目的 探讨肝移植术后肝动脉狭窄频谱Tardus Parvus波形和超声造影微灌注定量技术的临床意义。 方法 收集60例肝移植术后病人的相关影像资料，记录肝动脉多普勒超声的收缩期峰值血流速度（PSV）、舒张末期血流速度（EDV）、阻力指数（RI）及加速时间（SAT）等参数，Tardus Parvus波形的诊断标准为RI＜0.5且SAT＞0.8 s；超声造影分别记录肝边缘区域和中心区实质基础强度（BI）、到达时间（AT）、峰值强度（PI）、达峰时间（TTP）及中心区域与边缘区域的实质增强程度差异绝对值（REI）等定量参数，以CTA或DSA诊断肝动脉直径狭窄率≥50%为标准，将患者分为肝动脉狭窄组和非狭窄组。 结果 肝动脉狭窄组多普勒超声表现为Tardus Parvus波形阳性（P<0.05)，超声造影狭窄组与非狭窄组相比，REI减小（P<0.05），中心区域TTP延长（P<0.05）。 结论 Tardus Parvus波形和超声造影微灌注定量技术对肝移植术后肝动脉狭窄诊断具有一定的价值。
Abstract
Objective To explore the clinical value of Tardus Parvus waveform and contrast-enhanced ultrasound (CEUS) microperfusion quantitative technique in hepatic artery stenosis after liver transplantation. Methods Sixty cases of liver transplantation patients of hepatic artery doppler ultrasound, ultrasonic imaging and CTA/DSA examination data were collected separately. The systolic peak of hepatic artery doppler ultrasound blood flow velocity (PSV), end-diastolic velocity (EDV), resistance index (RI), acceleration time (SAT) were recorded. Tardus Parvus waveform of the diagnostic criteria were RI < 0.5 and SAT > 0.8 s. Contrast-enhanced ultrasound was used to record quantitative parameters such as marginal region of liver and central region basic identity (BI), arrival time (AT), peak intensity (PI), time to peak (TTP), absolute value of difference in real enhancement identity (REI) between the central region and the marginal region. Patients were divided into two groups according to the standard of hepatic artery stenosis rate ≥ 50% diagnosed by CTA or DSA: a hepatic artery stenosis group and a non-stenosis group. Results Doppler ultrasound in the hepatic artery stenosis group showed positive Tardus Parvus waveform (P<0.05). Compared with the non-stenosis group, absolute value of difference in REI between the central region and the marginal region reduced (P<0.05), and TTP in the central region prolonged (P<0.05). Conclusions Tardus Parvus waveform and contrast-enhanced microperfusion quantitative technique have a certain value in the diagnosis of hepatic artery stenosis after liver transplantation.
关键词
肝移植 /
肝动脉狭窄 /
Tardus Parvus波形 /
超声造影微灌注定量技术
Key words
Liver transplantation /
Hepatic artery stenosis /
Tardus Parvus waveform /
Quantitative technique of CEUS microperfusion
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] Goldsmith LE, Wiebke K, Seal J, et al. Complications after endovascular treatment of hepatic artery stenosis after liver transplantation[J]. J Vasc Surg, 2017, 66(5): 1488-1496.
[2] 黄勇慧, 杨建勇, 陈伟, 等. 介入放射学诊疗肝移植后血管并发症的初步探讨[J]. 中华放射学杂志, 2001, 35(6): 53-56.
[3] 李建初, 姜玉新, 秦卫, 等. Tardus-Parvus波形在肾动脉狭窄诊断中的应用研究[J]. 中华超声影像学杂志, 2006, 15(9): 677-680.
[4] Xie F, Wan WB, Fei X, et al. Quantitative evaluation of hepatic microvascular perfusion after ischemia-reperfusion injury in rabbits by contrast-enhanced ultrasound perfusion imaging[J]. Braz J Med Biol Res, 2018, 51(4): e7058.
[5] Manzia TM, Angelico R, Toti L,et al. Primary stent placement for hepatic artery stenosis after liver transplantation: improving primary patency and re-intervention rates[J]. Liver Transpl, 2018, 24(9): 1199-1208.
[6] 张国伟, 周杰. 供肝修整过程中防止肝动脉损伤的解剖方法[J]. 中国临床解剖学杂志, 2012, 30(2): 237-238, 242.
[7] Chung YK, Choi HJ, Na GH, et al. Postoperative doppler ultrasonography in liver transplantation[J]. Transplant Proc, 2018, 50(4): 1100-1103.
[8] Jin JS, Kim KW, Choi SH et al. Hepatic artery occlusion after liver transplantation in patients with doppler ultrasound abnormality: increasing sensitivity of contrast-Enhanced ultrasound diagnosis[J]. Korean J Radiol, 2019, 20(3): 459-468.
[9] Bude RO, Rubin JM, Platt JF, et al. Pulsus tardus: its cause and potential limitations in detection of arterial stenosis[J]. Radiology, 1994, 190(3): 779-784.
[10] Zheng BW, Tan YY, Fu BS, et al. Tardus parvus waveforms in Doppler ultrasonography for hepatic artery stenosis after liver transplantation: can a new cut-off value guide the next step[J]? Abdom Radiol, 2018, 43(7): 1634-1641.
[11] Derchi LE, Martinoli C, Pretolesi F, et al. Quantitative analysis of contrast enhancement[J]. Eur Radiol, 1999, 9(Suppl 3): S372-S376.
[12] 周易, 梁蕾, 孟晓暄, 等. 实时CEUS评估甲状腺乳头状癌侵袭性及其与病理微血管密度的关系[J]. 中国医学影像技术, 2019, 35(7): 993-996.
[13] Alzaraa A, Al-Leswas D, Chung WY, et al. Contrast-enhanced ultrasound detects perfusion defects in an ex vivo porcine liver model: a useful tool for the study of hepATic reperfusion[J]. J Artif Organs, 2013, 16(4): 475-482.
[14]Li H, Lu J, Zhou X, et al. Quantitative analysis of hepatic microcirculation in rabbits after liver ischemia-reperfusion injury using contrast-enhanced ultrasound[J]. Ultrasound Med Biol, 2017, 43(10): 2469-2476.
[15] 李杰, 董宝玮, 于晓玲, 等. 肝不同部位灰阶超声造影定量分析的实验研究[J]. 中华超声影像学杂志, 2004(6): 59-61.
[16] 沈文, 尹建中, 陈光, 等. 多层面螺旋CT对肝移植术后肝动脉狭窄肝灌注的研究[J]. 临床放射学杂志, 2003, 22(6): 482-485.
[17]Joo I, Lee JY, Lee DH, et al. Contrast-enhanced ultrasound using perfluorobutane-containing microbubbles in the assessment of liver allograft damage: an explorATory prospective study[J]. Ultrasound Med Biol, 2017, 43(3): 621-628.
[18] 张青萍, 周翔, 柳建华. 新型超声造影剂对组织器官血流灌注的研究[J]. 放射学实践, 2000, 15(3): 170-172.
[19] 杨琛, 彭婵娟. 超声造影定量评价体系及其影响因素分析[J]. 中国肿瘤, 2016, 25(3): 212-218.
[20] 刘秋颖. 超声造影评价兔动脉狭窄及其在观察不同程度球囊损伤后动脉狭窄中的应用[D]. 沈阳: 中国医科大学, 2009.
[21] 魏芳, 何晶玲, 龙春艳, 等. 超声造影定量分析失血性休克复苏期肝血流灌注变化的实验研究[J]. 中国医学影像学杂志, 2017, 25(6): 409-413.
基金
深圳市科技创新委员会（JCYJ20170413161913429）；深圳市医疗卫生三名工程（SZSM201612027）
京ICP备08002354号-3
