Romera-Villegas A, Vila-Coll R, Cairols-Castellote M, Poveda-Monge R, Masuet-Aumatell C, Grinyó-Boira M
Department of Vascular Surgery, Hospital Universitari de Bellvitge, Barcelona, Spain.
Int Angiol. 2009 Dec;28(6):461-8.
To determine the clinical usefulness of Doppler ultrasonography in the diagnosis of the Nutcracker phenomenon, as an alternative to computed tomographic scans (CT).
This study consisted of 52 patients that presented with intermittent hematuria of unknown origin between January 2006 to April 2008. Doppler ultrasonography was used to assess the left renal vein (LRV) by measuring the anteroposterior (AP) diameter and peak systolic velocity (PSV) in supine and standing positions, at the hilar and interaortomesenteric portions of the LRV. These data were compared with CT scans. The sensitivity and specificity of duplex sonography was determined using the AP diameter and PSV ratios to assess the cut-off levels. Kappa (k) statistic was also evaluated.
mean AP diameters of the LRV measured by Doppler sonography were 8.38 mm at the hilar and 3.17 mm under the SMA, compared to 9.3 mm (hilar) and 3.2 mm (SMA) in the supine and standing position respectively. The PSV in the supine position was 25.77 cm/s and 115.48 cm/s, respectively, compared to 25.54 cm/s and 125.96 cm/s in the standing position. The cut-off levels were 3.85 (sensitivity: 61.5%, specificity: 80.8%, k:0.42) for the supine and 4.12 (sensitivity:61.5%, specificity: 65.4%, k: 0.27) for the standing AP diameter, 2.99 (sensitivity: 92.3%, specificity: 73.1%, k: 0.65) for the supine and 3.73 (sensitivity: 96.4%, specificity: 79.2%, k: 0.76) for the standing PSV.
Our data show that the standing PSV ratio is the best parameter for to detecting entrapment of the LRV.
确定多普勒超声检查在胡桃夹现象诊断中的临床实用性，作为计算机断层扫描（CT）的替代方法。
本研究纳入了2006年1月至2008年4月间出现不明原因间歇性血尿的52例患者。使用多普勒超声通过测量仰卧位和站立位时左肾静脉（LRV）肾门部和腹主动脉肠系膜上动脉间段的前后径（AP）及收缩期峰值流速（PSV）来评估LRV。将这些数据与CT扫描结果进行比较。使用AP直径和PSV比值来确定双功超声的敏感性和特异性，以评估截断水平。还评估了kappa（k）统计量。
多普勒超声测量的LRV平均AP直径在肾门部为8.38mm，在肠系膜上动脉下方为3.17mm，而仰卧位和站立位时CT测量的相应值分别为9.3mm（肾门部）和3.2mm（肠系膜上动脉下方）。仰卧位时的PSV分别为25.77cm/s和115.48cm/s，站立位时分别为25.54cm/s和125.96cm/s。仰卧位AP直径的截断水平为3.85（敏感性：61.5%，特异性：80.8%，k：0.42），站立位为4.12（敏感性：61.5%，特异性：65.4%，k：0.27）；仰卧位PSV的截断水平为2.99（敏感性：92.3%，特异性：73.1%，k：0.65），站立位为3.73（敏感性：96.4%，特异性：79.2%，k：0.76）。
我们的数据表明，站立位PSV比值是检测LRV受压的最佳参数。
