, Ferrer-Fàbrega Joana, Ayuso Carmen, Garcia-Criado Ángeles
Radiology Department, Hospital Clinic de Barcelona, Barcelona, Spain.
Universitat de Barcelona, Barcelona, Spain.
Eur Radiol. 2025 Jun 25. doi: 10.1007/s00330-025-11772-1.
Rejection is the leading cause of graft failure, and its diagnosis remains a challenge. Elastography and dynamic contrast-enhanced ultrasound (DCE-US) are novel non-invasive techniques for quantifying tissue elasticity and perfusion. Their role in pancreas graft rejection has not yet been defined.
From October 16 to January 20, all pancreas transplantations performed at our institution were prospectively studied with elastography and DCE-US at 1 week, 3 weeks, and 12 months post-transplantation. Surveillance biopsies were performed at 3 weeks and 12 months. Elastography and DCE-US were also conducted in all requested biopsies during this period (regardless of the date of transplantation). Patients were categorized according to the biopsy result: normal/rejection. Grafts with other complications were excluded. Cut-off values were established.
One hundred twenty-one elastography and 127 DCE-US in 56 patients were included. All parameters showed a high dispersion during the first 90 days post-transplantation. After this period, the rejection group presented higher stiffness (0.97 vs 1.46 m/s, p < 0.001) and lower perfusion. The optimal cut-off value for elastography was 1.27 m/s (AUC 0.80), and for DCE-US were: peak enhancement 601 a.u. (AUC 0.67), wash-in AUC 2748 a.u. (AUC 0.70), wash-in rate 118 a.u. (AUC 0.65), wash-in perfusion index 369 a.u. (AUC 0.67), wash-out AUC 5181 a.u. (AUC 0.69) and total AUC 6388 a.u. (AUC 0.68). A combined predictive score showed that alteration of elastography and DCE-US was associated with a 23.2-fold probability of rejection.
After the first 90 days post-transplantation, pancreas graft rejection is associated with higher stiffness and lower graft perfusion.
Question Pancreas graft rejection remains a clinical challenge, as there are currently no reliable non-invasive tests for its diagnosis. Findings After the first 90 days post-transplantation, elastography and DCE-US show higher stiffness and lower pancreas graft perfusion in the presence of rejection. Clinical relevance These non-invasive tools, which can be easily integrated into daily routine practice, may be useful in identifying grafts at higher risk of rejection, allowing closer follow-up or early biopsy to establish early rejection treatment, improving graft and patient survival.
排斥反应是移植失败的主要原因，其诊断仍然是一项挑战。弹性成像和动态对比增强超声（DCE-US）是用于量化组织弹性和灌注的新型非侵入性技术。它们在胰腺移植排斥反应中的作用尚未明确。
从10月16日至1月20日，对在我们机构进行的所有胰腺移植在移植后1周、3周和12个月时进行前瞻性弹性成像和DCE-US研究。在3周和12个月时进行监测活检。在此期间所有要求的活检（无论移植日期）也进行弹性成像和DCE-US检查。根据活检结果对患者进行分类：正常/排斥。排除有其他并发症的移植物。确定临界值。
纳入了56例患者的121次弹性成像和127次DCE-US检查。所有参数在移植后的前90天内显示出高度离散性。在此之后，排斥组表现出更高的硬度（0.97对1.46 m/s，p < 0.001）和更低的灌注。弹性成像的最佳临界值为1.27 m/s（曲线下面积0.80），DCE-US的临界值为：峰值增强601 a.u.（曲线下面积0.67），流入曲线下面积2748 a.u.（曲线下面积0.70），流入率118 a.u.（曲线下面积0.65），流入灌注指数369 a.u.（曲线下面积0.67），流出曲线下面积5181 a.u.（曲线下面积0.69）和总曲线下面积6388 a.u.（曲线下面积0.68）。综合预测评分显示，弹性成像和DCE-US的改变与排斥反应的可能性增加23.2倍相关。
移植后90天，胰腺移植排斥反应与更高的硬度和更低的移植物灌注相关。
问题 胰腺移植排斥反应仍然是一个临床挑战，因为目前尚无可靠的非侵入性诊断测试。发现 移植后90天，弹性成像和DCE-US显示在存在排斥反应时硬度更高且胰腺移植物灌注更低。临床意义 这些非侵入性工具可轻松融入日常实践，可能有助于识别排斥风险较高的移植物，以便进行更密切的随访或早期活检以确立早期排斥反应治疗，提高移植物和患者的生存率。
