使用彩色血流双功扫描检测严重肾动脉狭窄。

The use of colorflow duplex scanning to detect significant renal artery stenosis.

作者信息

Hua H T, Hood D B, Jensen C C, Hanks S E, Weaver F A

机构信息

Department of Surgery, Division of Vascular Surgery, University of Southern California, School of Medicine, Los Angeles, CA, USA.

出版信息

Ann Vasc Surg. 2000 Mar;14(2):118-24. doi: 10.1007/s100169910022.

DOI:10.1007/s100169910022

PMID:10742425

Abstract

The purpose of this study was to review our institutional experience with colorflow duplex scanning in detecting significant renal artery stenosis and to validate the criteria used: renal artery peak systolic velocity (PSV) >/=200 cm/sec and renal-to-aortic peak systolic ratio (RAR) >/=3.5. The results of renal artery duplex and arteriography in 58 patients (107 kidneys) who underwent both exams were reviewed. Arteriography revealed 32 main renal arteries with >/=60% stenosis. The PSV criterion detected 29, for a sensitivity of 91%, specificity of 75%, positive predictive value (PPV) of 60%, negative predictive value (NPV) of 95%, and accuracy of 79%. Using RAR >/=3.5 provided a sensitivity of 72%, specificity of 92%, PPV of 79%, NPV of 88%, and accuracy of 86%. In a subset of 36 kidneys that had hilar scans, the criteria of acceleration time (AT) >/=100 cm/sec and index (AI) </=3.78 kHz/sec were evaluated. The AT and AI yielded sensitivity of 50% and 36%, specificity of 86% and 100%, PPV of 70% and 100%, NPV of 73% and 71%, and accuracy of 72% and 75%, respectively. Colorflow duplex scanning is clinically useful in screening for hemodynamically significant renal artery stenosis. The renal artery PSV criterion is highly sensitive, with a high NPV that obviates the need for arteriography in most cases of a negative duplex. The criteria of RAR, AT, and AI are of less value.

摘要

本研究的目的是回顾我们机构使用彩色多普勒双功扫描检测显著肾动脉狭窄的经验，并验证所采用的标准：肾动脉收缩期峰值流速（PSV）≥200 cm/秒和肾主动脉收缩期峰值比（RAR）≥3.5。对58例（107个肾脏）接受了肾动脉双功扫描和动脉造影两项检查的患者结果进行了回顾。动脉造影显示32支主要肾动脉存在≥60%的狭窄。PSV标准检测出29例，敏感性为91%，特异性为75%，阳性预测值（PPV）为60%，阴性预测值（NPV）为95%，准确性为79%。使用RAR≥3.5时，敏感性为72%，特异性为92%，PPV为79%，NPV为88%，准确性为86%。在36个进行了肾门扫描的肾脏子集中，评估了加速时间（AT）≥100 cm/秒和指数（AI）≤3.78 kHz/秒的标准。AT和AI的敏感性分别为50%和36%，特异性分别为86%和100%，PPV分别为70%和100%，NPV分别为73%和71%，准确性分别为72%和75%。彩色多普勒双功扫描在筛查血流动力学显著的肾动脉狭窄方面具有临床实用性。肾动脉PSV标准具有高度敏感性，NPV高，这使得在大多数双功扫描阴性的情况下无需进行动脉造影。RAR、AT和AI标准的价值较小。