| Objective:Color Doppler Flow Imaging(Color Doppler Flow Imaging,CDFI)and Superb Micro-vascular Imaging(Superb Micro-vascular imaging,SMI)were used to perform semi-quantitative of renal blood perfusion in patients with normal kidney and chronic kidney disease(Chronic kidney disease,CKD)respectively,to evaluate the clinical value of these two ultrasonic imaging techniques in renal blood perfusion of patients with chronic renal disease.It lays a foundation for clinical evaluation of blood perfusion changes and staging of chronic kidney disease.Methods:From January 2018 to December 2018,the clinically diagnosed 158 patients with chronic kidney disease were selected as the case group,aged 20 to 80 years,average age(52.93±15.01)years old,among which 80 were males,average age(53.52±15.74)years old,78 females,average age(52.66±14.37)years old.There were 27 cases in Chronic kidney disease group 1(CKD1 group)with 14 males and 13 females,29 cases in Chronic kidney disease group 2(CKD2 group)with 14 males and 15 females,32 cases in Chronic kidney disease group 3(CKD3 group)with 17 males and 15 females,34 cases in Chronic kidney disease group 4(CKD4 group)with 18 males and 16 females,and 36 cases in Chronic kidney disease group 5(CKD5 group)with 19 males and 17 females.From January 2018 to December 2018,200 patients with normal kidneys at the Fourth Affiliated Hospital of Kunming Medical University were selected as the control group,aged 20-80 years,with an average age of(49.69±15.87)years.There are 105 males with an average age of(50.27±16.42)years,and 95 females with an average age(49.05±15.30)years.The research used Toshiba Aplio 500 color Doppler ultrasonic diagnostic apparatus,equipped with color Doppler flow imaging and Superb micro-vascular imaging and image processing software platform,3?5 MHZ frequency convex array probe to observe,rate and record the bilateral renal blood perfusion in the mode of Color Doppler flow imaging(CDFI)and Superb blood flow imaging(SMI)respectively.According to the ultrasound performance,the renal blood perfusion was divided into a self-defined 6-grade scoring standard based on ultrasonic findings(the following scores were each level of each blood vessels as a scoring standard),and then the scores of each grade were added up to the final total score.0:No blood flow signal is detected.1 Score:The renal aorta can show a sparse blood flow signal.2 Scores:The renal aorta clearly shows that the renal artery tube is not continuous and is star-shaped.3 Scores:blood flow in the renal aorta and renal segment is continuous,and blood flow in the interlobar artery can be displayed.4 Scores:The renal aorta and renal artery blood flow signals are clearly displayed,and the arcuate artery shows a sparse blood flow signal.5 Scores:From the whole kidney to the level of the interlobular artery,the blood flow signal is continuous which is full and dendritic in the whole kidney.Results:1.Two-dimensional ultrasound of the kidneyThere were significant differences in length diameter,width diameter,thickness diameter and cortical thickness between the control group and the case group.(P<0.05)2.Color Doppler flow imagingThere was no significant difference between the left renal blood perfusion score and the right renal blood perfusion score in the control group.(P>0.05)The control group was divided into male and female groups.There was no significant difference in renal blood perfusion score between male group and female group.(P>0.05)There were significant differences in renal perfusion scores between control group and CKD1 group,CKD2 group,CKD3 group,CKD4 group and CKD5 group.(P<0.05)There was no significant difference in renal perfusion score between CKD4 group and CKD5 group.(P>0.05).There were significant differences between any two groups in the remaining groups.(P<0.05).3.Superb micro-vascular imagingThere was no significant difference between the left renal blood perfusion score and the right renal blood perfusion score in the control group.(P>0.05).The control group was divided into male and female groups.There was no significant difference in renal blood perfusion score between male group and female group.(P>0.05).There were significant differences in renal perfusion scores between control group and CKD1 group,CKD2 group,CKD3 group,CKD4 group and CKD5 group.(P<0.05).There were significant differences between any two groups in CKD1 group,CKD2 group,CKD3 group,CKD4 group and CKD5 group.(P<0.05).4.Comparison of Color Doppler ultrasound and Superb micro-vascular imagingThere was significant difference between Color Doppler flow imaging and Superb micro-vascular Imaging in renal blood perfusion score of chronic renal disease in the same period among these two techniques.(P<0.05)5.The best diagnostic cut-off score values,sensitivity and specific degrees of normal kidney and chronic kidney disease(CKD)perfusion in different historical periods by Color Doppler ultrasound and Superb micro-vascular imaging technology can be obtained through the analysis of ROC curve.The best diagnostic cut-off score values of the CKD1 group,CKD2 group,CKD3 group,CKD4 group and CKD5 group were 34.0,26.5,21.5,14.5,7.5,5.5;the sensitivity was 96%,93%,97%,97%,94%,96%;the specific degrees were 96%,90%,91%,88%,91%,97%respectively by SMI.The best diagnostic cut-off score values of the CKD1 group,CKD2 group,CKD3 group,CKD4 group and CKD5 group were 30.5,23.5,19.5,11.5,6.5,6.5;the sensitivity was 96%,96%,90%,91%,88%,91%;the specific degrees were 78%,83%,89%,83%,85%,87%respectively by CDFI.Conclusion:There was no significant difference in blood perfusion among the bilateral kidneys of normal people,and the kidney blood perfusion shows no significant difference in gender.Normal renal blood perfusion is significantly more than that of chronic kidney disease.Superb micro-vascular imaging is superior to Color Doppler flow imaging in the display of renal micro-vascular perfusion,which provides reference value for clinical evaluation of renal disease structure,function and blood perfusion changes.With the increase of chronic kidney disease stage,the renal blood flow perfusion shows a trend of decrease.Color Doppler ultrasound can distinguish the first three periods,but can't distinguish the fourth stage of chronic kidney disease and the fifth stage of chronic kidney disease;while Superb micro-vascular imaging can distinguish all stages of chronic kidney disease.Compared with Color Doppler imaging technology,Superb micro-vascular imaging has higher sensitivity in evaluating renal blood perfusion in patients with chronic kidney disease,which can lay a foundation for clinical evaluation of structural and functional changes of kidney disease,evaluation of staging and may provide a more accurate imaging basis for the reversible transition. |
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