The Comparison Study Of Color Doppler,three-dimensional Imaging Of Vascular Volume And Contrast-enhanced Ultrasound In Chronic Allograft Nephropathy

【0bjective】Pre-research of three-dimensional imaging of vascular volume and contrast-enhanced ultrasound had got the methodology, parameter values of perfusion in transplant kidney with stable functional condition and with complications.Based on the pre-research and the expanded sample size, this study applied receiver operating characteristic curve(ROC) to evaluate the diagnostic value of color Doppler, three-dimensional imaging of vascular volume and contrast-enhanced ultrasound in chronic allograft nephropathy(CAN). Then we can acquire useful parameters of the three techniques and determine the critical value with their accuracies, sensitivities and specificities. And further study would also investigate the clinical application of three technologies in different pathologic features of CAN. So, they would provide a new reference for clinical diagnosis and treatment of CAN.【Methods】1. Eighty-nine renal allograft patients underwent color doppler, three-dimensional imaging of vascular volume and contrast-enhanced ultrasound. The ROC curve was applied to analysis the accuracy, sensitivity and specificity of the parameters in evaluating the CAN.2. The patients with CAN were divided into three groups according to the biopsy results and the latest Banff classification: patients with no rejection (A group), patients with rejection (B group) and patients with critical rejection (C group).Then we can discuss the clinical value of color doppler, three-dimensional imaging of vascular volume and contrast-enhanced ultrasound in CAN with different pathological features. 【Results】1.The parameters and classification of the group with CAN were as follows when they were compared to the group with stable renal function: the grade of color doppler energy image(CDEI)were I to III,RI and PI of color doppler increased(P <0.05);the level of three-dimensional flow energy were 0 to 4,VI, FI and VFI were decreased(P <0.05), MG was increased(P <0.05), whereas V was no significant difference(P>0.05)among the parameters of three-dimensional imaging of vascular volume; RT, AT, TTP and mTT were extended(P <0.05)while QOF was no significant difference(P>0.05)among the parameters of contrast-enhanced ultrasound in the cortex and medulla.2. The areas under the curve of VI, FI and VFI were bigger than MG and V among the parameters of three-dimensional imaging of vascular volume(P <0.05). The areas under the curve of RT in the cortex were bigger than was higher than AT, TTP, mTT, QOF in the cortex and medulla including RT in the medulla in contrast-enhanced ultrasound(P <0.05).3.The areas under the curve of RT in the cortex, VI, FI and VFI were bigger than RI, and their sensitivity (86.7%, 86.7%, 84.4%, 88.9%) and specificity (75.0% 75.0%, 75.0%, 79.5%) were greater than RI (64.4%, 72.7%).4. The comparison of the parameters among A, B and C with CAN were as follows: the RI and PI of color Doppler, the MG, FI and V of three-dimensional imaging of vascular volume, AT, TTP, mTT, QOF in the cortex and medulla of contrast-enhanced ultrasound, these parameters were not different(P >0.05),but RT in the cortex and medulla ,VI,VFI were significantly different(P <0.05); the histological score was also different(P <0.05). The correlation coefficients of RT in the cortex, VI, FI and VFI with histological score were higher than the coefficients of RI.【Conclusions】1.The accuracy, sensitivity, specificity of three-dimensional imaging of vascular volume was better than color Doppler with its more meaningful indicators of VI, FI, VFI.2. The accuracy, sensitivity, specificity of contrast-enhanced ultrasound was higher than color Doppler with its more meaningful indicators of RT in the cortex.3. The comparison of accuracy, sensitivity, specificity between three dimensional imaging of vascular volume and contrast-enhanced ultrasound showed indifference. And further study would discuss the clinical value of them with the grouping of blood level.4.The threshold of three-dimensional imaging of vascular volume and contrast-enhanced ultrasound were as follows: The diagnostic point of RT in the cortex was 7.40s with sensitivity of 86.7%, specificity of 75.0%, positive predictive value of 86.8% in diagnosis of CAN. The diagnostic point of VI, FI, VFI was 24.03%,45.85%,11.19%,respectively. The sensitivity was 86.7%, 84.4%, 88.9%,the specificity was 75.0%, 75.0%, 79.5%, the positive predictive value was 84.6%, 82.5%, 87.5%, respectively. These parameters would provide new reference index with more accuracy, sensitivity and specificity in diagnosis of CAN.5. The RT in the cortex of contrast- enhanced ultrasound and VI, FI, VFI of three-dimensional imaging of vascular volume had shown difference in different lesion extent with higher correlation connecting to Scr. This would provide significance for further study in different pathological features of CAN with more cases.