The Application Study Of Functional Ultrasonic Imaging Technology In Chronic Rejection And Its Pathologic Types Of Transplanted Kidney

【Objective】 Pre-research of three-dimensional imaging of vascular volume andcontrast-enhanced ultrasound had got the methodology, parameter values of perfusion intransplant kidney with stable functional condition and CAN. Based on the Pre-research andthe expanded sample size,this study applied receiver operating characteristic curve(ROC) toevaluate the application value of color doppler, three-dimensional imaging of vascularvolume and contrast-enhanced ultrasound in chronic rejection and its pathologic types. Thenwe will acquire significative parameters and determine their critical value with sensitivity andspecific degrees. Making clinical departments to this study having a preliminaryunderstanding.【Methods】1. One hundred and nineteen renal allograft patients underwent color doppler,three-dimensional imaging of vascular volume and contrast-enhanced ultrasound. The ROCcurve was applied to acquire the sensitivity and specific degrees and the best threshold of theparameters in evaluating the chronic rejection and its pathologic types.2. The patients withCR were divided into two groups according to the latest Banff2009transplant renalpathology classification scheme and the biopsy results in our hospital: patients with Tcell-mediated rejection(TCMR groups), patients with antibody mediated rejection(AMRgroups). Then we can discuss the clinical value of color doppler, three-dimensional imagingof vascular volume and contrast-enhanced ultrasound in identifying different pathologicaltype and acquire the sensitivity and specific degrees and the best threshold by ROC curve.【Results】1. The parameters of the group with CR were as follows when they werecompared to the group with stable renal function: the grade of color doppler energyimage(CDEI) were0to4, RI and PI of color doppler increased(P<0.05); the level of3D-CPAwere0to5,VI,FI and VFI were decreased,MG was increased(P<0.05), whereas V was nosignificant difference(P>0.05) among the parameters of three-dimensional imaging of vascular volume; RT,TTP and mTT were extended(P<0.05) among the parameters ofcontrast-enhanced ultrasound in the cortex and medulla.2. The areas under the curve of RIwas bigger than PI among the parameters of color doppler. The areas under the curve of VI,FIand VFI were bigger than MG and V among the parameters of three-dimensional imaging ofvascular volume(P<0.05). The areas under the curve of RT in the cortex was higher than otherparameters of contrast-enhanced ultrasound(P<0.05). In addition, The areas under the curveof RT in the cortex were bigger than VI,FI, VFI and RI(P<0.05).3. In the most significantparameters, the diagnostic point of RT,VI,FI,VFI and RI were7.87s、36.77%、46.51%、23.18%、0.62with sensitivity degrees of90.2%、78.4%、75.7%、83.8%、65.6%, specificdegrees of75.6%、63.3%、73.3%、72.4%、73.5%.4. Compare two groups of CRpathological type, the grade of CDEI and3D-CPA was statistically significant (P <0.05), RTin the cortex among the parameters of contrast-enhanced ultrasound and VFI among theparameters of three-dimensional imaging of vascular were statistically significant (P <0.05).5. When the diagnostic point of RTc and VFI were9.15s and22.24%with sensitivity degreeof86.7%,83.3%, specific degree of79.2%,70.3%respectively in diagnosis of Tcell-mediated chronic rejection; when RTc was10.47s and VFI was20.47%with sensitivitydegree of87.5%,85.7%, specific degree of78.7%,70.0%respectively in diagnosis of theantibody-mediated chronic rejection.【Conclusions】1. The sensitivity and specific degrees of contrast-enhanced ultrasound andthree-dimensional imaging of vascular volume are better than color doppler, andcontrast-enhanced ultrasound is better than three-dimensional imaging of vascular volume inthe diagnosis of chronic rejection of transplanted kidney.2. The sensitivity and specificdegrees of RTc are relatively better than VI,FI,VFI and RI in evaluating the chronic rejectionof transplanted kidney. It can provide better reference for clinical diagnosis of CR.3. RTcamong the parameters in contrast-enhanced ultrasound and VFI among the parameters inthree-dimensional vascular volume can distinguish between TCMR and AMR in the renaltransplantation. But it may be affected by the level of blood flow, the late studies willincrease the size of two groups to group for further research according to the level of bloodflow.