The Comparison Study Of Color Doppler, Three Dimensional Imaging Of Vascular Volume And Contrast-enhanced Ultrasounin Acute Rejection After Kidney Transplantation

【0bjective】Pre-research of three-dimensional imaging of vascular volume and contrast-enhanced ultrasound had study the 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 acute rejection(AR). Then we can acquire useful parameters of the three techniques and determine the critical value with their accuracies, sensitivities and specificities in diagnosis the different pathologic feather of AR, they would provide a new reference for clinical diagnosis of AR.【Methods】(1) Eighty-six renal allograft patients underwent color doppler, three-dimensional imaging of vascular volume and contrast-enhanced ultrasound.(2) The patients with AR were divided into two groups according to the biospsy results and the 2007 Banff classification:patient with cellular-mediated acute rejection,patients with antibody-mediated acute rejection. Then we discuss the clinical value of color doppler, three-dimensional imaging of vascular volume and contrast-enhanced ultrasound in AR with different pathological features,and ROC curve was applied to analysis the accuracy, sensitivity and specificity of the parameters in evaluating the different pathological of AR.【Results】1.The parameters and classification of the two groups with AR were as follows when they were compared to the group with stable renal function: the grade of color doppler energy image(CDEI) in group of cellular-mediated acute rejection were III to V,RI and PI of color doppler increased(P <0.05);the level of three-dimensional flow energy were III to V,VI, FI and VFI were decreased(P <0.05 ) , MG and V were increased ( P <0.05 ) among the parameters of three-dimensional imaging of vascular volume; RT , TTP were extended(P <0.05)among the parameters of contrast-enhanced ultrasound in the cortex and medulla. The grade of color doppler energy image(CDEI) in group of antibody-mediated acute rejection were II to V,RI and PI of color doppler increased(P <0.05);the level of three-dimensional flow energy were II to V,VI, FI and VFI were decreased(P <0.05), MG and V were increased(P <0.05)among the parameters of three-dimensional imaging of vascular volume; RT,TTP were extended(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 in two grups 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 and VFI were bigger than RI, and in the group of cellular-mediated, their sensitivity are 80.0%,79.0%,90.3% and specificity are 90.3%,84.0%,79.2%, in the group of antibody-mediated, their sensitivity are 96.3%,79.0%,90.3% and specificity are 84.7%,78.9%,78.9%.【Conclusions】1.The accuracy, sensitivity of three-dimensional imaging of vascular volume was better than color Doppler with its more meaningful indicators of VI, FI, VFI in the group of celluar-mediate acute rejection. The threshold as fllows: The diagnostic point of VI, VFI was 40.84%,20.17%,respectively. The sensitivity was 79.0%,90.3%,the specificity was 78.9%,78.9%.The accuracy, sensitivity, specificity of contrast-enhanced ultrasound was higher than color Doppler with its more meaningful indicators of RT in the cortex. The threshold as fllows: The diagnostic point of RT in the cortex was 6.24s with sensitivity of 96.3%, specificity of 84.7%. These parameters would provide new reference index with more accuracy and sensitivity in diagnosis of celluar-medate acute rejection.2. The accuracy, sensitivity of three-dimensional imaging of vascular volume was better than color Doppler with its more meaningful indicators of VI, FI, VFI in the group of antibody-mediate acute rejection. The threshold as fllows: The diagnostic point of VI, VFI was 38.24%,19.78%,respectively. The sensitivity was 79.3%,92.0%,the specificity was 84.0%,79.2%.The accuracy, sensitivity, specificity of contrast-enhanced ultrasound was higher than color Doppler with its more meaningful indicators of RT in the cortex. The threshold as fllows: The diagnostic point of RT in the cortex was 7.04s with sensitivity of 80.0%, specificity of 90.3%. These parameters would provide new reference index with more accuracy and sensitivity in diagnosis of antibody-medate acute rejection3. The RT in the cortex of contrast-enhanced ultrasound and VFI of three-dimensional imaging of vascular volume showed difference in identify diagnosis with different pathological features of AR, this would have clinical value for further study in researsh features of AR with more cases.