肾动脉狭窄：影像学选择、误区及关注点。

Renal artery stenosis: imaging options, pitfalls, and concerns.

机构信息

Department of Radiology, Weill Medical College of Cornell University, 416 East 55th Street, New York, NY 10022, USA.

出版信息

Prog Cardiovasc Dis. 2009 Nov-Dec;52(3):209-19. doi: 10.1016/j.pcad.2009.10.003.

DOI:10.1016/j.pcad.2009.10.003

PMID:19917332

Abstract

Renal artery stenosis can be diagnosed with multiple imaging modalities, each one having different risk vs accuracy tradeoffs. Catheter angiography with pressure gradient measurements is the definitive gold standard but also the most invasive and thus reserved primarily for imaging at the time of renal revascularization. Ultrasonography is the safest and least expensive but also the least accurate and most operator-dependent. Contrast-enhanced computed tomographic angiography and magnetic resonance angiography are intermediate (between ultrasound and catheter angiography) with respect to accuracy and expense. Exciting new advances in magnetic resonance that include new contrast agents, which eliminate nephrogenic systemic fibrosis risk, and techniques to characterize the hemodynamic significance of renal artery stenoses are now becoming available. In addition, magnetic resonance angiography without any contrast has become more accurate and rivals contrast-enhanced techniques in some patients. This review explores these techniques for renal artery stenosis imaging.

摘要

肾动脉狭窄可以通过多种成像方式进行诊断，每种方式都有不同的风险与准确性权衡。导管血管造影术结合压力梯度测量是明确的金标准，但也是最具侵入性的，因此主要保留用于肾血运重建时的影像学检查。超声检查是最安全、最便宜的，但也是最不准确和最依赖操作者的。增强 CT 血管造影和磁共振血管造影在准确性和费用方面处于中间位置（介于超声和导管血管造影之间）。磁共振领域令人兴奋的新进展包括新型对比剂，可消除肾源性系统性纤维化的风险，以及用于确定肾动脉狭窄血流动力学意义的技术，现在已经开始应用。此外，无对比剂的磁共振血管造影术已经变得更加准确，在某些患者中可以与增强技术相媲美。本文综述了这些用于肾动脉狭窄成像的技术。