Stavros A T, Parker S H, Yakes W F, Chantelois A E, Burke B J, Meyers P R, Schenck J J
Department of Ultrasound, Swedish Medical Center, Englewood, Colo.
Radiology. 1992 Aug;184(2):487-92. doi: 10.1148/radiology.184.2.1620853.
Segmental renal artery branches within the renal sinus were prospectively evaluated with color Doppler imaging and pulsed-Doppler spectral analysis in 56 patients before angiography. Waveforms were evaluated for the tardus and parvus abnormalities of prolonged acceleration time, diminished acceleration index, and loss of the normal early systolic compliance peak/reflective-wave complex (ESP). Findings obtained with these parameters were compared with the subsequent findings on angiograms to ascertain their efficacy in detection of hemodynamically significant (greater than or equal to 60%) renal arterial stenosis (RAS), which was present in 32 kidneys in 26 patients. Simple pattern-recognition analysis of ESP proved to be the best of the three parameters. Loss of ESP enabled identification of RAS with 95% sensitivity, 97% specificity, a 92% positive predictive value, a 98% negative predictive value, a 96% overall accuracy. On the basis of the high technical success rate, high sensitivity and specificity, and short examination time, waveform analysis for detection of tardus-parvus abnormalities, especially loss of ESP, of the segmental artery is recommended as an alternative to direct examination of the main renal arteries for evaluation of RAS.
在56例患者血管造影术前，采用彩色多普勒成像和脉冲多普勒频谱分析对肾窦内的节段性肾动脉分支进行前瞻性评估。评估波形的加速时间延长、加速度指数降低以及正常早期收缩期顺应性峰值/反射波复合体（ESP）消失等迟缓和小慢异常情况。将这些参数获得的结果与随后血管造影的结果进行比较，以确定它们在检测血流动力学显著（大于或等于60%）肾动脉狭窄（RAS）方面的有效性，26例患者的32个肾脏存在肾动脉狭窄。ESP的简单模式识别分析被证明是这三个参数中最好的。ESP消失能够识别RAS，其敏感性为95%，特异性为97%，阳性预测值为92%，阴性预测值为98%，总体准确率为96%。基于高技术成功率、高敏感性和特异性以及短检查时间，建议采用波形分析来检测节段动脉的迟缓和小慢异常，特别是ESP消失，作为直接检查主肾动脉以评估RAS的替代方法。
