Transplant renal artery stenosis: Evaluation with contrast-enhanced ultrasound

Objective: To assess the efficacy of contrast-enhanced ultrasound (CEUS) in depicting transplant renal artery stenosis (TRAS). Materials and methods: Seventy-eight patients (56 men and 22 women; aged 36 I 12.2 years) who were suspected of TRAS due to either Doppler ultrasound (DUS) abnormalities or difficult control of blood pressure and/or persistent deterioration of renal function were enrolled to perform CEUS. The reference standard for the TRAS diagnoses was computed tomography angiography (CTA). The diagnostic performance of DUS and CEUS parameters was assessed by the area under the receiver operating characteristic curve (AUC). Results: TRAS was diagnosed in 32 out of 78 cases by CTA. The AUC, accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of CEUS in predicting TRAS were 0.92, 92.3%, 87.5%, 95.7%, 93.3%, and 91.7%, respectively. CEUS rectified 13 (28.3%) false-positive cases on DUS, which were confirmed by CTA. Compared to DUS parameters, CEUS showed the highest AUC, statistically significant differences of AUC were found (P=0.006-0.039), except for that of the PSV ratio in the main transplant renal artery to that in interlobar artery (PSV-ratio) (AUC: 0.92 versus 0.86, P=0.422). However, CEUS showed a significantly higher specificity (95.7% versus 76.1%, P= 0.008) and the same sensitivity compared to PSV-ratio. Conclusions: CEUS is superior to DUS in depicting TRAS. Moreover, our results suggest that CEUS might potentially be used as a noninvasive tool to spare many patients from unnecessary CTA. (C) 2017 Elsevier B.V. All rights reserved.