Real-time contrast-enhanced sonography of renal transplant recipients predicts chronic allograft nephropathy.
Real-time contrast-enhanced sonography (RT-CES) can assess microvascular tissue perfusion using gas-filled microbubbles. The study was performed to evaluate the feasibility of RT-CES in detecting chronic allograft nephropathy (CAN) in comparison to color Doppler ultrasonography (CDUS). A total of 26 consecutive renal transplant recipients were prospectively studied using RT-CES and conventional CDUS. Transplant tissue perfusion imaging was performed by low-power imaging during i.v. administration of the sonocontrast Optison. Renal tissue perfusion was assessed quantitatively using flash replenishment kinetics of microbubbles to estimate renal blood flow A *beta (A = peak signal intensity, beta= slope of signal intensity rise). In contrast to conventional CDUS resistance and pulsatility indices, renal blood flow estimated by CES was highly significant related to S-creatinine (r =-0.62, p = 0.0004). Determination of renal blood flow by CES reached a higher sensitivity (91% vs. 82%, p < 0.05), specificity (82% vs. 64%, p < 0.05) and accuracy (85% vs. 73%, p < 0.05) for the diagnosis of CAN as compared to conventional CDUS resistance indices. Perfusion parameters derived from RT-CES significantly improve the early detection of CAN compared to conventional CDUS. RT-CES using low-power real-time perfusion imaging is a feasible method to evaluate microvascular perfusion in renal allograft recipients.
Department of Nephrology, University of Heidelberg, Germany. vedat.schwenger@med.uni-heidelberg.de
V
V
Schwenger
G
G
Korosoglou
U-P
UP
Hinkel
C
C
Morath
A
A
Hansen
C
C
Sommerer
R
R
Dikow
S
S
Hardt
J
J
Schmidt
H
H
Kücherer
H A
HA
Katus
M
M
Zeier
D000293:Adolescent; D000328:Adult; D000368:Aged; D000418:Albumins / Q000008:administration & dosage; D001783:Blood Flow Velocity / Q000502:physiology; D003287:Contrast Media / Q000008:administration & dosage*; D005260:Female; D005466:Fluorocarbons / Q000008:administration & dosage; D005500:Follow-Up Studies; D006801:Humans; D007275:Injections, Intravenous; D007676:Kidney Failure, Chronic / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D016030:Kidney Transplantation / Q000000981:diagnostic imaging*; D008297:Male; D008863:Microspheres; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D013997:Time Factors; D014184:Transplantation, Homologous; D014463:Ultrasonography
D000418:Albumins; D003287:Contrast Media; C099458:FS 069; D005466:Fluorocarbons