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When is contrast-enhanced sonography preferable over conventional ultrasound combined with Doppler imaging in renal transplantation?

Zeisbrich M, Kihm LP, Drüschler F, Zeier M, Schwenger V - Clin Kidney J (2015)

Bottom Line: It is an easy to perform and non-invasive imaging technique that augments diagnostic capabilities in patients after renal transplantation.Specifically in the postoperative setting, CES has been shown to be superior to conventional ultrasound in combination with Doppler imaging in uncovering even subtle microvascular disturbances in the allograft perfusion.In addition, quantitative perfusion parameters derived from CES show predictive capability regarding long-term kidney function.

View Article: PubMed Central - PubMed

Affiliation: Department of Nephrology , University Hospital , Heidelberg , Germany.

ABSTRACT
Conventional ultrasound in combination with colour Doppler imaging is still the standard diagnostic procedure for patients after renal transplantation. However, while conventional ultrasound in combination with Doppler imaging can diagnose renal artery stenosis and vein thrombosis, it is not possible to display subtle microvascular tissue perfusion, which is crucial for the evaluation of acute and chronic allograft dysfunctions. In contrast, real-time contrast-enhanced sonography (CES) uses gas-filled microbubbles not only to visualize but also to quantify renal blood flow and perfusion even in the small renal arterioles and capillaries. It is an easy to perform and non-invasive imaging technique that augments diagnostic capabilities in patients after renal transplantation. Specifically in the postoperative setting, CES has been shown to be superior to conventional ultrasound in combination with Doppler imaging in uncovering even subtle microvascular disturbances in the allograft perfusion. In addition, quantitative perfusion parameters derived from CES show predictive capability regarding long-term kidney function.

No MeSH data available.


Related in: MedlinePlus

Kidney allograft with a thrombus in the renal transplant artery. CES mode reveals a missing tissue perfusion in two-thirds of the organ (arrows). Blood supply of the cranial renal pole is ensured by a segmental artery that originates proximal from the thrombus.
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SFV070F3: Kidney allograft with a thrombus in the renal transplant artery. CES mode reveals a missing tissue perfusion in two-thirds of the organ (arrows). Blood supply of the cranial renal pole is ensured by a segmental artery that originates proximal from the thrombus.

Mentions: The potency of CES arises in the follow-up examination for the assessment of postoperative microvascular graft perfusion. To determine a homogenous allograft perfusion, CES is a valuable tool, whereas conventional ultrasound is not able to show microvascular perfusion accurately [7]. This is of particular importance when graft function is delayed despite regular colour Doppler indices and no detectable signs of disturbed allograft perfusion. Then, the qualitative assessment with CES technique enables even small areas of postoperative disturbed perfusion to be uncovered as well as local parenchyma infarction, which may be a feasible explanation for delayed graft function (Figure 3). In a comparative study, CES technique was superior in the identification of parenchyma perfusion disturbances to conventional ultrasound with colour and power Doppler. CES revealed quantitatively more perfusion disturbances and visualized them more precisely [32].Fig. 3.


When is contrast-enhanced sonography preferable over conventional ultrasound combined with Doppler imaging in renal transplantation?

Zeisbrich M, Kihm LP, Drüschler F, Zeier M, Schwenger V - Clin Kidney J (2015)

Kidney allograft with a thrombus in the renal transplant artery. CES mode reveals a missing tissue perfusion in two-thirds of the organ (arrows). Blood supply of the cranial renal pole is ensured by a segmental artery that originates proximal from the thrombus.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4581388&req=5

SFV070F3: Kidney allograft with a thrombus in the renal transplant artery. CES mode reveals a missing tissue perfusion in two-thirds of the organ (arrows). Blood supply of the cranial renal pole is ensured by a segmental artery that originates proximal from the thrombus.
Mentions: The potency of CES arises in the follow-up examination for the assessment of postoperative microvascular graft perfusion. To determine a homogenous allograft perfusion, CES is a valuable tool, whereas conventional ultrasound is not able to show microvascular perfusion accurately [7]. This is of particular importance when graft function is delayed despite regular colour Doppler indices and no detectable signs of disturbed allograft perfusion. Then, the qualitative assessment with CES technique enables even small areas of postoperative disturbed perfusion to be uncovered as well as local parenchyma infarction, which may be a feasible explanation for delayed graft function (Figure 3). In a comparative study, CES technique was superior in the identification of parenchyma perfusion disturbances to conventional ultrasound with colour and power Doppler. CES revealed quantitatively more perfusion disturbances and visualized them more precisely [32].Fig. 3.

Bottom Line: It is an easy to perform and non-invasive imaging technique that augments diagnostic capabilities in patients after renal transplantation.Specifically in the postoperative setting, CES has been shown to be superior to conventional ultrasound in combination with Doppler imaging in uncovering even subtle microvascular disturbances in the allograft perfusion.In addition, quantitative perfusion parameters derived from CES show predictive capability regarding long-term kidney function.

View Article: PubMed Central - PubMed

Affiliation: Department of Nephrology , University Hospital , Heidelberg , Germany.

ABSTRACT
Conventional ultrasound in combination with colour Doppler imaging is still the standard diagnostic procedure for patients after renal transplantation. However, while conventional ultrasound in combination with Doppler imaging can diagnose renal artery stenosis and vein thrombosis, it is not possible to display subtle microvascular tissue perfusion, which is crucial for the evaluation of acute and chronic allograft dysfunctions. In contrast, real-time contrast-enhanced sonography (CES) uses gas-filled microbubbles not only to visualize but also to quantify renal blood flow and perfusion even in the small renal arterioles and capillaries. It is an easy to perform and non-invasive imaging technique that augments diagnostic capabilities in patients after renal transplantation. Specifically in the postoperative setting, CES has been shown to be superior to conventional ultrasound in combination with Doppler imaging in uncovering even subtle microvascular disturbances in the allograft perfusion. In addition, quantitative perfusion parameters derived from CES show predictive capability regarding long-term kidney function.

No MeSH data available.


Related in: MedlinePlus