Diagnostic Value of Color Doppler Ultrasound in Transplanted Renal Artery Stenosis

IF 0.8 4区医学 Q4 IMMUNOLOGY

Transplantation proceedings Pub Date : 2025-05-10 DOI:10.1016/j.transproceed.2025.03.009

Yu Huimin, Kong Weina, Niu Ningning, Wu Hongtao, Zhang Guoying, Hao Xiaoye, Wang Jing, Tang Ying

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引用次数: 0

Abstract

Objective

This study is to investigate the diagnostic features and efficacy of ultrasonography in transplanted renal artery stenosis (TRAS).

Methods

We collected data from 20 patients diagnosed with TRAS via digital subtraction angiography (DSA) between July 2016 and January 2024 at the First Central Hospital of Tianjin. Additionally, we randomly selected 30 patients with normal blood flow and stable renal function following renal transplantation to serve as the control group. We utilized color Doppler ultrasound to assess various blood flow parameters, including the peak systolic velocity (PSV1) and diastolic velocity (EDV1) of the interlobar artery, the resistance index (RI) of the interlobar artery, and the systolic acceleration time (SAT) of the interlobar artery. We also measured the velocity of the interlobar vein (V), the peak systolic velocity (PSV2) and diastolic velocity (EDV2) at the stenosis site of the transplanted renal artery, the resistance index at the stenosis site, and the diameter of the stenosis of the transplanted renal artery (D). Concurrently, we recorded creatinine (Cr) levels within 24 hours. We compared the color Doppler ultrasound blood flow parameters of the TRAS group before interventional therapy with those of the control group and constructed ROC curves to determine the area and critical values under each parameter curve. We also selected cases post-stent implantation to compare the differences in color Doppler blood flow parameters before and after treatment, thereby analyzing the characteristics of hemodynamic changes.

Results

PSV1, EDV1, interlobar RI, stenosis RI in the TRAS group were significantly lower than those in the control group (t = 6.976, P = .000; T = 3.748, P = .000; Z = -4.115, P = .000; T = 6.537, P = .000; Z = -4.979, P = .000). Conversely, the PSV2, EDV2, SAT, and Cr levels in the TRAS group were higher than those in the control group (Z = -5.942, P = .000; Z = -5.735, P = .000; Z = -5.897, P = .000; Z = -5.941, P = .000). ROC curve analysis revealed that PSV2 exhibited the highest sensitivity and specificity for diagnosing TRAS, both at 100%, with a critical value of 205 cm/s. This was followed by the interlobar artery SAT, which showed a sensitivity of 95% and a specificity of 100%, with a critical value of 0.08 s. Additionally, after stent placement, the PSV1, EDV1, interlobar RI, and stenosis RI were significantly higher than before stent placement (Z = -5.17, P = .000; Z = -2.695, P = .019; T = 3.841, P = .002; Z = -4.974, P = .000). In contrast, the PSV2, EDV2, and Cr levels after stent placement were lower than those prior to the procedure (t = 7.518, P = .000; T = 5.837, P = .000; Z = 11.567, P = .000).

Conclusion

Color doppler ultrasound is a non-invasive, effective, simple, and rapid imaging modality that can serve as the first choice for the initial diagnosis of TRAS following renal transplantation and for postoperative follow-up. The peak systolic velocity at stenosis and the systolic acceleration time of the interlobar artery are particularly effective in diagnosing TRAS.

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彩色多普勒超声对移植肾动脉狭窄的诊断价值。

目的：探讨移植性肾动脉狭窄（TRAS）的超声诊断特点及疗效。方法：我们收集2016年7月至2024年1月在天津市第一中心医院通过数字减影血管造影（DSA）诊断为TRAS的20例患者的数据。另外，我们随机选取30例肾移植术后血流量正常、肾功能稳定的患者作为对照组。我们利用彩色多普勒超声评估各血流参数，包括叶间动脉的峰值收缩速度（PSV1）和舒张速度（EDV1），叶间动脉的阻力指数（RI）和叶间动脉的收缩加速时间（SAT）。测量移植肾动脉狭窄处叶间静脉流速(V)、收缩峰值流速（PSV2）、舒张峰值流速（EDV2）、狭窄处阻力指数、移植肾动脉狭窄直径(D)。同时，我们记录了24小时内的肌酐（Cr）水平。我们比较TRAS组介入治疗前与对照组的彩色多普勒超声血流参数，并构建ROC曲线，确定各参数曲线下的面积和临界值。我们还选择支架植入术后的病例，比较治疗前后彩色多普勒血流参数的差异，分析血流动力学变化的特点。结果：TRAS组PSV1、EDV1、叶间RI、狭窄RI显著低于对照组(t = 6.976, P = 0.000；T = 3.748, p = 0.000；Z = -4.115, p = 0.000；T = 6.537, p = 0.000；Z = -4.979, p = .000)。相反，TRAS组PSV2、EDV2、SAT和Cr水平高于对照组(Z = -5.942, P = 0.000；Z = -5.735, p = 0.000；Z = -5.897, p = 0.000；Z = -5.941, p = .000)。ROC曲线分析显示，PSV2诊断TRAS的敏感性和特异性最高，均为100%，临界值为205 cm/s。其次是叶间动脉SAT，其灵敏度为95%，特异性为100%，临界值为0.08 s。此外，支架置入术后PSV1、EDV1、叶间RI、狭窄RI均显著高于支架置入术前(Z = -5.17, P = 0.000；Z = -2.695, p = 0.019；T = 3.841, p = 0.002；Z = -4.974, p = .000)。相比之下，支架置入术后PSV2、EDV2和Cr水平低于术前(t = 7.518, P = 0.000；T = 5.837, p = 0.000；Z = 11.567, p = 0.000)。结论：彩色多普勒超声是一种无创、有效、简便、快速的成像方式，可作为肾移植术后TRAS的初步诊断和术后随访的首选。狭窄时的收缩峰值速度和叶间动脉的收缩加速时间对诊断TRAS特别有效。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Transplantation proceedings 医学-免疫学

CiteScore

1.70

自引率

0.00%

发文量

502

审稿时长

60 days

期刊介绍： Transplantation Proceedings publishes several different categories of manuscripts, all of which undergo extensive peer review by recognized authorities in the field prior to their acceptance for publication. The first type of manuscripts consists of sets of papers providing an in-depth expression of the current state of the art in various rapidly developing components of world transplantation biology and medicine. These manuscripts emanate from congresses of the affiliated transplantation societies, from Symposia sponsored by the Societies, as well as special Conferences and Workshops covering related topics. Transplantation Proceedings also publishes several special sections including publication of Clinical Transplantation Proceedings, being rapid original contributions of preclinical and clinical experiences. These manuscripts undergo review by members of the Editorial Board. Original basic or clinical science articles, clinical trials and case studies can be submitted to the journal?s open access companion title Transplantation Reports.