11
臯腵腷腨腹腯膄膔膞臅臍 Vol. 36, pp. 435445, 2008 腝腕腔腖腜腄腁腂腆腋腌腉腌腊腈腍腗腎腘腏腚腇 腟腀腃腓腠腑腙腞腅腒腡腛腐 腕腤腅腆 腆腡腣 1 腟腑 腏腄腋 1 腎腦 腛腍腙腋 1 腃腒 腘腏 膵膆腊腧腃腔腥腄 1 腏腛腎腈 1 膕腓 腍腉腢腓 腑腔腞 1 腏腢 1 臓膛 腏腘腇腈 腠腄 1 腝腢 腊腧 腥腄 1 腕腐腞腖 腚腜 2 : 20 10 22 臁膡臙腾臁膱膡腘膖膌臤膚腙臭自臸CKD腗腃腈腥自膧臤膚臩膺腘膆膇腓腀 腗自臸腝腶腘膱膌腲膐腙臛腓腀腥腋腄腋CT MRI 腖腕腘臹膉腘臈腙臬膶腅腀腥腏腟腎腘膐腙膽腖臥膼腅腎腉腓膖自臸腝腶腘膱臧臚臭 腓自膧臤膚臏腗腠腼臲腗膐膓腓腀腥臹膉腉膄腋腏臹膉腗腢腤腙腐腦腥臟腘膀腗腃腈腥膱腔自膧臤膚腔腘膤腘膀腔腘膝膴腧膺腐腏CKD 77 腃腢腚臢膭腔腋腒膳臦臔 5 腗腴腸腱腸腲腭腹 腫腯腬腩腮 腁腏自臸臹 腧臋膺腋腏臹膉腗腢腤臟腘膀腙腐腮腳腶腁腒臟腘膀腢腚腘膀腘臘臜膦臀PSV: peak systolic velocity腊腽膦膱EDV: end diastolic velocity膱膡RI: resistive index腧臺腍腥腔腔腠腗腰腸腪膮腘 1 臰腄腣膱膌膏膊腍腥 VTI velocity-time integral腧臆臝腋腏臹膉膅腖膈腗腢腤臩膺腋腏 CKD 腧膥腟臲腓臟腘膀膐腅膓腔腖腐腏RI 腙臟腘膀腃腢腚腘膀腔腠 CKD 臩膺腓腘腝膀腖臷膒腧臐腋腏RI 腽膙腘臊腓腀腥 PSVEDV腃腢腚 VTI 腙臟腘膀腗腃腁腒腘腝 CKD 致膦腔臩膺腔腘膣腓膀腖膾膁腅腝腣腦腜腏自膧腔膫腁臵膤腧臐腋腏臲臣腗腃腁腒腡自膧臤膚腘臷 腺腙腝腣腦腖腄腐腏自臸臹膉腗腢腤腙腐腊腦腥臟腘膀腄腣腣腦腥膱腘膀膝腋腒腢腤膋腗自膧臤膚腧膊腍腥腉腔腅臐腊腦腏ῐῌ῏ 臹膉臭自臸腘膀腘膀腴腸腱腸腲腭腹 自臸腓腙膴膿腡膱膌膴膿腗膒腂腒膗臶膴 膿腅臨腡膰膕膢臄腗臛腓腀腥自臸腘膗臶臨臕腗膱膡膯腧膥腟腏自臸腘膮腃腢腚膧膐腗腁腣腦腒腁腥自臸腘膱膺腘腄臖臭腘腏 膪膱腗腢腥臎臼臇至腘腧膓腙自臫臒腡臒腓腘臁膡腘膃臜腔膣臒腘臱膂膏腧膈腆膨腉腋自臤膚臩膺腧臡腇臛膇腘膆腑腔膹腂腣腦腒腁 1῍ῐ5腋腏腅腐腒腘膀腧腙腌腟臌膩臁膡臙腾臁膱膡膱膡腖腕腘臟臞膠腧膥腟腏 膌腲膐腅自臑膟臨腓腙臦腗臛腓腀腥膱膡 膯腘膐腗腙臹膉腁腏 CTMRI腃腢腚 1 臯腵腷腨腹腯膄膔膔膞 自臸膻膱腻2 臠膴膿膄膞 435 49

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Page 1: ˘ˇˆ˙˝˛˚˜igakukai.marianna-u.ac.jp/idaishi/www/365/05-36-6Kayori Tsuruoka.pdfVol. 36, pp. 435 445, 2008 ˘ˇˆ˙˝˛˚˜ !" 1 1 1 1 ˘ 1 ˇ 1 ˆ ˙ ˘ ˝˛ ˇˆ˙ ˛ ˝ ˛ ˚

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������������ �������� ��������������������� ������������� � ��� � ���!�"#$�������� � ��%&���'��()�������*��+,-.��/0���1�� �!������2�3* ���'�4����!����5-6-789 �:;<="�������4�>�?�� 5-6-789���@ 2�3mm ��A�B��C� D��+,- ���'E4�>�2�� FG!��H�blood pool agent >)2"IJ#I� �I�K G!$%JLM&N�� �'�K���'%EO�$%��'P6��8�� .�� (Q��R>SK�T�)*+ ������� �UV%EW,%��4�>�2��X��� ����-Y ���'�./%0��� �CKD: chronic kidney disease� UV�12%5-6-789�������!����Z()�� ����%&C��*�� [3�45)� \]6]"#$��%&C��*��>>E%�*�� ����')�� 7��%&C8��^� _$`a8>���J�b> c9�� �*��B�8��:;><dP�>%&C� 0���%e���*���� =>�f?)��

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�� ���bzV�Wc��[>)� deMf��g�%2���hi)�� j�%�����Z()�� kMc�%��-a���l)� mn)�5-6-789�DGop�q 0.015mg�kg 1�2q �0.0075mg�kg���a$�cr)� VYs�t 10ml �6$���)�� �� �'��u� L��v���(�� w�J[3�K���N����Ow�� S�B�Luv����>��[)2u����)�� ����wA%Bx*� 0a>)� cr��&C 45a*�����96)2�^)� t� 10Q*��)�� ���9  y��!�]3 ¡a"¢£�¤%¥z)�� ¦%� �!� B �a"�e&j"#$��DG ���!����Z()��_-�"#$%2� �*�� �interlobar artery:ILA� e&j��*�� �interlobular artery: ILBA� �§�hi)� �¨ ��%e�2� ©{ª�O��|} �peak systolic velocity: PSV�� «~�ª��|} �end diastolic velocity: EDV� �¬�P>>E%� ���§�¥z)����� ����������������­ �resistive index: RI� �� 5�%®� PSV e&j EDV &C¦ ¯�°i)��RI�PSV-EDV��PSV.�� �!�]3%¥z)�"#$±^¢a8�c²±>)2³Ci)� ±^f?:6� MITANIWinROOF��Mitani Corp., Fukui, Japan� ���2� �*��e&j��*�� ���§%e�1� �´N�CB�µ¶C.� �§��� P�¶´�|3*�Q; �velocity-time integral: VTI��°i)� �Fig. 1���CKD ����������� �' ��� CKD Q�9����2�o° GFR �eGFR: estimate-glomerular filtrationrate� ·>%� CKD �¸a¹ 1eGFR 90ml�mintN� CKD �¸a¹ 2eGFR 60�89ml�min�CKD �¸a¹ 3eGFR 30�59ml�min� CKD �¸a¹ 4eGFR 15�29ml�min� CKD �¸a¹ 5 eGFR 15ml�min �� 5 �º%Q�)��CKD �¸a¹ 1 �� n2 >�G%�:�� _-�"#$%28��;� CKD�¸a¹ 2>v��B?���� CKD �¸a¹ 12 >)2w¶�

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���������������������� �������� ������� SAS Jump� �SAS Institute Inc, Cary, NC,USA� ����� �������������� �� ANOVA ���� ��!"#$%&� Welch����������� '(�)*��� Turkey-Kramer � HSD �������� P�0.05�%&����+,-���

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� �CKD 77�./0123 5��� 45�6,� 789:;./0<=>9:;�?�@A���CKD B��C��� D� 21�85 ��� 56.8�16.41�E� ��F� 54�� G� 23�� HIJKLM� �eGFR�3.28�97.5� �36.83�26.12�mlmin,NOPQRSTU �Cr� 0.60�13.66 �2.83�2.67�mgdl� VWX �UP� 0�12.7 �2.09�2.76�ggCr� YZ[\ 72.7�133.7 �104.4�11.58�mm�+]�� 9:;�?�� 74 ��^Y� 3 ��_Y��`��CKD B��ab� Mc�Yd�ef�/,g�hi!j`�`$B�� 26��� IgAYB 12�� kl�mnopqrsBt' 1�� �Vuv(wx

y 3�� ��z{�Y| 2�� ��YB 3�� Y}mB 1 �� ~�JKL}mB 1 �� ����B 1�� R�q�<r�� 1�� opqU� �medullarynephronophthisis� 1 ��+]�� Yd��@A�@A��� 51��� ������� �V�YB 25�� �JKLY| 14�� Y}mB 4�� �(wVuv| 4�-������ ��� 4�������]�� 123� 5 ��� D� 28�31 �29.8�1.64�E� F� 4�� G� 1��+]�� ����Y���)*�����-����� ������A�#�]���B��.`�� 78��/$����� �#¡� 78�¢�£ 3¤¥(�V�Y��xy�z¦�§�#�]��

� � ��������CKD B��Y¨©�ª`�«Y��!¬��­®��`$���� 784�<=>���l�(¯��N�;°������+]�� ���� 78�����/]�� ���.`�l�(¯��N�;°��!±�-#]�� 789:;�?�²³��l�(¯�!��´�$µn�#�¶�� ·¸�CKD �¹rº 3 ./0�¹rº 5 B���»�Fig. 2 �����

Figure 1. The wave profile of color Doppler echography at the position of interlobular

artery. The parameters obtained from the wave profile of doppler echog-

raphy are illustrated. The points of peak systolic velocity �PSV� and enddiastolic velocity �EDV� are as shown in the figure. Velocity-time integral�VTI� denotes the area under the single wave.

YZ789:;�/$l�(¯��N� ¼ 437

51

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�a� Normal �b� CKD Stage 3 �c� CKD Stage 5Figure 2. Representative serial enhancement images with early-phase real-time pulse inversion after a bolus injection

of ultrasound contrast agent in the control subject �a�, patients with CKD stage 3 �b�, and patient withCKD stage 5. Shortly after the injection of contrast agent, enhancement begun from the hilar portion of the

kidney, and then spread peripherally along the interlobar arteries, arcuate arteries, and interlobular arteries

in sequence. The interlobular arteries were visualized even in advanced CKD.

���� �� � �438

52

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�� �������������� ���PSV, EDV, RI, VTI� � CKD ��������CKD �������� �ILA� ��� �� �ILBA� ������������ PSV�EDV� RI� VTI ����� Table 1 ����� � !� ILA "! PSV # 23.93� 9.72 cm� s�EDV # 6.80�3.57 cm�s "� ILBA "! PSV #15.57� 5.21 cm� s� EDV # 4.73� 2.20 cm� s $�ILBA "�� ! ILA �%�&'(� )*+��,��-./012"3� VTI!� ILA" 20154.6�8271.7� ILBA " 12933.2�5035.4� $� VTI 4ILBA #'(� )*+�� -5� RI !� ILA "0.71�0.10� ILBA " 0.70�0.07$ RI �67&!ILBA $ ILA "'(8!9��:*+��;�<���=>�?@A��� CKDBCDEF�%G�� �Fig. 3��PSV !� ILA ��� ILBA $4 CKD BCDE

�HI$$4�JKLM#N���� ILA "!

CKD BCDE 4A$BCDE 5A���9'(:8#N���#� ILBA ��7&!BCDE 1�2$O�P�BCDE 3A� 4A� 5A�� O�&BCDE 3A$BCDE 5A�'(:8#N����EDV 4 PSV $QR� CKD BCDE�HI$$4�JK#N��� ILA "!?@A$BCDE1�2A��7&4'(:8#N����RI !� ILA�ILBA ST$4� CKD BCDE�HI$$4�UV���� BCDE 4A���BCDE 5A!� ?@A� BCDE 1�2A� O�&3A�%�&� O�P�'(:UV#N����VTI !� ILA ��� ILBA $4 CKD BCDE

�HI$$4�WXLM����� ILA "!BCDE 5A#?@A���BCDE 1�2A�%�&'(�W�"3+�� -5� ILBA"! ILA "'(8�9���A��VY&� BCDE 1�2A"!BCDE 3A� 4A$%�&'(�Z�"3+��

Table 1. Average Value of the Doppler Parameter in Interlobar Arteries and Interlobular

Arteries in All CKD Cases

ILA: interlobar artery, ILBA: interlobular artery, PSV: peak systolic velocity, EDV:

end diastolic velocity, RI: resistive index, VTI: velocity-time integral �VTI�

Table 2. Coe$cient of Correlation Between the Doppler Parameters and eGFR, SBP, DBP, PP,

and UP.

eGFR: estimated glomerular filtration rate, SBP: systolic blood pressure, DBP: diastolic blood

pressure, PP: pulse pressure, UP: urinary

[\]^_`/��� ���a�bc 439

53

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Figure 3. The Doppler parameters of interlobar arteries and interlobular arteries in the control and each CKD stage

group.

���� �� � �440

54

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�� �������������� ���PSV, EDV, RI, VTI� � eGFR� ��� �������������� ������ eGFR� �� � ��

�������� �Table 2�� eGFR �� ILA �� EDV ������ �r�0.60��� RI ������ �r�-0.69� ������ ILBA ��� eGFR� EDV !" VTI ������ �EDV: r�0.66� VTI: r�0.69� �� RI ������ �r�-0.60� �#$��%&'�� ()'����*�� ILA !

" ILBA +,� �*� -�������./0��123�� �2�4��� ILA !" ILBA�+,0 RI 55�������6����ILA-RI: r�0.56� ILBA-RI: r�0.49��7 � � ���� ILA !" ILBA ��8�

���09:7���.;723��

�� �������������� ���PSV, EDV, RI, VTI� ��������

<=>�?�!@A������� ILA ILBAB� EDV !" RI ��������.���EDV: r�0.75� RI: r�0.83� �Fig. 4�� C�� VTI��55������ �r�0.59� �#$�����PSV � DE���F23� �r�0.36��

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����

1� Laura G Sanchez-Lozada, Edilia Tapia, Rich-ard J Johnson, Bernardo Rodriguez-Iturbe and

Jaime Herrera-Acosta. Glomerular hemody-

namic changes associated with arteriolar le-

sions and tubulounterstitial inflammation.

Kidney Int 2003; 64: S9�S14.2� Adalbert Bohle and Gerhard A. Muller.Pathogenesis of chronic renal failure in the

primary glomerulopathies, renal vasculo-

pathies, and chronic interstitial nephritides.

Kidney Int 1996; 54: S2�S9.3� David P. Basile. Renal ischemic injury resultsin permanent damage to peritubular capillaries

and influences long-term function. Am J

Physiol Renal Physiol 2001; 281: F887�F899.4� Masaomi Nangaku. Mechanisms of Tubu-

lointerstitial Injury in the kidney:Final com-

mon pathways to end-stage renal failure. In-

ternal Medicine 2004; 43: 9�17.5� Makiko Matsumoto. Hypoperfusion of Peri-tubular capillaries induces chronic hypoxia be-

fore progression of tubulointerstitial injury in a

progressive model of rat glomerulonephritis. J

Am Soc Nephrol 2004; 15: 1574�1581.6� Kristin Eitrem Landmark, Per Wiik Johansen,Judith A. Johnson, Bjorn Johansen, Steinar

Uran and Tore Skotland. Pharmacokinetics of

Perfluorobutane following intravenous bolus

injection and continuous infusion of Sona-

zoid� in healthy volunteers and in patients with

reduced pulmonary di#using capacity. Ultra-

sound in Med. Biol 2008; 34: 494�501.7� Per Christian Sontum. Physicochemical char-acteristics of Sonazoid, a new cintrast agent for

ultrasound imaging. Ultrasound in Med. Biol

2008 ;34: 1�10.8� R. Barr. Seeking consensus: contrast ultra-sound in radiology. European J Radiology

2002; 41: 207�216.9� Kunitoshi Iseki. Chronic kidney disease in Ja-pan. Intern Med 2008; 47: 681�689.

10� Giorgio Ascenti, Michele Gaeta, Carlo Magno,

��kl��!�F�34������T 443

57

Page 10: ˘ˇˆ˙˝˛˚˜igakukai.marianna-u.ac.jp/idaishi/www/365/05-36-6Kayori Tsuruoka.pdfVol. 36, pp. 435 445, 2008 ˘ˇˆ˙˝˛˚˜ !" 1 1 1 1 ˘ 1 ˇ 1 ˆ ˙ ˘ ˝˛ ˇˆ˙ ˛ ˝ ˛ ˚

Silvio Mazziotti, Alfredo Blandino, Darwin

Melloni and Giovanni Zimbaro. Contrast-

Enhanced Second-Harmonic Sonography in

the Detection of Pseudocapsule in Renal Cell

Carcinoma. AJR 2004; 182: 1525�1530.11� J. H. Kim, H. W. Eun, H. K. Lee, S. J. Park,J. H. Shin, J. H. Hwang, D. E. Goo and D. L.

Choi. Coded harmonic angio US with con-

trast agent. Acta Radiologica 2003; 44: 166�171.

12� Seeler D, von Klinggra# G, Christl SU. Sono-graphic detection of kidney infarctions using

ultrasound contrast media. Ultraschall Med

2005: 518�523.13� Thomas Fischer, Sergej Filimonow, Jan

Dieckhofer, Torsten Slowinski, Matthias Muh-

ler, Alexander Lembcke, Klemens Budde,

Hans-H. Neumayer, Volker Ebeling, Markus

Giessing, Anke Thomas and Stanislao

Morgera. Improved diagnosis of early kidney

allograft dysfunction by ultrasound with echo

enhancer-a new method for the diagnosis of

renal perfusion. Nephrol Dial Transplant

2006; 21: 2921�2929.14� Correas JM, Claudon M, Tranquart F and

Helenon AO. The kidney: imaging with mi-

crobubble contrast agents. Ultrasound Q 2006;

22: 53�66.15� Bertolotto M, Martegani A, Aiani L, ZappettiR, Cernic S, Cova MA. Value of contrast-

enhanced ultrasonography for detecting renal

infarcts proven by contrast enhanced CT. A

feasibility study. Eur Radiol 2008; 18: 376�383.16� Karl Q. Schwarz, Harald Becher, ChristinaSchimpfky, Dierk Vorwerk, Ulrich Bogdahn

and Reinhard Schlief. Doppler enhacement

with SHU 508A in multiple vascular regions.

Radiology 1994; 193: 195�201.17� Yoko Hosotani, Norihiro Takahashi, Hidey-

asu Kiyomoto, Koji Ohmori, Hirofumi Hi-

tomi, Hiroshi Fujioka, Yasuharu Aki, Megu-

mu Fukunaga, Shigekazu Yuasa, Katsufumi

Mizushige and Masakazu Kohno. A New

Method for Evaluation of Split Renal Cortical

Blood Flow with Contrast Echography. Hy-

pertens Res 2002; 25: 77�83.18� Kim Gunnar Toft, Svein Olaf Hustvedt, Pet-ter-Arnt Hals, Inger Oulie, Steinar Uran, Kris-

tin Landmark, Per Trygve Normann and Tore

Skotland. Disposition of Perflubtane in rats

after intravenous injection of Sonazoid. Ultra-

sound in Med 2006; 32: 107�114.19� Platt JF, Ellis JH, Rubin JM, Dipietro MA andSedman AB. Intrarel Arterial Doppler Sono-

graphy in Patients with Nonobstructive Renal

Disease. Correlation of Resistive Index with

Biopsy Findings. AJR 1990; 154: 1223�1227.20� Milovanceva-Popovska M and Dzikova S.

Progression of diabetic nephropathy:value of

intrarenal resistive index �RI�. Prilozi 2007; 28:69�79.

21� Ryota Ikee, Shuzo Kobayashi, Noriaki Hem-mi, Toshihiko Imakiire, Yuichi Kikuchi, Hide-

kazu Moriya, Shigenobu Suzuki and Soichiro

Miura. Correlation Between the Resistive In-

dex by Doppler Ultrasound and Kidney Func-

tion and Histology. Am J Kidey Disease 2005;

46: 603�609.22� T. Sugiura, A. Nakamori, A. Wada, Y. Fuku-hara. Evaluation of tubulointerstitial injury by

Doppler ultrasonography in glomerular dis-

ease. Clinical Nephrology 2004; 61: 119�126.23� A. Kirkpantur, R. Yilmaz, D. Ertoy Baydar,T. Aki, B. Cil, M. Arici, B. Altun, Y. Erdem, I.

Erkan, M. Bakkaloglu, U. Yasavul and C.

Turgan. Utility of the Doppler Ultrasound

Parameter, Resistive Index, in Renal Trans-

plant Histopathology. Transplantation Pro-

ceedings 2008; 40: 104�106.

���� �� � �444

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Abstract

Evaluation of Interlobular Artery Blood Flow by

Contrast-Enhanced Ultrasound with Perfluorobutane

as a Contrast Agent in Chronic Kidney Disease

Kayori Tsuruoka1, Takashi Yasuda1, Masahiko Yazawa1, Kenichirou Koitabashi1,

Minako Shimazaki1, Tsutomu Sakurada1, Sayuri Shirai1, Yugo Shibagaki1,

Kenjiro Kimura1, and Fumio Tsujimoto2

Continuous hypoxia due to hypoperfusion in peritubular capillaries is one of the factors aggravating

chronic kidney disease �CKD�, but evaluation of perfusion in kidney is di$cult using clinically availablemethods of imaging. The second-generation ultrasound contrast medium perfluorobutane �SonazoidTM�enables visualization of renal vasculature including identification of the interlobular arteries in patients with

renal dysfunction safely. We therefore evaluated the changes in the parameters obtained from the color

Doppler waves at the interlobular arteries identified by the contrast-enhanced ultrasound imaging �CEUI�with Perfluorobutane in patients with CKD.

Perfluorobutane was used in seventy-seven CKD patients and five control subjects, and peak systolic

velocity �PSV�, end diastolic flow velocity �EDV�, resistive index �RI�, and velocity-time integral �VTI� weremeasured from the color Doppler ultrasonography in the interlobar and interlobular arteries.

The interlobular arteries were identified in all cases by CEUI. In both interlobar and interlobular

arteries, significant increases in RI were observed only in the late stage of CKD. Another three Doppler

parameters, PSV, EDV, and VTI had significant di#erence between early and late stage of CKD and showed

a significant correlation with estimated glomerular filtration rate only at the interlobular arteries. No side

e#ects of the contrast agent were observed in any subjects.

In patients with CKD, the blood flow parameters at the interlobular arteries obtained from Doppler

ultrasonography reflex the renal function more accurately than those at the interlobar arteries.

1 Department of Nephrology and Hypertension, Internal Medicine, St. Marianna University School of Medicine2 Department of Clinical Laboratory of Medicine, St. Marianna University School of Medicine

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