Wong J J, Krebs T L, Klassen D K, Daly B, Simon E M, Bartlett S T, Grumbach K, Drachenberg C B
Department of Diagnostic Radiology, University of Maryland Medical System, Baltimore 21201, USA.
AJR Am J Roentgenol. 1996 Apr;166(4):803-7. doi: 10.2214/ajr.166.4.8610554.
Despite the increasing success of pancreatic transplantation for diabetes, rejection remains the most common cause of graft loss. The purpose of this study was to correlate gray-scale sonographic morphology and Doppler resistive index (RI) with acute pancreatic transplant rejection as determined by percutaneous, sonographically guided biopsy of the pancreas.
Fifty-one sonograms of 36 patients were correlated with sonographically guided biopsies performed for clinically suspected acute rejection. Sonographic studies consisted of gray-scale morphologic assessment of gland size, texture, marginal definition, peripancreatic fluid, and duct dilatation as well as measurement of the average Doppler RI. Biopsies were performed within 48 hr of sonography. After localization by sonography, we performed percutaneous biopsy with an 18-gauge automated biopsy device.
Biopsy findings were acute rejection (n = 40, 78%), chronic rejection (n = 2, 4%), and no evidence of rejection (n = 9, 18%). Procedure-related hemorrhage occurred in one patient and resolved spontaneously. Gray-scale sonographic abnormalities were present in 37 studies (73%). The most common abnormality was pancreatic enlargement (n = 23) with a sensitivity and specificity of 58% and 100%, respectively, for acute rejection. Loss of marginal definition occurred in nine studies with a sensitivity and specificity of 15% and 73%, respectively, for acute rejection. An RI > or = 0.7 was found in 11 studies (22%) with a sensitivity of 20% and a specificity of 73% for acute rejection.
For the diagnosis of acute pancreatic rejection, sonographically guided percutaneous biopsy is superior to gray-scale and spectral Doppler sonography. Sonographically guided percutaneous biopsy is a safe technique with a high success rate. Gray-scale and spectral Doppler sonography lack sensitivity, and a normal RI should not delay biopsy.
尽管胰腺移植治疗糖尿病越来越成功，但排斥反应仍是移植物丢失的最常见原因。本研究的目的是将灰阶超声形态学和多普勒阻力指数（RI）与经皮超声引导下胰腺活检所确定的急性胰腺移植排斥反应相关联。
对36例患者的51份超声图像与因临床怀疑急性排斥反应而进行的超声引导下活检进行关联分析。超声检查包括对腺体大小、质地、边缘清晰度、胰腺周围液体、导管扩张进行灰阶形态学评估以及测量平均多普勒RI。活检在超声检查后48小时内进行。在超声定位后，我们使用18号自动活检装置进行经皮活检。
活检结果为急性排斥反应（n = 40，78%）、慢性排斥反应（n = 2，4%）以及无排斥反应证据（n = 9，18%）。1例患者发生了与操作相关出血，且自行缓解。37项研究（73%）存在灰阶超声异常。最常见的异常是胰腺肿大（n = 23），对急性排斥反应的敏感性和特异性分别为58%和100%。9项研究出现边缘清晰度丧失，对急性排斥反应的敏感性和特异性分别为15%和73%。在11项研究（22%）中发现RI≥0.7，对急性排斥反应的敏感性为20%，特异性为73%。
对于急性胰腺排斥反应的诊断，超声引导下经皮活检优于灰阶和频谱多普勒超声检查。超声引导下经皮活检是一种安全且成功率高的技术。灰阶和频谱多普勒超声检查缺乏敏感性，正常的RI不应延迟活检。
