Contribution of sonographic contrast media in assessment of pancreatic transplantation / Contribuição do meio de contraste ultra-sonográfico na avaliação do pâncreas transplantado

AUTOR(ES)
DATA DE PUBLICAÇÃO

2008

RESUMO

INTRODUCTION: Pancreatic transplantation is the long-term therapeutic option for maintaining normoglycemic status in patients with type 1 diabetes mellitus. Sonographic contrast medium allows to evaluate tissue perfusion but there are no studies comparing this parameter in normal and pathologic pancreatic grafts in the literature at the time of this writing. The importance of assessment of graft perfusion and the potential role of contrast-enhanced sonography with microbubbles in this regard were the reasons for this research. The study conducted at the Instituto de Radiologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo between November, 2004 and September, 2006 had the following objectives: A) to establish patterns of graft vascularization in normal patients and in those with suspected abnormalities; B) to compare grayscale mode and contrastenhanced sonographic findings with clinical status, laboratory results, and need for exogenous insulin; C) to define the role of contrast-enhanced sonography with microbubbles in the evaluation of pancreatic transplantation.MATERIALS AND METHODS: Twenty-six patients underwent a total of 30 sonographic examinations with microbubbles, 20 (66.7%) men and 10 (33.3%) women. Age range was 25 to 51 years, with a mean of 40 years (+ 7.3 years). Time elapsed between transplantation and imaging ranged from 1 day to 63 months (median, 24 months). Using grayscale mode, pancreas was assessed for echogenicity, dimensions (both quantitatively and qualitatively) and contours. Following intravenous contrast medium administration, time for enhancement of the pancreatic graft, pattern and intensity of enhancement were documented. A classification system based on grayscale and contrast-enhanced sonographic findings was designed, with the following categories: normal perfusion pattern, acute changes (rejection, pancreatitis or thrombosis) and chronic changes (chronic rejection). RESULTS: There was a statistically significant association between echogenicity and clinical status (p=0.010); echogenicity and need for exogenous insulin (p=0.021); dimensions (qualitative criteria) and clinical status (p=0.011); dimensions (qualitative criteria) and need for exogenous insulin (p=0.028); pattern (p=0.024) and intensity of enhancement versus clinical status (p=0.039). There was also statistically significant association between need for exogenous insulin and graft perfusion (p=0.014), and sonography-based diagnosis (p=0.001). CONCLUSION: The study provided patterns of vascularization in normal pancreatic grafts and in patients with suspected abnormalities. Distinction of normal and abnormal pancreatic grafts was possible using echogenicity and qualitative analysis of graft size on grayscale mode. Contrast-enhanced sonography with microbubbles also contributed to differentiation between normal and abnormal pancreatic grafts, using pattern and intensity of enhancement and perfusion of the graft during the arterial phase.

ASSUNTO(S)

diabetes mellitus diagnostic imaging microbolhas diagnóstico por imagem diabetes mellitus transplante de pâncreas sonography ultra-sonografia microbubbles pancreas transplantation

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