肾灌注的容积超声造影显像.pptx

Volumetric contrast-enhanced ultrasound imaging of renal perfusion肾灌注容积超声造影显像肾灌注的容积超声造影显像第1页肾灌注的容积超声造影显像第2页一 ObjectiveVolumetric contrast-enhanced ultrasound(VCEUS)imaging has the potential to monitor changes in renal perfusion following vascular injury.容积超声造影显像能够作为一个监测血管损伤后肾脏灌注改变潜在伎俩。肾灌注的容积超声造影显像第3页Current methods for quantifying AKI are searching for bio-markers indicative of kidney injury such as positive fluctuations in serum creatinine.However,serum creatinine levels lack the sensitivity and specificity necessary for early detection.Due to the nephrotoxic nature of both CT and MR contrast agents,other standard perfusion imaging modalities are not suitable for diagnosis and monitoring of AKI.当前确诊AKI方法主要经过寻找血液中肾脏损害生物标志物，比如血肌酐水平升高。不过血肌酐缺乏早期诊疗敏感性及特异性。因为CT及MR造影本身存在肾毒性，而其它标准灌注显像模式不适合诊疗及监测AKI。肾灌注的容积超声造影显像第4页VCEUS could provide a more detailed idea of the actualpercentage of ischemic tissue resulting from this renal complication by identifying regions of ischemic tissue.经过判别缺血组织区域，肾脏造影能够对因为肾脏并发症造成缺血组织实际百分比提供愈加细致理念。肾灌注的容积超声造影显像第5页The focus of this paper is to investigate the repeatability and robustness of VCEUS imaging for tracking perfusion changes in the healthy and injured kidney.这篇文章主要致力于观察超声造影显像追踪正常及受损肾脏灌注改变可重复性及稳定性。肾灌注的容积超声造影显像第6页二MethodVCEUS utilizes a series of planar image acquisitions,capturing the non-linear second harmonic signal from microbubble(MB)contrast agents flowing in the vasculature.Tissue perfusion parameters(peak intensity,IPK;time-to-peak intensity,TPK;wash-in rate,WIR;areaunder curve,AUC)were derived from time-intensity curve data collected during in vitro flow phantom studies and in vivo animal studies of healthy and injured kidney.容积超声造影经过一系列二维图像采集，捕捉流入脉管系统微气泡造影剂形成非线性二次谐波信号。在体外流速模型及体内正常/受损肾脏动物研究中，搜集来自时间-强度曲线组织灌注参数（峰强度、达峰值强度时间、內洗率、曲线下面积）。肾灌注的容积超声造影显像第7页For the flow phantom studies,either the concentration of MB contrast agent was held constant(10 L/L)with varying volumetric flow rates(10,20,and 30 mL/min)or the flow rate was held constant(30 mL/min)and the contrast agent concentration was varied(5,10,and 20 L/L).在体外流速模型研究中，确保微气泡浓度稳定（10 L/L），改变容积流速率（10,20,and 30 mL/min），或者确保流速稳定（30 mL/min），改变微气泡浓度(5,10,and 20 L/L)。肾灌注的容积超声造影显像第8页Animal studies were performed using either healthy rats or those that underwent renal ischemia-reperfusion injury.A series of renal studies were performed using healthy rats(N=4)while the angle of the transducer was varied for each VCEUS image acquisition(reference or 0,45,and 90)to assess if repeated renal perfusion measures were isotropic and independent of transducer position.Blood serumbiomarkers and immunohistology were used to confirm acute kidney injury.动物研究应用健康小鼠及遭受缺血再灌注小鼠来完成。用正常小鼠完成一系列肾脏研究，每次超声造影图像采集传感器角度是多变（参考角度为0、45、90），方便评定重复肾脏灌注方法是等向性，其独立于传感器方位。血浆生物标识物及免疫组织学用来确诊急性肾损害。肾灌注的容积超声造影显像第9页三Results1.Flow phantom results revealed a linear relationship between MB concentrations injected into the flow system and the IPK,WIR,and AUC perfusion measures(R2 0.56,P 0.77,P 0.56，P 0.77,P 0.005)。肾灌注的容积超声造影显像第10页图1a显示固定容积流速，改变微泡造影剂浓度所形成时间-强度曲线。三条时间强度曲线均在同一时间到达了峰强度。Figure 1a shows time-intensity curves for three different MB concentrations for a fixed volumetric flow rate.All three time-intensity curves reach their peak intensity at the same time point。The derived perfusion parameters from time-intensity curve data(i.e.,IPK,TPK,WIR,and AUC)are described in Figure 1a.从时间强度曲线中能够得出IPK/TPK/WRI/AUC等灌注参数。肾灌注的容积超声造影显像第11页IPK revealed a linear relationship with the concentration of contrast agent used(Figure 2e,R2=0.56,P 0.001),as did WIR(Figure2g,R2=0.75,P 0.005)and AUC(Figure 2h,R2=0.93,P 0.001).TPK(Figure 2b,R2=0.93,P 0.001),WIR(Figure 2c,R2=0.92,P 0.001),and AUC(Figure 2d,R2=0.77,P 0.85)as well as IPK with respect to flow speed(Figure 2a,P 0.06).肾灌注的容积超声造影显像第12页2.No significant difference was found between the transducer angle during data acquisition and any of the derived renal perfusion measures(P 0.60).2.数据获取期间传感器角度与全部肾脏灌注参数之间无显著性相关性(P 0.60)。肾灌注的容积超声造影显像第13页Figure 3 illustrates the time intensity curves obtained at different transducer orientations:0(origin),45,and 90.Importantly,a strong correlation was found between time intensity curves acquired at the various transducer scanning angles(0.98,P 0.48).图4提醒灌注参数与接收器角度改变之间关系。从图中能够看出四个灌注参数与与传感器角度无统计学差异(P 0.48)。肾灌注的容积超声造影显像第15页3.After induction of renal ischemia-reperfusion injury in a rat animal model(N=4),VCEUS imaging of the injured kidney revealed an initial reduction in renal perfusion when compared to control animals followed by a progressive recovery of vascular function.3.建立老鼠肾脏缺血再灌注损害动物模型后，与连续血管功效恢复对照组动物模型组相比，受损肾脏容积超声造影图像显示肾脏灌注显著降低。肾灌注的容积超声造影显像第16页Figure 5 depicts the relative difference between the percent change of the mean values for each of the perfusion measurement obtained in control kidneys and those subjected to acute ischemic conditions.Early US measurements indicate that perfusion was considerably lower in the injured kidneys.图5描述对照组肾脏及缺血再灌注肾脏组两组间每个灌注值均数值改变相对偏差。早期提醒灌注超声参数，肾损伤组较对照组显著下降。肾灌注的容积超声造影显像第17页Specifically,the IPK parametric measurement was the most disparate at the 5-hr time point and most similar at the 48-hr time point.This data suggests that postsurgery the injury group was less perfused than the control group,and by the 48-hr time point limited reperfusion had occurred.Similar results were found for TPK,WIR,and AUC demonstrating a peak difference at either the 5-hr or 24-hr time point with an increase in similarity to control measures by the 48-hr time point.尤其是灌注参数IPK，在第5小时是最不一样，在48小时是最相同。这组数听说明，与对照组相比，术后肾损害组存在低灌注，在48小时时出现有限再灌注。其它灌注参数也有相同结果，与对照组相比，TPK、WIR及AUC在5小时或24小时时到达峰值差异，在48小时时逐步增加到对照组参数相同值。肾灌注的容积超声造影显像第18页This was also supported by serum creatinine levels,as shown in Figure 6,where there was a peak in the difference between mean serum creatinine values from control rats and rats subjected to ischemic injury at the 24-hr time point and then had partially recovered by 48 hr.图6中血浆肌酐水平能支持上述结果，在24小时时，对照组小鼠及缺血再灌注小鼠肌酐水平均数差值到达最大，在48小时时有部分恢复。肾灌注的容积超声造影显像第19页四DiscussionEnhancing methods for detecting severity of AKI has the potential of improving patient outcome by increasing the information,knowledge and understanding of how to treat the disease.The strategies investigated here are intended to supplement current methods to gain a more informative description of AKI where portions of the tissue become is-chemic.经过优化提升探知AKI严重性方法，增加对怎样治疗AKI信息、知识和了解，为提升患者预后提供可能性。本文目标是为当前方法提供补充，方便对由缺血造成AKI提供愈加详尽描述。肾灌注的容积超声造影显像第20页五ConclusionAcute kidney injury is a serious disease in need of more methods to help diagnose extent of injury and monitor the tissue throughout disease progression.Data and preliminary work described shows that further examinations of these methods have the potential of increasing the understanding of how the disease progresses on a patient to patient basis.急性肾损害是一个非常严重疾病，需要更多方法去诊疗损伤程度，动态监测疾病过程肾脏改变。本文所描述前期工作和数据显示，这些方法深入检验有一定潜能，能够提升我们对患者疾病病程了解。肾灌注的容积超声造影显像第21页This data suggests that transducer angulation for VCEUS does not affect time-intensity curves or the resulting perfusion parameters derived from them.Successfully identifying ischemic regions through future studies could potentially improve treatment strategies and boost patient prognosis.本文说明传感器获取图像角度对时间强度曲线及由其所取得灌注参数不会造成影响。未来经过深入研究来成功断定缺血部位，可能提升治疗策略及预后。肾灌注的容积超声造影显像第22页谢谢肾灌注的容积超声造影显像第23页