Oliva V L, Soulez G, Lesage D, Nicolet V, Roy M C, Courteau M, Froment D, René P C, Thérasse E, Carignan L
Department of Radiology, Centre Hospitalier de l'Université de Montréal, Quebec, Canada.
AJR Am J Roentgenol. 1998 Jan;170(1):169-75. doi: 10.2214/ajr.170.1.9423626.
The goal of this study was to assess the value of quantitative and qualitative analysis of the early systolic rise on Doppler waveforms obtained before and after administration of captopril in patients suspected of having renal artery stenosis.
Seventy-one hypertensive patients (135 kidneys) were studied with transrenal Doppler sonography. Ninety-six kidneys were studied again after administration of captopril. All patients also underwent renal angiography. All Doppler studies were independently reviewed by two observers. Specific criteria for Doppler waveform patterns that were applied in the detection of renal artery stenosis included acceleration, acceleration time of early systolic rise, differential velocity of systolic rise, and resistive index. These criteria were then correlated with angiography, and receiver operating characteristic curves were generated.
On the basis of waveform pattern recognition. Doppler sonograms obtained before administration of captopril had a sensitivity of 81% and a specificity of 98% for the detection of renal artery stenosis greater than or equal to 50%. Sensitivity of Doppler sonography obtained after administration of captopril was 100%, and specificity was 100%. For renal artery stenosis greater than or equal to 70%, sensitivity was 94% and specificity was 89% before administration of captopril. The area under the receiver operating characteristic curve for the acceleration criterion was significantly larger after administration of captopril (p = .009) for the detection of renal artery stenosis greater than or equal to 50%. After captopril administration, an acceleration threshold value of 440 cm/sec2 for early systolic rise was associated with a sensitivity of 100% and a specificity of 94% for the detection of renal artery stenosis greater than or equal to 50%.
Doppler sonography of the renal arteries performed before administration of captopril appears to be an excellent screening tool in the detection of severe stenosis (> or = 70%). Administration of captopril improves the detection of renal artery stenosis greater than or equal to 50% with Doppler sonography when observers use both morphologic and quantitative criteria.
本研究的目的是评估在疑似肾动脉狭窄患者中，卡托普利给药前后通过多普勒波形对早期收缩期上升进行定量和定性分析的价值。
对71例高血压患者（135个肾脏）进行经肾多普勒超声检查。96个肾脏在给予卡托普利后再次进行研究。所有患者均接受了肾血管造影。所有多普勒研究均由两名观察者独立审查。用于检测肾动脉狭窄的多普勒波形模式的具体标准包括加速度、早期收缩期上升的加速时间、收缩期上升的速度差以及阻力指数。然后将这些标准与血管造影结果进行关联，并生成受试者操作特征曲线。
基于波形模式识别，在给予卡托普利前获得的多普勒超声心动图对检测大于或等于50%的肾动脉狭窄的敏感性为81%，特异性为98%。给予卡托普利后获得的多普勒超声检查的敏感性为100%，特异性为100%。对于大于或等于70%的肾动脉狭窄，在给予卡托普利前敏感性为94%，特异性为89%。在检测大于或等于50%的肾动脉狭窄时，卡托普利给药后加速度标准的受试者操作特征曲线下面积显著增大（p = 0.009）。给予卡托普利后，早期收缩期上升的加速度阈值为440 cm/sec2时，对检测大于或等于50%的肾动脉狭窄的敏感性为100%，特异性为94%。
在给予卡托普利前进行肾动脉多普勒超声检查似乎是检测严重狭窄（≥70%）的优秀筛查工具。当观察者同时使用形态学和定量标准时，卡托普利给药可提高多普勒超声对大于或等于50%的肾动脉狭窄的检测能力。
