超声造影课件.ppt

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1、关于超声造影现在学习的是第1页，共23页现在学习的是第2页，共23页一 ObjectiveVolumetric contrast-enhanced ultrasound(VCEUS)imaging has the potential to monitor changes in renal perfusion following vascular injury.容积超声造影显像可以作为一种监测血管损伤后肾脏灌注变化的潜在手段。现在学习的是第3页，共23页Current methods for quantifying AKI are searching for bio-markers indica

2、tive 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

3、diagnosis and monitoring of AKI.目前确诊AKI的方法主要通过寻找血液中肾脏损害的生物标志物，例如血肌酐水平升高。但是血肌酐缺乏早期诊断的敏感性及特异性。由于CT及MR造影本身存在肾毒性，而其他标准灌注显像模式不适合诊断及监测AKI。现在学习的是第4页，共23页VCEUS could provide a more detailed idea of the actualpercentage of ischemic tissue resulting from this renal complication by identifying regions of ische

4、mic tissue.通过鉴别缺血组织区域，肾脏造影能够对由于肾脏并发症造成的缺血组织的实际百分比提供更加细致的理念。现在学习的是第5页，共23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变化的可重复性及稳定性。现在学习的是第6页，共23页二MethodVCEUS uti

5、lizes 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 c

6、urve data collected during in vitro flow phantom studies and in vivo animal studies of healthy and injured kidney.容积超声造影通过一系列的二维图像采集，捕捉流入脉管系统的微气泡造影剂形成的非线性二次谐波信号。在体外流速模型及体内正常/受损肾脏的动物研究中，收集来自时间-强度曲线的组织灌注参数（峰强度、达峰值强度时间、內洗率、曲线下面积）。现在学习的是第7页，共23页For the flow phantom studies,either the concentration of MB

7、 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，保证微气泡浓度稳定（10 L/L），改变容积流速率（10,20,and 30 mL/min），或者保证流速稳定（30 mL/min），改变微气泡浓度(5,10,and

8、 20 L/L)。现在学习的是第8页，共23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

9、 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的小鼠来完成。用正常小鼠完成一系列肾脏研究，每次超声造影图像采集的传感器角度是多变的（参考角度为0、45、90），以便评估重复的肾脏灌注方法是等向性的，其独立于传感器方位。血浆生物标记物及

10、免疫组织学用来确诊急性肾损害。现在学习的是第9页，共23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)。现在学习的是第10页，共23页图1a显示固定容积流速，改变微泡造影剂浓度所形成的时间-强度曲线。三条时间强度曲线均在同一时间达到了峰强度。Fig

11、ure 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

12、 1a.从时间强度曲线中可以得出IPK/TPK/WRI/AUC等灌注参数。现在学习的是第11页，共23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

13、(Figure 2d,R2=0.77,P 0.85)as well as IPK with respect to flow speed(Figure 2a,P 0.06).现在学习的是第12页，共23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所有肾脏灌注参数之间无显著性相关性(P 0.60)。现在学习的是第13页，共

14、23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提示灌注参数与接收器角度变化之间的关系。从图中可以看出四个灌注参数与与传感器角度无统计学差

15、异(P 0.48)。现在学习的是第15页，共23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

16、后，与持续血管功能恢复的对照组动物模型组相比，受损肾脏的容积超声造影图像显示肾脏灌注显著降低。现在学习的是第16页，共23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

17、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的均数值变化的相对偏差。早期提示灌注的超声参数，肾损伤组较对照组明显下降。现在学习的是第17页，共23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

18、 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-h

19、r time point.尤其是灌注参数IPK，在第5小时是最不同的，在48小时是最相似的。这组数据说明，与对照组相比，术后肾损害组存在低灌注，在48小时时出现有限的再灌注。其它灌注参数也有相似结果，与对照组相比，TPK、WIR及AUC在5小时或24小时时达到峰值差异，在48小时时逐步增加到对照组参数相似值。现在学习的是第18页，共23页This was also supported by serum creatinine levels,as shown in Figure 6,where there was a peak in the difference between mean seru

20、m 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达到最大，在48小时时有部分恢复。现在学习的是第19页，共23页四DiscussionEnhancing methods for detecting severity of AKI has the potential of i

21、mproving 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.通过优化提高探知AKI严重性的方法，增加对

22、怎样治疗AKI的信息、知识和理解，为提高患者预后提供可能性。本文目的是为目前的方法提供补充，以便对由缺血造成的AKI提供更加详尽的描述。现在学习的是第20页，共23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 furthe

23、r examinations of these methods have the potential of increasing the understanding of how the disease progresses on a patient to patient basis.急性肾损害是一种非常严重的疾病，需要更多的方法去诊断损伤程度，动态监测疾病过程肾脏变化。本文所描述的前期工作和数据显示，这些方法进一步检查有一定的潜能，能够提高我们对患者疾病病程的理解。现在学习的是第21页，共23页This data suggests that transducer angulation for

24、 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获得的灌注参数不会造成影响。将来通过进一步研究来成功断定缺血部位，可能提高治疗策略及预后。现在学习的是第22页，共23页感谢大家观看现在学习的是第23页，共23页