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Clinical Use of Renal Perfusion Imaging by Means of Harmonic Sonography With a Microbubble Contrast Agent in Patients After Renal Transplantation

Preliminary Study

Department of Radiology, Soonchunhyang University Hospital, Seoul, Korea (J.H.K., D.E.G., D.L.C.); Department of Diagnostic Radiology, College of Medicine, Ewha Womans University, Tongdaemun Hospital, Seoul, Korea (H.W.E.); and Department of Preventive Medicine, College of Medicine, Hallym University, Seoul, Korea (H.J.L.).

Address correspondence to Jung Hoon Kim, MD, Department of Radiology, Soonchunhyang University Hospital, 657 Hannam-Dong, Youngsan-Ku, Seoul 140-743, Korea. E-mail: junghkim{at}hosp.sch.ac.kr

Objective. The purpose of this research was to determine the feasibility of renal perfusion imaging by means of harmonic sonography with a microbubble contrast agent for the evaluation of renal perfusion after renal transplantation compared with technetium Tc 99m diethylenetriamine pentaacetic acid (^99mTc-DTPA) scans. Methods. During a 10-month period, 100 patients with renal transplantation that included normal perfusion (n = 68) and delayed perfusion including chronic rejection (n = 19), acute rejection (n = 9), arterial stenosis (n = 2), and urinary stricture (n = 2) underwent sonographic renal perfusion imaging and ^99mTc-DTPA scans. Sonographic images were obtained every 3 seconds for a total of 3 minutes after administration of a bolus injection of 4 g of the microbubble contrast agent at a concentration of 300 mg/mL. Sonographic renal perfusion images were converted into a renal perfusion curve, and the calculated time at the peak of the curve (T_peak) was compared with that of the ^99mTc-DTPA scan. Results. The T_peak with the ^99mTc-DTPA scan was 14.9 seconds in the normal group and 33 seconds in the delayed perfusion group. The T_peak on sonographic renal perfusion images was 25 seconds in the normal group and 44.8 seconds in the delayed perfusion group. Sonographic renal perfusion images showed good correlation with the ^99mTc-DTPA scan (r = 0.74; P = .0001). The cutoff value of the T_peak on sonographic renal perfusion images was 35 seconds (sensitivity = 85%; specificity = 90%). Conclusions. The renal perfusion images obtained by means of harmonic sonography with a microbubble contrast agent constitute an effective sonographic technique for the evaluation of renal perfusion abnormalities after renal transplantation compared with a ^99mTc-DTPA scan.

Key Words: contrast agent • harmonic sonography • kidney transplantation • perfusion • scintigraphy

Abbreviations: CHA, coded harmonic angio • MI, mechanical index • ^99mTc-DTPA, technetium Tc 99m diethylenetriamine pentaacetic acid • T_peak, time at the peak of the curve

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