Staub D, Canevascini R, Huegli R W, Aschwanden M, Thalhammer C, Imfeld S, Singer E, Jacob A L, Jaeger K A
Angiology, University Hospital Basel, Switzerland.
Ultraschall Med. 2007 Feb;28(1):45-51. doi: 10.1055/s-2007-962881.
Colour coded duplex sonography (DS) is widely used for the assessment of renal artery stenosis (RAS). Different criteria have been specified for the detection of significant RAS. The aim of our study was to compare routinely used DS criteria, both with intra-arterial pressure gradients and arteriographic degree of stenosis, and to validate different cut-off points of these DS criteria for the assessment of haemodynamically significant RAS.
We retrospectively analysed forty-nine patients (median age 67 years, 29 male) with RAS documented by duplex sonography, referred for renal arterial subtraction arteriography and intra-arterial pressure measurement (93 renal arteries). DS measurement of peak systolic velocity (PSV) in the main renal artery, the renal/aortal velocity ratio (RAR) and the side-to-side differences of the intrarenal resistive indices (DeltaRI) were correlated to intra-arterial pressure measurements and arteriographic degree of stenosis. Receiver operating characteristics (ROC) were used to determine the best cut-off value of DS criteria.
39 (41 %) renal arteries had normal findings or non significant stenosis < 50 %, 23 (25 %) had a diameter reduction between 50 % and 69 %, and 31 (33 %) > or = 70 %. The systolic pressure gradient showed good correlation with the arteriographic degree of RAS (r = 0.77, p < 0.001) and the PSV measured by duplex sonography (r = 0.67, p < 0.001). Mean systolic pressure gradient was 24 mmHg at 50 % stenosis and 23 mmHg at PSV of 200 cm/sec. A PSV of > or = 200 cm/sec provided a sensitivity of 92 % and specificity of 81 % for detecting RAS of > or = 50 %. Similar results were found for RAR > or = 2.5 with a sensitivity of 92 % and specificity of 79 %. These cut-off values have a negative predictive value of 100 % for excluding high-grade RAS of > or = 70 %. A DeltaRI of > or =0.05 has low sensitivity of 31 %, but a high specificity of 97 % for detecting RAS of > or = 50 %.
DS measurements and the severity of arteriographic diameter reduction correlate well with systolic pressure gradients. Clinically expedient DS criteria for detecting RAS of > or = 50 % are a PSV of > or = 200 cm/sec or a RAR of > or =2.5. These criteria allow reliable exclusion of severe RAS of > or = 70 %.
彩色编码双功超声（DS）广泛用于评估肾动脉狭窄（RAS）。已规定了不同的标准用于检测显著的RAS。我们研究的目的是将常规使用的DS标准与动脉内压力梯度和动脉造影狭窄程度进行比较，并验证这些DS标准的不同截断点用于评估血流动力学显著的RAS。
我们回顾性分析了49例经双功超声记录有RAS的患者（中位年龄67岁，男性29例），这些患者被转诊进行肾动脉减影动脉造影和动脉内压力测量（93条肾动脉）。测量主肾动脉的收缩期峰值速度（PSV）、肾动脉/主动脉速度比值（RAR）以及肾内阻力指数的左右差值（DeltaRI），并将其与动脉内压力测量值和动脉造影狭窄程度进行相关性分析。采用受试者操作特征（ROC）曲线确定DS标准的最佳截断值。
39条（41%）肾动脉检查结果正常或狭窄不显著（<50%），23条（25%）直径减少50%至69%，31条（33%）直径减少≥70%。收缩压梯度与动脉造影RAS程度相关性良好（r = 0.77，p < 0.001），与双功超声测量的PSV相关性良好（r = 0.67，p < 0.001）。狭窄50%时平均收缩压梯度为24 mmHg，PSV为200 cm/秒时为23 mmHg。PSV≥200 cm/秒检测≥50%的RAS时，敏感性为92%，特异性为81%。RAR≥2.5时结果相似，敏感性为92%，特异性为79%。这些截断值排除≥70%的高度RAS时，阴性预测值为100%。DeltaRI≥0.05检测≥50%的RAS时，敏感性低，为31%，但特异性高，为97%。
DS测量值与动脉造影直径减少的严重程度与收缩压梯度相关性良好。检测≥50%的RAS的临床便捷DS标准为PSV≥200 cm/秒或RAR≥2.5。这些标准可可靠排除≥70%的严重RAS。
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