American Journal of Roentgenology, Vol 154, 785-787, Copyright © 1990 by American Roentgen Ray Society
Doppler evaluation of renal transplants in children: a prospective analysis with histopathologic correlation
DG Drake, DL Day, JG Letourneau, BA Alford, RK Sibley, SM Mauer and TE Bunchman
Department of Radiology, University of Minnesota Hospital and Clinics, Minneapolis 55455.
Duplex Doppler sonography recently has been used to evaluate renal
transplants. Some authors have stated that high resistive indexes (RIs)
occur in the presence of acute renal transplant rejection. RIs less than
0.7 are considered as probably excluding acute transplant rejection. We
performed a prospective study of duplex sonographic examinations of
pediatric patients (mean age, 8 years; 13 boys, two girls) with renal
allografts and clinically suspected transplant disease. The results of 22
duplex studies were correlated with histopathologic data obtained between
July 1987 and June 1988. RIs of the arcuate arteries in patients with acute
rejection (n = 14) averaged 0.62 (range, 0.50-0.80). The RI in patients
with chronic rejection (n = 1) was 0.59. RIs in patients with acute tubular
necrosis (n = 3) averaged 0.66 (range, 0.59-0.72). RIs in patients with
cyclosporine A toxicity (n = 4) averaged 0.66 (range, 0.58-0.79).
Tubulointerstitial rejection was predominant, with only two patients
showing minimal acute vascular rejection. Thirteen of 14 pediatric patients
with histologically proved renal transplant rejection had a resistive index
of less than 0.70. This study refutes the concept that resistive indexes of
less than 0.7 exclude acute rejection.
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