Duplex Doppler Ultrasound in the Evaluation of Renal Transplants

複合都卜勒超音波於腎臟移植之評估

周宜宏(Yi-Hong Chou) ； 許重權(Chung-Chuan Hsu) ； 陳啓昌(Chi-Chang Chen) ； 單子元(Tzyy-Yuan Shann) ； 李建賢(Chen-Hsen Lee) ； 彭芳谷(Fang-Ku P'eng) ； 刁翠美(Chui-Mei Tiu) ； 張遵(Tsuen Chang)

《中華放射線醫學雜誌》 18卷2期 (1993/06) Pp. 111-120

摘要

The use of different available spectral Doppler indices obtained from normal and pathological renal transplants was evaluated in the assessment of renal allografts. Forty-one patients with renal transplants were examined by duplex Doppler ultrasound from April 1985 to June 1988. A total of 76 examinations were performed within 24 hours to 10 months after renal transplantation. The scanner used was ATL UM8 (Advanced Technology Laboratories, Bellevue, WA) with a 5.0 and/or 7.5-MHz transducer. The Doppler spectrum was obtained from arcuate arteries, main renal arteries, and sometimes segmental or interlobar artery or renal veins. Measurement was done for the frequency shift (△f) in the peak systolic (PS), early diastolic (ED), late (or lowest) diastolic (LD) phases, time average freqency shift (TAFS), and slopes in the early systolic, late systolic, and diastolic phases. Some indices were determined by using the following formula: (a) Index of early diastolic resistivity (EDRI)=(△f in PS - △ f in ED)/ △ f in PS; (b) Index of pulsatility (PI)=(△ f in PS - △ f in LD)/TAFS; (c) Pourcelot index (POI)=(△ f in PS - △ f in LD)/△ fin PS.
The results showed that the indices obtained from the main renal artery and arcuate artery in patients with acute rejection were significantly higher than those with normal transplant or chronic rejection (p＜0.05). The main renal artery and the arcuate artery showed similar indices. We therefore recommanded to measure the arcuate artery instead of main renal artery because more difficulty may be encountered during examining the main renal artery.
The sensitivity and specificity for determining an acute rejection by using an EDRI value of 0.59 were 66% and 74%. A PI value of 1.93 provided a sensitivity of 72% and a specificity of 86%, and a POI of 0.81 would give 73% and 88% respectively. Duplex US is a useful adjunct in the evaluation of post-transplantation renal dysfunction with acceptable specificity but limited sensitivity in determining an allograft rejection. POI may be used as a single effective index for detection of acute rejection.

關鍵字

腎臟移植 ； 腎臟，超音波 ； 杜卜勒超音波

並列摘要

The use of different available spectral Doppler indices obtained from normal and pathological renal transplants was evaluated in the assessment of renal allografts. Forty-one patients with renal transplants were examined by duplex Doppler ultrasound from April 1985 to June 1988. A total of 76 examinations were performed within 24 hours to 10 months after renal transplantation. The scanner used was ATL UM8 (Advanced Technology Laboratories, Bellevue, WA) with a 5.0 and/or 7.5-MHz transducer. The Doppler spectrum was obtained from arcuate arteries, main renal arteries, and sometimes segmental or interlobar artery or renal veins. Measurement was done for the frequency shift (△f) in the peak systolic (PS), early diastolic (ED), late (or lowest) diastolic (LD) phases, time average freqency shift (TAFS), and slopes in the early systolic, late systolic, and diastolic phases. Some indices were determined by using the following formula: (a) Index of early diastolic resistivity (EDRI)=(△f in PS - △ f in ED)/ △ f in PS; (b) Index of pulsatility (PI)=(△ f in PS - △ f in LD)/TAFS; (c) Pourcelot index (POI)=(△ f in PS - △ f in LD)/△ fin PS.
The results showed that the indices obtained from the main renal artery and arcuate artery in patients with acute rejection were significantly higher than those with normal transplant or chronic rejection (p＜0.05). The main renal artery and the arcuate artery showed similar indices. We therefore recommanded to measure the arcuate artery instead of main renal artery because more difficulty may be encountered during examining the main renal artery.
The sensitivity and specificity for determining an acute rejection by using an EDRI value of 0.59 were 66% and 74%. A PI value of 1.93 provided a sensitivity of 72% and a specificity of 86%, and a POI of 0.81 would give 73% and 88% respectively. Duplex US is a useful adjunct in the evaluation of post-transplantation renal dysfunction with acceptable specificity but limited sensitivity in determining an allograft rejection. POI may be used as a single effective index for detection of acute rejection.

並列關鍵字

Kidney, transplantation ； kidney, ultrasound ； ultrasound, Doppler study