Kessler R M, Quevedo H, Lankau C A, Ramirez-Seijas F, Cepero-Akselrad A, Altman D H, Kessler K M
Department of Radiology, Miami Children's Hospital, FL 33155.
AJR Am J Roentgenol. 1993 Feb;160(2):353-7. doi: 10.2214/ajr.160.2.8424349.
The resistive index in cortical or arcuate renal arteries of children was calculated to determine whether obstructive uropathy could be differentiated from nonobstructive dilatation.
Kidneys (n = 176) were prospectively evaluated by using duplex Doppler sonography in patients 3 days to 20 years old. Obstruction was confirmed by renography with furosemide and/or by surgery.
The normal resistive index was 0.57 +/- 0.06 and the normal difference in resistive indexes between kidneys was 0.03 +/- 0.02 (n = 15). Abnormal values indicative of ureteropelvic junction obstruction were defined as the normal mean +/- 2 SD (i.e., a resistive index of > or = 0.70 plus a difference in resistive indexes between kidneys of > or = 0.08). Patients with unilateral dilatation and obstruction at the ureteropelvic junction (n = 20) had a mean resistive index of 0.77 +/- 0.05 and a difference in resistive indexes between kidneys of 0.16 +/- 0.05 (p < .001 compared with patients with normal kidneys and p < .001 compared with patients with unilateral dilatation without obstruction). Patients with unilateral dilatation but without obstruction (n = 16) had a mean resistive index of 0.63 +/- 0.06 and a difference between kidneys of 0.06 +/- 0.04 (values within normal limits). The positive and negative predictive values of the obstruction criteria for unilateral collecting system dilatation were 95% and 100%, respectively. After successful surgical correction of ureteropelvic junction obstruction (n = 29), patients had a normal mean resistive index of 0.61 +/- 0.05 and a normal difference between kidneys of 0.03 +/- 0.03. Five patients examined both before and after surgery showed a statistically significant drop in the resistive index of the obstructed kidney (0.75 +/- 0.03 to 0.65 +/- 0.05, p < .05) after surgery and a small rise in the resistive index of the contralateral kidney (0.56 +/- 0.04 to 0.63 +/- 0.04, p < .02).
The resistive index appears to be an effective parameter for the evaluation and follow-up of unilateral obstructive or nonobstructive ureteropelvic junction dilatation in children.
计算儿童皮质或弓形肾动脉的阻力指数，以确定梗阻性尿路病是否可与非梗阻性扩张相鉴别。
前瞻性地采用双功多普勒超声对176例3天至20岁患者的肾脏进行评估。通过速尿肾图和/或手术证实梗阻。
正常阻力指数为0.57±0.06，双肾阻力指数的正常差值为0.03±0.02（n = 15）。提示肾盂输尿管连接处梗阻的异常值定义为正常均值±2个标准差（即阻力指数≥0.70，且双肾阻力指数差值≥0.08）。单侧肾盂输尿管连接处扩张并梗阻的患者（n = 20），平均阻力指数为0.77±0.05，双肾阻力指数差值为0.16±0.05（与正常肾脏患者相比，p <.001；与单侧扩张但无梗阻的患者相比，p <.001）。单侧扩张但无梗阻的患者（n = 16），平均阻力指数为0.63±0.06，双肾差值为0.06±0.04（值在正常范围内）。单侧集合系统扩张的梗阻标准的阳性和阴性预测值分别为95%和100%。肾盂输尿管连接处梗阻成功手术后（n = 29），患者平均阻力指数正常，为0.61±0.05，双肾差值正常，为0.03±0.03。5例手术前后均接受检查的患者显示，术后梗阻肾的阻力指数有统计学意义的下降（从0.75±0.03降至0.65±0.05，p <.05），对侧肾的阻力指数有小幅上升（从0.56±0.04升至0.63±0.04，p <.02）。
阻力指数似乎是评估和随访儿童单侧梗阻性或非梗阻性肾盂输尿管连接处扩张的有效参数。
