Ultrasonic microbubble contrast agents and the transplant kidney.
OBJECTIVE
To evaluate the potential application of microbubble agents in the immediate post-transplant period, by studying contrast uptake and washout, and to correlate these values with clinical indices, and thus, assess the potential prognostic value of this technique.


METHODS
The study group comprised 20 consecutive renal transplant patients within 7 days of transplantation. Sonovue was administered as an intravenous bolus with continuous imaging of the transplant kidney at low mechanical index (MI) for 1 min post-injection. These data were analysed off-line by two observers, and time intensity curves (TIC) for the upper, mid, and lower poles constructed. Within each pole, a region of interest (5 mm square) was placed over the cortex, medullary pyramid, and interlobar artery, resulting in a total of nine TIC for each patient. TIC parameters included the arrival time (AT), time to peak (TTP), peak intensity (Max), gradient of the slope (M), and the area under curve (AUC).


RESULTS
For both observers there was good agreement for all values measured from the cortex and medulla, but poor interobserver correlation for the vascular values. In addition, there was only agreement for these values in the upper and mid-pole of the transplant with poor agreement for the lower pole values. The mid-pole of the transplant kidney was chosen as the point of measurement for subsequent studies. Mid-pole values were correlated with clinical data and outcome over the 3-month post-transplant period. Renal microbubble perfusion correlated with the transplant estimated glomerular filtration rate (eGFR) at 3 months post-transplantation (p=0.016).


CONCLUSIONS
In conclusion, this is the first study to confirm reproducibility of the Sonovue TIC data in transplant patients and to quantify regional variation and perfusion. The statistically significant estimates of transplant perfusion may be of future benefit to transplant recipients and potentially utilized as a prognostic tool. However, a more in depth study will be required to support or refute these early study findings.
Kay
D H
DH
Department of Radiology, Western Infirmary, Glasgow, UK. davidhkay@doctors.org.uk
Mazonakis
M
M
Geddes
C
C
Baxter
G
G
D000328:Adult; D003287:Contrast Media / Q000493:pharmacokinetics*; D005260:Female; D006801:Humans; D007668:Kidney / Q000000981:diagnostic imaging*; D016030:Kidney Transplantation / Q000000981:diagnostic imaging*; D008297:Male; D045423:Microbubbles; D008875:Middle Aged; D015588:Observer Variation; D010743:Phospholipids; D010865:Pilot Projects; D011184:Postoperative Period; D011379:Prognosis; D011446:Prospective Studies; D015203:Reproducibility of Results; D013459:Sulfur Hexafluoride / Q000493:pharmacokinetics*; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography
D003287:Contrast Media; D010743:Phospholipids; C420843:contrast agent BR1; D013459:Sulfur Hexafluoride