Gottlieb R H, Lieberman J L, Pabico R C, Waldman D L
Department of Radiology, University of Rochester, School of Medicine and Dentistry, NY 14642-8648, USA.
AJR Am J Roentgenol. 1995 Dec;165(6):1441-6. doi: 10.2214/ajr.165.6.7484582.
The objective of this study was to determine in renal transplant patients if the acceleration time and subjective assessment of dampening of the waveforms from the intrarenal arteries improves the accuracy of detecting a hemodynamically significant (> or = 50%) proximal arterial stenosis compared with measurements of peak systolic velocity from a main renal artery.
In 15 patients, the findings of 19 Doppler sonograms and corresponding arteriograms of their renal transplants were reviewed, with arteriography serving as the gold standard. Four patients had a significant proximal arterial stenosis; three were of the main renal artery and one was of the adjacent external iliac artery proximal to the anastomosis with the renal artery.
We found a significant prolongation of the acceleration time in patients with a significant proximal arterial stenosis (p = .0004). Use of a threshold acceleration time of 0.10 sec or subjective assessment of dampening of the waveforms resulted in an accuracy of 95% in detecting a significant proximal arterial stenosis. This compared with an accuracy of 62% in detecting a significant proximal arterial stenosis using a peak systolic velocity threshold of 2.0 m/sec as the sole criterion. Using intrarenal arterial Doppler waveform parameters alone would have spared arteriography in 11 patients and would have detected three of four significant proximal arterial stenoses.
In this study, Doppler waveform analysis of the intrarenal arteries improved the accuracy of screening for a significant proximal arterial stenosis. The results suggest that such analyses can be used to spare many patients with suspected renal vascular hypertension from unnecessary arteriography.
本研究的目的是确定在肾移植患者中，与测量主肾动脉的收缩期峰值流速相比，肾内动脉波形的加速时间和波形衰减的主观评估是否能提高检测血流动力学显著（≥50%）近端动脉狭窄的准确性。
回顾了15例患者19次肾移植多普勒超声检查结果及相应的动脉造影结果，以动脉造影作为金标准。4例患者存在显著的近端动脉狭窄；3例为主肾动脉狭窄，1例为与肾动脉吻合处近端的髂外动脉狭窄。
我们发现有显著近端动脉狭窄的患者加速时间显著延长（p = 0.0004）。使用0.10秒的加速时间阈值或波形衰减的主观评估在检测显著近端动脉狭窄方面的准确率为95%。相比之下，以2.0米/秒的收缩期峰值流速阈值作为唯一标准检测显著近端动脉狭窄的准确率为62%。仅使用肾内动脉多普勒波形参数可使11例患者免于动脉造影检查，并能检测出4例显著近端动脉狭窄中的3例。
在本研究中，肾内动脉多普勒波形分析提高了筛查显著近端动脉狭窄的准确性。结果表明，这种分析可用于使许多疑似肾血管性高血压患者免于不必要的动脉造影检查。
