Renal Allografts: Prospective Analysis of Doppler Sonography

Allen, Kenneth S.; Jorkasky, Diane K.; Arger, Peter H.; Velchik, Michael G.; Grumbach, Kathryn; Coleman, B G; Mintz, Marshall C.; Betsch, S E; Perloff, Leonard J.

doi:10.1016/s0022-5347(17)41116-5

Cited by 8 publications

(6 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…They found the sensitivity and specificity for OS (at an RI of ~ 0.75) to be 76% and 83%, respectively, similar to our results. Their sensitivity and specificity (63% and 94%, respectively) for the RS examinations 12 were higher than we found. Their better RS results could be due to their use of IH in addition to technetium-99m DTPA, or to the different distribution of causes of allograft dysfunction in the two study groups.…”

Section: Discussioncontrasting

confidence: 85%

“…The only other comparative study of OS and RS in renal allografts was reported by Allen et al 12 Their study differed from ours in at least two respects: (1) they used two radionuclides: technetium-99m DTPA and iodine 131 hippuran (IH); and (2) ATN was the cause of allograft dysfunction in many of their patients, but none of the patients in this study had ATN. They found the sensitivity and specificity for OS (at an RI of ~ 0.75) to be 76% and 83%, respectively, similar to our results.…”

Section: Discussionmentioning

confidence: 64%

“…12 The aim of this study is to compare the accuracy of these examinations in the detection of all forms of rejection.…”

mentioning

confidence: 99%

See 2 more Smart Citations

Detection of rejection in renal allografts. Evaluation with duplex sonography and DTPA renal scintigraphy with kidney/aorta perfusion ratios.

Don

Kopecky²,

Tuli³

et al. 1990

Journal of Ultrasound in Medicine

View full text Add to dashboard Cite

Duplex sonography and technetium-99m DTPA renal scintigraphy have been used to distinguish acute rejec· tion from other forms of renal allograft dysfunction. In this study, duplex sonography and renal scintigraphy were compared as methods to detect rejection. Eighty· four episodes of renal allograft dysfunction that had concurrent duplex sonography and renal scintigraphy over a 17 -month period were reviewed. During the duplex sonography examinations the resistive index (RI) was measured from the renal cortex. Scintigrams were evaluated for allograft perfusion and function, The kidney to aorta (K/A) ratio was calculated from the upstroke T he evaluation of the dysfunctioning renal allograft commonly includes renal scintigraphy (RS) and duplex sonography (OS). The aim of imaging is to separate rejection, especially acute rejection (AR), from other forms of allograft dysfunction, which includes acute tubular necrosis (ATN), cyclosporine A (CSA) toxicity, ureteral obstruction, infection, and renal artery stenosis.All forms of rejection, including hyperacute rejection (HR), AR, and chronic rejection ( CR) cause luminal narrowing of renal arteries and arterioles whether due to humoral vasculitis, cellular infiltration, or fibrosis. 1 -3 This luminal narrowing results in increased vascular impedance.•-6 OS is a sensitive method of detecting in· Received September 6, 1989, from the Department of Radiology, Indiana University Medical Center, Indianapolis, Indiana. Revised manuscript accepted for publication March 14, 1990.Address correspondence and reprint requests to Dr. Kopecky: Indiana University Hospital, Room X64, 926 West Midtigan Street, Indianapolis, IN 46223. of the perfusion curve. All diagnoses were established by clinical criteria. Histologic proof was available in 49 cases. There were two episodes of hyperacute rejection, 30 episodes of acute rejection, 14 episodes of chronic rejection, and 38 episodes of dysfunction without rejec· tion. Using an Rl 2: 0.70, the sensitivity and specificity for detecting acute rejection were 90% and 76%, respectively, compared with 37% and 76% for renal scintigraphy. The KJA ratio was not helpful in the diagnosis of rejection.

show abstract

Section: Discussioncontrasting

confidence: 85%

Section: Discussionmentioning

confidence: 64%

See 1 more Smart Citation

Detection of rejection in renal allografts. Evaluation with duplex sonography and DTPA renal scintigraphy with kidney/aorta perfusion ratios.

Don

Kopecky²,

Tuli³

et al. 1990

Journal of Ultrasound in Medicine

View full text Add to dashboard Cite

show abstract

“…This has been explained by an elevated peripheral vascular resistance [2,14]. Other work has shown that the elevated RI, although indicative of pathology, is not specific for rejection and can be found in acute tubular necrosis, cyclosporine toxicity, and hydronephrosis [1, [3][4][5]. Even the weight of the transducer can affect the RI [14].…”

Section: Discussionmentioning

confidence: 99%

Hepatic arterial resistive indices: Correlation with the severity of cirrhosis

et al. 1993

View full text Add to dashboard Cite

Forty-three patients who were scheduled to undergo a percutaneous liver biopsy were evaluated with Doppler sonography to determine the hepatic arterial resistive index (RI). The histologic specimens were graded by a pathologist regarding cirrhosis and inflammation. The specimens demonstrated no cirrhosis in 12 of 43 (28%) patients, early cirrhosis in 10 of 43 (23%), and established cirrhosis in 21 of 43 (49%). Analysis also revealed that inflammation was absent in three of 43 (7%) patients, minimal in seven of 43 (16%), mild in 17 of 43 (40%), moderate in 13 of 43 (30%), and severe in three of 43 (7%). Hepatic artery RIs (without correction for heart rate) ranged from 0.64 +/- 0.06 in patients with early cirrhosis to 0.68 +/- 0.09 in patients with severe inflammation. There was no significant correlation between the degree of cirrhosis and/or inflammation and hepatic artery RI (with or without correction for heart rate). We conclude that Doppler determination of hepatic artery RIs is not a reliable method of predicting the severity of hepatic cirrhosis and/or inflammation.

show abstract

“…Since there is a considerable overlap in the indices of patients with 'normal' function, ATN and patients with acute rejection, a single PI and RI value is of limited utility in the diagnosis [3,8,91. Trilaud et al [9] reported that one-time Doppler sonongraphy (n = 3 1 patients) is insensitive in differentiating the causes of graft dysfunction.…”

Section: Discussionmentioning

confidence: 99%

Utility of serial Doppler ultrasound scans for the diagnosis of acute rejection in renal allografts

Sharma

Rustom

Evans

et al. 2004

Transplant International

View full text Add to dashboard Cite

This study aims to explore the utility of serial duplex scanning and to compare its results with those of single time-point scans of renal allografts in the diagnosis of acute rejection (AR). A retrospective analysis of 60 17 serial duplex scans (mean: 9.8 scans per patient, 5.7 of which were done during the first 10 days) was performed in 614 patients with 462 episodes of AR from 1992-2000. Even in the absence of AR (n = 278), there were day-to-day fluctuations in pulsatility index (PI) and resistive index (RI). An increase of > 10% in intra-renal indices was noted 0.95 days (mean) before the commencement of treatment for AR (SD 1.3, range 1-6 days). In patients with acute tubular necrosis (ATN), who have high base line indices, sensitivity of single value of PI and RI was 58% (cut-off level 1.8) and 68% (cut-off level 0.8), with specificity of 66% and 56%, respectively. By contrast, a > 10% increase over the previous 'best' in PI and RI had a sensitivity of 78% and 60% respectively, and a specificity of 78% and go%, respectively. Reversal of flow during diastole (n = 50) was found to be associated with 22% graft loss within 3 months of transplantation. We can conclude that a considerable overlap between the indices of patients with AR and those with ATN greatly limits the diagnostic yield of duplex scanning. Nonetheless, serial scanning of renal allografts is more likely to herald the need for biopsy in the diagnosis of AR than one-time scanning.

show abstract

Renal Allografts: Prospective Analysis of Doppler Sonography

Cited by 8 publications

References 0 publications

Detection of rejection in renal allografts. Evaluation with duplex sonography and DTPA renal scintigraphy with kidney/aorta perfusion ratios.

Detection of rejection in renal allografts. Evaluation with duplex sonography and DTPA renal scintigraphy with kidney/aorta perfusion ratios.

Hepatic arterial resistive indices: Correlation with the severity of cirrhosis

Utility of serial Doppler ultrasound scans for the diagnosis of acute rejection in renal allografts

Contact Info

Product

Resources

About