肾动脉彩色双功超声成像及血流动力学相关肾动脉狭窄的检测

[Color duplex ultrasound imaging of renal arteries and detection of hemodynamically relevant renal artery stenoses].

作者信息

Zeller T, Frank U, Späth M, Roskamm H

机构信息

Abteilung klinische Kardiologie II, Sektion Angiologie, Herz-Zentrum Bad Krozingen.

出版信息

Ultraschall Med. 2001 Jun;22(3):116-21. doi: 10.1055/s-2001-15287.

DOI:10.1055/s-2001-15287

PMID:11484442

Abstract

AIM

Although colour coded Doppler ultrasound (CCDU) is established as a non-invasive diagnostic tool for detecting renal artery stenoses (RAS), no uniform criterion for defining a hemodynamically relevant stenosis (i.e. angiographic stenosis of > or = 70% of the diameter) exists. We therefore investigated the predictive value of the renal-aortic flow-velocity ratio (RAR) > 3.5 m/s and a difference of < 0.05 between the left and right side for the resistance index according to Pourcelot (dRI) in the detection of a relevant RAS.

PATIENTS AND METHODS

We analysed 500 consecutive CCDU examinations of patients with hypertension retrospectively. An RAR > 3.5 and/or a lateral inequality of the RI < 0.05 were used as stenosis criterion.

RESULTS

In 448 patients (90%) both renal arteries could be found, in 11 patients (2%) only the right artery, in 6 patients (1%) the left artery, and in 35 patients (7%) no renal artery was detectable. In 98 patients (19.6%), RAS was diagnosed, 69 (71%) of them underwent angiography. 38 patients presented an RAR > 3.5 plus dRI > 0.05. In 29 of these, angiography was performed. 96% of them presented with an RAS of > or = 70% and 4% showed an RAS of 40-69% (specificity 97%, sensitivity 76%). In 54 patients the RAR was > 3.5, but dRI < 0.05. 24% of the patients undergoing angiography (n = 37) presented with an RAS of > or = 70%, 68% with an RAS of 40-69%, and 8% with an RAS of < 40% (specificity 60%, sensitivity 100%). 44 hypertensive patients who underwent angiography after a CCDU examination not suggesting the presence of RAS were used as control group.

CONCLUSION

An experienced physician using a high quality colour-coded duplex-machine can reliably detect the renal arteries. The presence of RAS can be diagnosed with certainty by CCDU applying the criterion of RAR > 3.5, but the diagnosis of a one-sided haemodynamically relevant RAS can only be certain if the criterion of dRI > 0.05 is used in addition.

摘要

目的

尽管彩色编码多普勒超声（CCDU）已成为检测肾动脉狭窄（RAS）的一种非侵入性诊断工具，但目前尚无统一标准来定义血流动力学相关狭窄（即血管造影显示直径狭窄≥70%）。因此，我们研究了肾主动脉流速比值（RAR）>3.5 m/s以及左右两侧根据普尔塞洛阻力指数（dRI）的差值<0.05在检测相关RAS中的预测价值。

患者与方法

我们回顾性分析了500例连续接受CCDU检查的高血压患者。将RAR>3.5和/或RI的侧别差异<0.05用作狭窄标准。

结果

在448例患者（90%）中可发现双侧肾动脉，11例患者（2%）仅发现右侧动脉，6例患者（1%）仅发现左侧动脉，35例患者（7%）未检测到肾动脉。在98例患者（19.6%）中诊断出RAS，其中69例（71%）接受了血管造影。38例患者RAR>3.5且dRI>0.05。其中29例接受了血管造影。其中96%表现为RAS≥70%，4%表现为RAS为40 - 69%（特异性97%，敏感性76%）。54例患者RAR>3.5，但dRI<0.05。接受血管造影的患者中24%（n = 37）表现为RAS≥70%，68%表现为RAS为40 - 69%，8%表现为RAS<40%（特异性60%，敏感性100%）。44例在CCDU检查未提示存在RAS后接受血管造影的高血压患者作为对照组。