肾动脉狭窄的彩色多普勒超声评价
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摘要
第一部分血流动力学参数在肾动脉狭窄诊断中的应用研究
目的
探讨内径减少≥50%肾动脉狭窄(RAS)的血流动力学特点及其诊断价值。
方法
经彩色多普勒血流显像(CDFI)检查后并进行肾动脉造影的77例患者共153条肾动脉构成研究组。测量了肾动脉峰值流速(RPSV)、肾动脉与腹主动脉峰值流速比值(RAR)、肾动脉与肾动脉峰值流速比值(RRR)、肾动脉与段动脉峰值流速比值(RSR)和肾动脉与叶间动脉峰值流速比值(RIR)。肾动脉造影显示肾动脉内径减少≥50%者确定为RAS。使用ROC曲线(receive operatingcharacteristic curves)分析确定最佳诊断指标。计算这些流速指标不同阈值的敏感性、特异性、阳性预测值、阴性预测值和准确率。
结果
在肾动脉造影显示的153条主肾动脉中,68条狭窄程度为50%～99%,6条闭塞。在狭窄程度50%～99%的68条肾动脉中,动脉粥样硬化性RAS 40条,大动脉炎RAS 17条,纤维肌性发育不良性RAS 9条,其它病因2条。肾动脉CDFI检查成功率为98.7%(151/153)。ROC曲线分析结果显示RIR是最佳指标,其对RAS的诊断敏感性、特异性、准确率分别为85.29%、89.87%、87.76%。RPSV、RAR、RRR、RSR、RIR最佳阈值依次分别为170cm/s、2.3、2.0、4.0、5.5。
结论
对于内径减少≥50%的RAS,RIR是最好的山流动力学指标,其诊断效率稍高于其他指标,RAR和RRR的诊断敏感性较差。分析肾动脉血流动力学特点及其影响因素,能够明显改善RAS的诊断效率。
第二部分动脉粥样硬化性与非动脉粥样硬化性肾动脉狭窄的小慢波差异
目的
探讨动脉粥样硬化性与非动脉粥样硬化性肾动脉狭窄(renal arerty stenosis,RAS)患者小慢波的表现差异及其原因。
方法
选择经彩色多普勒血流显像检查并经肾动脉造影证实的RAS患者135例,其中大动脉炎性35例,纤维肌性发育不良性29例,动脉粥样硬化性71例。将所有患者分为动脉粥样硬化组和非动脉粥样硬化组,每组又分为轻度狭窄,中度狭窄、重度狭窄和闭塞4个亚组。测量叶间动脉加速时间(acceleration time,AT)和阻力指数(resistive index,RI)。
结果
肾动脉造影显示肾动脉中度狭窄31条,重度狭窄129条和闭塞19条。对于轻度狭窄组,中度狭窄组或重度狭窄组,AT值存动脉粥样硬化组与非动脉粥样硬化组之间差异无统计学意义(P依次为0.07,0.28,0.10);而RI值在动脉粥样硬化组与非动脉粥样硬化之间差异却有统计学意义(P依次＜0.001,＜0.001,＜0.001)。
结论
目前常用的AT测量方法存在不足,不能检测出AT存动脉粥样硬化性与非动脉粥样硬化性RAS之间可能存在的差异,但仍可用于RAS的检查。应针对RAS类型来建立RI的诊断阈值。
第三部分小慢波在肾动脉狭窄诊断中的应用研究
目的
探讨小慢波对不同病因肾动脉狭窄(RAS)的诊断价值。
方法
经彩色多普勒血流显像检查后并进行肾动脉造影的RAS患者141例,其中大动脉炎组38例,纤维肌肉发育不良组33例,动脉粥样硬化组70例。测量叶间动脉加速时间(AT)、阻力指数(RI),并计算双侧RI差值(△RI)。结果
在肾动脉造影显示的280条主肾动脉中,中度狭窄(50%～69%)31条,重度狭窄(70%～99%)145条,闭塞20条。在145条重度狭窄肾动脉中,大动脉炎性38条,纤维肌肉发育不良性33条,动脉粥样硬化性74条。对于重度狭窄,AT≥0.07s时敏感性82.58%,特异性94.40%,准确率87.86%。最佳RI阈值(0.50)对非动脉粥样硬化性RAS(内径减少≥70%)的诊断敏感性65.79%,特异性87.88%,准确率70.06%,最佳RI阈值(0.60)对动脉粥样硬化性RAS(内径减少≥70%)的诊断敏感性39.24%,特异性89.83%,准确率60.87%。△RI对内径减少≥70%RAS的最佳阈值为0.08,其敏感性64.76%,特异性80.65%,准确率68.38%。
结论
对于内径减少≥70%RAS,AT≥0.07s的诊断价值最好,且适合三类常见RAS。动脉粥样硬化性RAS的最佳RI阈值为0.6,非动脉粥样硬化性RAS的最佳RI阈值为0.5,应针对RAS类型来建立RI诊断阈值。RI和ARI的诊断效果均不令人满意,前者与肾动脉RI的影响因素较多有关,后者与本组双侧RAS患者较多有关。ARI的诊断阂值以0.08较为合适,适合单侧RAS者。
第四部分彩色多普勒超声对端-端与端-侧吻合移植肾动脉重度狭窄的对比研究
目的
探讨两种吻合方式(端-端吻合与端-侧吻合)移植肾动脉重度狭窄(TRAS)(内径减少≥80%)的彩色多普勒超声(Color Doppler sonography,CDS)诊断指标的差异。
方法
回顾性分析2000年1月1日全2006年11月31日期间,CDS发现的38例移植肾动脉重度狭窄患者(端-端吻合和端-侧吻合各19例),均经数字减影血管造影(DSA)证实。采用CDS测量了7项多普勒参数:髂动脉、移植肾动脉主干、吻合口、肾内动脉(叶间动脉或段动脉)峰值流速(PSV),狭窄处与狭窄近端PSV比值(也称为PSV前比),狭窄处与狭窄远端PSV比值(也称为PSV后比),肾内动脉加速时间(AT)。并对这些参数进行统计学分析。
结果
DSA显示所有患者的动脉内径减少≥80%,狭窄部位位于髂动脉4例,吻合口20例和移植肾动脉14例。端-端吻合者与端.侧吻合者的狭窄处动脉PSV、髂动脉PSV及PSV前比之间差异均有非常显著性意义(P＜0.01,P＜0.001,P＜0.001),但两种吻合方式的AT之间差异无统计学意义(P＞0.05)。
结论
两种吻合方式重度TRAS患者的肾动脉血流动力学差异,很可能是导致它们之间狭窄处PSV和PSV前比差异的主要原因。为了提高重度TRAS的诊断准确性,应依据吻合方式来建立狭窄处PSV和PSV前比的诊断闽值,而同一的AT诊断阂值很可能适合两种吻合方式患者。
PartⅠEvaluation of Hemodanamic Parameters in the Diagnosis of Renal Artery Stenosis
Objective
To evaluate the characteristic of hemodynamic change of renal artery stenosis (RAS)(diameter reductions≥50%) and its diagnostic value.
Methods
A study group was composed of 77 patients with 153 renal arteries that were detected by color Doppler flow imaging and were referred to renal arteriography afterwards. Five Doppler parameters,including renal peak systolic velocity(RPSV),renal aortic ratio(RAR),renal-renal ratio(RRR),renal-segmental ratio(RSR) and renal-interlobar ratio(RIR) were measured.Arteries were considered stenosed on renal arteriography if there was a diameter reduction of greater than 50%.Statistical analysis to determine the best parameter for predicting a RAS was performed with receive operating characteristic curves.The sensitivity,specificity,and negative predicting value,positive predicting value and accuracy at various cutoffs were calculated.
Results
In the 153 main renal arteries demonstrated by renal arteriography,there were 6 occlusion and 68 stenoses(diameter reduction 50%～99%).Among the 68 stenoses,40 were caused by atherosclerosis,17 by Takayasu's arteritis,9 by fibromuscular dysplasia and 2 by other etiology.Doppler examination was technically successful in 98.7%of renal arteries(151/153).Receiver operating characteristic analysis showed that the RIR was the best parameter with 85.29%sensitivity,89.87%specificity and 87.76%accuracy.The best cutoff
values for the 5 parameters(RPSV,RAR,RRR,RSR,RIR) were 170cm/s,2.3,2.0,4.0, 5.5,respectively.
Conclusions
For the detection of RAS(diameter reduction≥50%),the RIR is the best indicator in the five velocity parameters,and its diagnostic efficiency is only little higher than other most parameters.The RAR and RRR have worse sensitivity.Valuing the characteristic of hemodynamic change of renal artery and its influencing factors can improve diagnostic efficiency of RAS.
PartⅡDifferentiations of tardus-parvus pattern between the atherosclerotic and non-atherosclerotic renal artery stenosis
Objective
To evaluate the differences in tardus—parvus pattern between atheroscelrotic and non-atherosclerotic renal artery stenosis(RAS).
Methods
A study group of 135 RAS patients confirmed by renal arteriography were examined by color Doppler sonography.These patients included 35 cases of Takayasu arteritis,29 cases of fibromuscular dysplasia and 71 cases of atherosclerosis.They were categorized into atheroscelrotic and non-atherosclerotic group,and each group were graded into mild,moderate,severe and occlusive subgroups.Doppler spectra of interlobar arteries were obtained,and the acceleration time(AT) and resistive index(RI) was recorded.
Results
Renal angiography revealed 31 moderate RAS,129 severe RAS,and 19 occlusions.No statistically significant difference was found in AT between the atherosclerotic and non-atherosclerotic groups in the mild(P=0.07),moderate(P=0.28) or severe stenotic subgroup(P=0.10).However,statistically significant differences were found in RI between the atherosclerotic and non-atherosclerotic groups in the mild(P＜0.001), moderate(P＜0.001) or severe subgroup(P＜0.001).
Conclusions
The measurement method of AT used widely at present can not differentiate possible differences in pulsus-tardus waveforms between atherosclerotic and non-atherosclerotic RAS,but it still can be applied to the detection of RAS.Furthermore,different cut off values of RI should be established according to the types of RAS.
PartⅢDiagnostic value of Tardus—Parvus pattern in the detection of renal artery stenosis
Objective
To evaluate the diagnostic value of Tardus—Parvus pattern in the detection of different types of renal artery stenosis(RAS).
Methods
A study group was composed of 141 patients whose renal arteries were detected by color Doppler flow imaging and were referred to renal arteriography afterwards, including 38 Takayasu arteritis,33 fibromascular dysplasia and 70 atherosclerosis. Doppler spectra of interlobar arteries were obtained,and the acceleration time(AT),the resistive index(RI) and the side-to-side differences of RI(△RI) were recorded.
Results
In the 280 main renal arteries demonstrated by renal arteriography,there were 31 moderate stenoses(diameter reduction 50%～69%),145 severe stenoses(diameter reduction 70%～99%) and 20 occlusions.Among the 145 stenoses,38 were caused by Takayasu's arteritis,33 by fibromuscular dysplasia and 74 by atherosclerosis.The sensitivity,specificity and accuracy of AT≥0.07s for predicting all severe RAS were 82.58%,94.40%,87.86%,respectively.The best cutoff value of RI(0.50)for predicting severe non- atherosclerotic RAS had a sensitivity of 60.92%,specificity of 90.91%, accuracy of 72.54%.The best cutoff value of RI(0.60) for predicting severe atherosclerotic RAS had a sensitivity of 39.24%,specificity of 89.83%,accuracy of 60.87%.The best cutoff value of△RI was 0.08 with a sensitivity of 64.74%, specificity of 80.65%and accuracy of 68.38%.
Conclusions
AT≥0.07s is the best parameter for predicting≥70%RAS,and suitable for the three types of common RAS.The best cutoff value of RI is 0.6 for atherosclerotic RAS,and 0.5 for non-atherosclerotic RAS.The cutoff value of RI should be established according to the types of RAS.The diagnostic efficiency of RI and△RI was not satisfactory,the former might be contributed to the various influencing factors on RI, while the unsatisfactory efficiency of△RI is associated with the high percentage of patients with bilateral RAS.The cutoff of△RI had better to be set at 0.08 for unilateral severe stenosis.
PartⅣColor Doppler Sonography in Severe Transplant Renal Artery Stenosis:A Comparison of End-to-End and End-to-Side Arterial Anastomosis
Objective
The aim of this study was to investigate differences in Doppler parameters between severe transplant renal artery stenosis(TRAS,arterial lumen reduction≥80%) with end-to-end anastomosis and that with end-to-side anastomosis.
Methods
We retrospectively reviewed color Doppler sonography(CDS) and digital subtraction angiography(DSA) images in 38 patients with severe TRAS(19 cases with end-to-end anastomosis and 19 cases with end-to-side anastomosis) between January 1,2000 and December 31,2006.All 38 cases with severe TRAS were initially diagnosed with CDS and confirmed by DSA afterwards.Seven Doppler parameters,including the peak systolic velocity(PSV) in the renal,iliac,anastomosis site and segmental or interlobar artery,Pre-PSV ratio(the ratio of the PSV at the stenotic site to that in the iliac artery), Post-PSV ratio(the ratio of the PSV at the stenotic site to that in the intrarenal arteries, acceleration time in the intrarenal arteries,were measured.
Results
DSA demonstrated all patients with severe arterial stenosis(diameter reduction≥80%). With regard to the location of stenosis.4 stenotic lesions were found in the iliac artery, 20 were at the site of the anastomosis,and the other 14 involved the transplanted renal artery.There were significant differences in PSV in the stenotic artery(P＜0.01),PSV in the iliac artery(P＜0.001) and Pre-PSV ratio(P＜0.001) between TRAS with end-to-end anastomosis and that with end-to-side anastomosis.However,there was no statistically significant difference in AT in the intrarenal artery between the two types of anastomosis(P＞0.05).
Conclusions
Significantly hemodynamic differences between severe TRAS with end-to-end anastomosis and that with end-to-side anastomosis may be the reason for the significantly statistical differences in PSV in the stenotic artery and Pre-PSV ratio.In order to raise the diagnostic accuracy for severe TRAS,PSV in the stenotic artery and Pre-PSV ratio should be established according to the types of arterial anastomoses. However,the same diagnostic cutoff of AT is most suitable for both types of anastomosis.
目的
探讨内径减少≥50%肾动脉狭窄(RAS)的血流动力学特点及其诊断价值。
方法
经彩色多普勒血流显像(CDFI)检查后并进行肾动脉造影的77例患者共153条肾动脉构成研究组。测量了肾动脉峰值流速(RPSV)、肾动脉与腹主动脉峰值流速比值(RAR)、肾动脉与肾动脉峰值流速比值(RRR)、肾动脉与段动脉峰值流速比值(RSR)和肾动脉与叶间动脉峰值流速比值(RIR)。肾动脉造影显示肾动脉内径减少≥50%者确定为RAS。使用ROC曲线(receive operatingcharacteristic curves)分析确定最佳诊断指标。计算这些流速指标不同阈值的敏感性、特异性、阳性预测值、阴性预测值和准确率。
结果
在肾动脉造影显示的153条主肾动脉中,68条狭窄程度为50%～99%,6条闭塞。在狭窄程度50%～99%的68条肾动脉中,动脉粥样硬化性RAS 40条,大动脉炎RAS 17条,纤维肌性发育不良性RAS 9条,其它病因2条。肾动脉CDFI检查成功率为98.7%(151/153)。ROC曲线分析结果显示RIR是最佳指标,其对RAS的诊断敏感性、特异性、准确率分别为85.29%、89.87%、87.76%。RPSV、RAR、RRR、RSR、RIR最佳阈值依次分别为170cm/s、2.3、2.0、4.0、5.5。
结论
对于内径减少≥50%的RAS,RIR是最好的山流动力学指标,其诊断效率稍高于其他指标,RAR和RRR的诊断敏感性较差。分析肾动脉血流动力学特点及其影响因素,能够明显改善RAS的诊断效率。
第二部分动脉粥样硬化性与非动脉粥样硬化性肾动脉狭窄的小慢波差异
目的
探讨动脉粥样硬化性与非动脉粥样硬化性肾动脉狭窄(renal arerty stenosis,RAS)患者小慢波的表现差异及其原因。
方法
选择经彩色多普勒血流显像检查并经肾动脉造影证实的RAS患者135例,其中大动脉炎性35例,纤维肌性发育不良性29例,动脉粥样硬化性71例。将所有患者分为动脉粥样硬化组和非动脉粥样硬化组,每组又分为轻度狭窄,中度狭窄、重度狭窄和闭塞4个亚组。测量叶间动脉加速时间(acceleration time,AT)和阻力指数(resistive index,RI)。
结果
肾动脉造影显示肾动脉中度狭窄31条,重度狭窄129条和闭塞19条。对于轻度狭窄组,中度狭窄组或重度狭窄组,AT值存动脉粥样硬化组与非动脉粥样硬化组之间差异无统计学意义(P依次为0.07,0.28,0.10);而RI值在动脉粥样硬化组与非动脉粥样硬化之间差异却有统计学意义(P依次＜0.001,＜0.001,＜0.001)。
结论
目前常用的AT测量方法存在不足,不能检测出AT存动脉粥样硬化性与非动脉粥样硬化性RAS之间可能存在的差异,但仍可用于RAS的检查。应针对RAS类型来建立RI的诊断阈值。
第三部分小慢波在肾动脉狭窄诊断中的应用研究
目的
探讨小慢波对不同病因肾动脉狭窄(RAS)的诊断价值。
方法
经彩色多普勒血流显像检查后并进行肾动脉造影的RAS患者141例,其中大动脉炎组38例,纤维肌肉发育不良组33例,动脉粥样硬化组70例。测量叶间动脉加速时间(AT)、阻力指数(RI),并计算双侧RI差值(△RI)。结果
在肾动脉造影显示的280条主肾动脉中,中度狭窄(50%～69%)31条,重度狭窄(70%～99%)145条,闭塞20条。在145条重度狭窄肾动脉中,大动脉炎性38条,纤维肌肉发育不良性33条,动脉粥样硬化性74条。对于重度狭窄,AT≥0.07s时敏感性82.58%,特异性94.40%,准确率87.86%。最佳RI阈值(0.50)对非动脉粥样硬化性RAS(内径减少≥70%)的诊断敏感性65.79%,特异性87.88%,准确率70.06%,最佳RI阈值(0.60)对动脉粥样硬化性RAS(内径减少≥70%)的诊断敏感性39.24%,特异性89.83%,准确率60.87%。△RI对内径减少≥70%RAS的最佳阈值为0.08,其敏感性64.76%,特异性80.65%,准确率68.38%。
结论
对于内径减少≥70%RAS,AT≥0.07s的诊断价值最好,且适合三类常见RAS。动脉粥样硬化性RAS的最佳RI阈值为0.6,非动脉粥样硬化性RAS的最佳RI阈值为0.5,应针对RAS类型来建立RI诊断阈值。RI和ARI的诊断效果均不令人满意,前者与肾动脉RI的影响因素较多有关,后者与本组双侧RAS患者较多有关。ARI的诊断阂值以0.08较为合适,适合单侧RAS者。
第四部分彩色多普勒超声对端-端与端-侧吻合移植肾动脉重度狭窄的对比研究
目的
探讨两种吻合方式(端-端吻合与端-侧吻合)移植肾动脉重度狭窄(TRAS)(内径减少≥80%)的彩色多普勒超声(Color Doppler sonography,CDS)诊断指标的差异。
方法
回顾性分析2000年1月1日全2006年11月31日期间,CDS发现的38例移植肾动脉重度狭窄患者(端-端吻合和端-侧吻合各19例),均经数字减影血管造影(DSA)证实。采用CDS测量了7项多普勒参数:髂动脉、移植肾动脉主干、吻合口、肾内动脉(叶间动脉或段动脉)峰值流速(PSV),狭窄处与狭窄近端PSV比值(也称为PSV前比),狭窄处与狭窄远端PSV比值(也称为PSV后比),肾内动脉加速时间(AT)。并对这些参数进行统计学分析。
结果
DSA显示所有患者的动脉内径减少≥80%,狭窄部位位于髂动脉4例,吻合口20例和移植肾动脉14例。端-端吻合者与端.侧吻合者的狭窄处动脉PSV、髂动脉PSV及PSV前比之间差异均有非常显著性意义(P＜0.01,P＜0.001,P＜0.001),但两种吻合方式的AT之间差异无统计学意义(P＞0.05)。
结论
两种吻合方式重度TRAS患者的肾动脉血流动力学差异,很可能是导致它们之间狭窄处PSV和PSV前比差异的主要原因。为了提高重度TRAS的诊断准确性,应依据吻合方式来建立狭窄处PSV和PSV前比的诊断闽值,而同一的AT诊断阂值很可能适合两种吻合方式患者。
PartⅠEvaluation of Hemodanamic Parameters in the Diagnosis of Renal Artery Stenosis
Objective
To evaluate the characteristic of hemodynamic change of renal artery stenosis (RAS)(diameter reductions≥50%) and its diagnostic value.
Methods
A study group was composed of 77 patients with 153 renal arteries that were detected by color Doppler flow imaging and were referred to renal arteriography afterwards. Five Doppler parameters,including renal peak systolic velocity(RPSV),renal aortic ratio(RAR),renal-renal ratio(RRR),renal-segmental ratio(RSR) and renal-interlobar ratio(RIR) were measured.Arteries were considered stenosed on renal arteriography if there was a diameter reduction of greater than 50%.Statistical analysis to determine the best parameter for predicting a RAS was performed with receive operating characteristic curves.The sensitivity,specificity,and negative predicting value,positive predicting value and accuracy at various cutoffs were calculated.
Results
In the 153 main renal arteries demonstrated by renal arteriography,there were 6 occlusion and 68 stenoses(diameter reduction 50%～99%).Among the 68 stenoses,40 were caused by atherosclerosis,17 by Takayasu's arteritis,9 by fibromuscular dysplasia and 2 by other etiology.Doppler examination was technically successful in 98.7%of renal arteries(151/153).Receiver operating characteristic analysis showed that the RIR was the best parameter with 85.29%sensitivity,89.87%specificity and 87.76%accuracy.The best cutoff
values for the 5 parameters(RPSV,RAR,RRR,RSR,RIR) were 170cm/s,2.3,2.0,4.0, 5.5,respectively.
Conclusions
For the detection of RAS(diameter reduction≥50%),the RIR is the best indicator in the five velocity parameters,and its diagnostic efficiency is only little higher than other most parameters.The RAR and RRR have worse sensitivity.Valuing the characteristic of hemodynamic change of renal artery and its influencing factors can improve diagnostic efficiency of RAS.
PartⅡDifferentiations of tardus-parvus pattern between the atherosclerotic and non-atherosclerotic renal artery stenosis
Objective
To evaluate the differences in tardus—parvus pattern between atheroscelrotic and non-atherosclerotic renal artery stenosis(RAS).
Methods
A study group of 135 RAS patients confirmed by renal arteriography were examined by color Doppler sonography.These patients included 35 cases of Takayasu arteritis,29 cases of fibromuscular dysplasia and 71 cases of atherosclerosis.They were categorized into atheroscelrotic and non-atherosclerotic group,and each group were graded into mild,moderate,severe and occlusive subgroups.Doppler spectra of interlobar arteries were obtained,and the acceleration time(AT) and resistive index(RI) was recorded.
Results
Renal angiography revealed 31 moderate RAS,129 severe RAS,and 19 occlusions.No statistically significant difference was found in AT between the atherosclerotic and non-atherosclerotic groups in the mild(P=0.07),moderate(P=0.28) or severe stenotic subgroup(P=0.10).However,statistically significant differences were found in RI between the atherosclerotic and non-atherosclerotic groups in the mild(P＜0.001), moderate(P＜0.001) or severe subgroup(P＜0.001).
Conclusions
The measurement method of AT used widely at present can not differentiate possible differences in pulsus-tardus waveforms between atherosclerotic and non-atherosclerotic RAS,but it still can be applied to the detection of RAS.Furthermore,different cut off values of RI should be established according to the types of RAS.
PartⅢDiagnostic value of Tardus—Parvus pattern in the detection of renal artery stenosis
Objective
To evaluate the diagnostic value of Tardus—Parvus pattern in the detection of different types of renal artery stenosis(RAS).
Methods
A study group was composed of 141 patients whose renal arteries were detected by color Doppler flow imaging and were referred to renal arteriography afterwards, including 38 Takayasu arteritis,33 fibromascular dysplasia and 70 atherosclerosis. Doppler spectra of interlobar arteries were obtained,and the acceleration time(AT),the resistive index(RI) and the side-to-side differences of RI(△RI) were recorded.
Results
In the 280 main renal arteries demonstrated by renal arteriography,there were 31 moderate stenoses(diameter reduction 50%～69%),145 severe stenoses(diameter reduction 70%～99%) and 20 occlusions.Among the 145 stenoses,38 were caused by Takayasu's arteritis,33 by fibromuscular dysplasia and 74 by atherosclerosis.The sensitivity,specificity and accuracy of AT≥0.07s for predicting all severe RAS were 82.58%,94.40%,87.86%,respectively.The best cutoff value of RI(0.50)for predicting severe non- atherosclerotic RAS had a sensitivity of 60.92%,specificity of 90.91%, accuracy of 72.54%.The best cutoff value of RI(0.60) for predicting severe atherosclerotic RAS had a sensitivity of 39.24%,specificity of 89.83%,accuracy of 60.87%.The best cutoff value of△RI was 0.08 with a sensitivity of 64.74%, specificity of 80.65%and accuracy of 68.38%.
Conclusions
AT≥0.07s is the best parameter for predicting≥70%RAS,and suitable for the three types of common RAS.The best cutoff value of RI is 0.6 for atherosclerotic RAS,and 0.5 for non-atherosclerotic RAS.The cutoff value of RI should be established according to the types of RAS.The diagnostic efficiency of RI and△RI was not satisfactory,the former might be contributed to the various influencing factors on RI, while the unsatisfactory efficiency of△RI is associated with the high percentage of patients with bilateral RAS.The cutoff of△RI had better to be set at 0.08 for unilateral severe stenosis.
PartⅣColor Doppler Sonography in Severe Transplant Renal Artery Stenosis:A Comparison of End-to-End and End-to-Side Arterial Anastomosis
Objective
The aim of this study was to investigate differences in Doppler parameters between severe transplant renal artery stenosis(TRAS,arterial lumen reduction≥80%) with end-to-end anastomosis and that with end-to-side anastomosis.
Methods
We retrospectively reviewed color Doppler sonography(CDS) and digital subtraction angiography(DSA) images in 38 patients with severe TRAS(19 cases with end-to-end anastomosis and 19 cases with end-to-side anastomosis) between January 1,2000 and December 31,2006.All 38 cases with severe TRAS were initially diagnosed with CDS and confirmed by DSA afterwards.Seven Doppler parameters,including the peak systolic velocity(PSV) in the renal,iliac,anastomosis site and segmental or interlobar artery,Pre-PSV ratio(the ratio of the PSV at the stenotic site to that in the iliac artery), Post-PSV ratio(the ratio of the PSV at the stenotic site to that in the intrarenal arteries, acceleration time in the intrarenal arteries,were measured.
Results
DSA demonstrated all patients with severe arterial stenosis(diameter reduction≥80%). With regard to the location of stenosis.4 stenotic lesions were found in the iliac artery, 20 were at the site of the anastomosis,and the other 14 involved the transplanted renal artery.There were significant differences in PSV in the stenotic artery(P＜0.01),PSV in the iliac artery(P＜0.001) and Pre-PSV ratio(P＜0.001) between TRAS with end-to-end anastomosis and that with end-to-side anastomosis.However,there was no statistically significant difference in AT in the intrarenal artery between the two types of anastomosis(P＞0.05).
Conclusions
Significantly hemodynamic differences between severe TRAS with end-to-end anastomosis and that with end-to-side anastomosis may be the reason for the significantly statistical differences in PSV in the stenotic artery and Pre-PSV ratio.In order to raise the diagnostic accuracy for severe TRAS,PSV in the stenotic artery and Pre-PSV ratio should be established according to the types of arterial anastomoses. However,the same diagnostic cutoff of AT is most suitable for both types of anastomosis.
引文
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13 Bude RO,Rubin JM.Detection of renal artery stenosis with Doppler sonography:it is more complicated than originally thought(editorial).Radiology,1995,196:612-613.
14 Li JC,Wang L,Jiang YX,et al.Evaluation of renal artery stenosis with velocity parameters of Doppler sonography.J Ultrasound Med,2006,6:735-742.
15 李建初.腹主动脉及其王要分支疾病的多普勒超声诊断.见李建初,袁光华,柳文仪主编:血管和浅表器官彩色多普勒超声诊断学(第1版),北京:中国协和医科大学出版社,1999.134.
16 de Oliveira SIRS,Widman A,Molnar L J,et al.Color Doppler ultrasound:a new index improves the diagnosis of renal artery stenosis.Ultrasound Med Biol,2000,26:41-47.
17 Li JC,Ji ZG,Cai S,et al.Evaluation of severe transplant renal artery stenosis with Doppler sonography.J Clin Ultrasound,2005,6:261-269.
18 李建初,姜玉新,秦卫,等.Tardus-Parvus波形在.旨动脉狭窄诊断中的应用研究.中华超声影像学杂志,2006,9:677-680.
19 Schwerk WB,Restrepo IK,Stellwaag M,et al.Renal artery stenosis:grading with image-directed Doppler US evaluation of renal resistive index.Radiology,1994,190:785-790.
20 Krumme B,Blum U,Schwertfeger E,et al.Diagnosis of renovascular disease by intra- and extrarenal Doppler scanning.Kidney Int,1996,4:1288-1292.
21 Ripolles T,Aliaga R,Morote V,et al.Utility of intrarenal Doppler ultrasound in the diagnosis of renal artery stenosis.Eur J Radiol,2001,1:54-63.
22 秦卫,王芳,王梅,等.彩色多普勒超声在动脉粥样硬化性肾动脉狭窄诊断中的应用.中华超声影像学杂志,2005.7:508-511.
23 Conkbayir I,Yucesoy C,Edguer T,et al.Doppler sonography in renal artery stenosis.An evaluation of intrarenal and extrarenal imaging parameters.Clin Imaging,2003,27(4):256-260.
24 Demirpolat G,Ozbek SS,Parildar M,et al.Reliability of intrarenal Doppler sonographic parameters of renal artery stenosis.J Clin Ultrasound,2003,7:346-351.
25 LI JC,Yuan Y,Qin W,et al.Evaluation of tardus-parvus pattern in patients with atherosclerotic and non-atherosclerotic renal artery stenosis.J Ultrasound Med,2007,4:419-426.
26 Rene PC,Oliva VL,Bui BT,et al.Renal artery stenosis:evaluation of Doppler US after inhibition of angiotensin-converting enzyme captopril.Radiology,1995,196:675-679.
27 Qanadli SD,Soulez G,Therasse E,et al.Detection of renal artery stenosis:prospective comparison of captopril-enhances Doppler sonography,captopril-enhaced scintigraphy,and MR angiography.A JR Am J Roentgenol,2001,5:1123-1129.
28 Lee HY,Grant EG.Sonography in renovascular hypertension.J Ultrasound Med,2002,4:431-441.
29 高敬,Kazam E,Whalen JP,等.彩色多普勒超声检测自体肾和移植肾的肾动脉狭窄.中国医学影像技术,2003,3:307-310.
30 Lafortune M, Patriquin H, Demeule E, et al. Renal arterial stenosis: slowed systole in the downstream circulation-experimental study in dogs. Radiology, 1992,184:475-478.
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22. Li JC, Ji ZG, Cai S, et al. Evaluation of severe transplant renal artery stenosis with Doppler sonography. J Clinical Ultrasound, 2005, 33:261-269
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27. Gottlieb RH, Hartley DF, Rubens DJ, et al. Effect of a main renal artery stenosis on the downstream Doppler waveform in dogs.Acad Radiol,1995,2:768-775.
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8 de Oliveira SIRS,Widman A,Molnar LJ,et al.Color Doppler ultrasound:a new index improves the diagnosis of renal artery stenosis.Ultrasound Med Biol,2000,26:41-47.
9 Landwehr P,Schindler R,Heinrich U,et al.Quantification of vascular stenosis with color Doppler flow imaging:in vitro investigation.Radiol,1991,178:701-704.
10 Chain S,Luciardi H,Feldman G,et al.Diagnostic role of new Doppler index in assessment of renal artery stenosis.Cardiovascular Ultrasound,2006,4:4.
11 Li JC,Wang L,Jiang YX,et al.Evaluation of renal artery stenosis with velocity parameters of Doppler sonography.J Ultrasound Med,2006;25:735-742.
12 Rabbia C,Valpreda S.Duplex scan sonography of renal artery stenosis.Int Angiol 2003;22:101-115.
13 Spies KP,Fobbe F,El-Bedewi M,Wolf KJ,Distler A,Schulte KL.Color-coded duplex sonography for noninvasive diagnosis and grading of renal artery stenosis.Am J Hypertens 1995;8:1222-1231.
14 Nchimi A,Biquet JF,Brisbois D,et al.Duplex ultrasound as first-line screening test for patients suspected of renal artery stenosis:prospective evaluation in high-risk group.Eur Radiol 2003;13:1413-1419.
15 van der Hulst VP,van Baalen J,Kool LS,et al.Renal artery stenosis:endovascular flow wire study for validation of Doppler US.Radiology,1996,200:165-168.
16 尚云鹏,姜玉新,荣雪余,等.彩色多普勒超声诊断肾动脉粥样硬化性狭窄.中国医学影像技术,2001,17:75-77.
17 House MK,Dowling RJ,King P,et al.Using Doppler sonography to reveal renal artery stenosis:an evaluation of optimal imaging parameters.Am J Roentgenol,1999,173:761-765.
18 李建初,张缙熙,周墨宽,等.彩色多普勒超声对肾动脉狭窄的评价.中华超声影像学杂志,1996,4:159-161.
19 李建初,腹主动脉及其主要分支疾病的多普勒超声诊断.见李建初,袁光华, 医学大学出版社, 1999. 134.
20 Soares GM, Murphy TP, Singha MS, et al. Renal artery duplex ultrasonogrphy as a screening and surveillance tool to detect renal artery stenosis: a comparison with current references standard imaging. J Ultrasound Med, 2006, 25:293-298.
21 Conkbayir I, Yucesoy C , Edguer T, Yanik B, Yasar Ayaz U, Hekimoglu B. Doppler sonography in renal artery stenosis. An evaluation of intrarenal and extrarenal imaging parameters. Clin Imaging 2003;27:256-260.
22 Napoli V, Pinto S, Bargellini I, et al. Duplex ultrasonographic study of the renal arteries before and after renal artery stenting. Eur Radiol, 2002, 12:796-803.
23 Bude RO, Rubin JM. Detection of renal artery stenosis with Doppler sonography: it is more complicated than originally thought (editorial). Radiology 1995;196:612-613.
24 Burdick L, Airoldi F, Marana I, et al. Superiority of acceleration and acceleration time over pulsatility and resisitance indices as screening tests for renal artery stenosis. J Hypertension 1996;14:1229-1235.
25 De Morais RH, Muglia VF, Mamere AE, et al, Duplex Doppler sonography in transplant renal artery stenosis. J Clin Ultrasound 2003; 31:135.
26 Fervenza FC, Lafayette RA, Alfrey EJ, et al, Renal artery stenosis in kidney transplants. AJKD 1998; 31: 142-148.
27 Clerbaux G, Goffette P, Pirson Y, et al. Two kidney-transplant women with therapy-resistant hypertension: diagnostic error of a renal artery stenosis. Nephrol Dial Transplant 2003; 18: 1401-1404.
28 Loubeyre P, Cahen R, Grozel F, et al. Transplant renal artery stenosis: evaluation of diagnosis with magnetic resonance angiography compared with color duplex sonography and angiography. Transplantation 1996; 62: 446-450.
29 Plainfosse MC, Calonge VM, Beyloune-Mainardi C, et al. Vascular complications in the adult kidney transplant recipient. J Clin Ultrasound, 1992, 20:517-527.
30 Merkus JWS, Hoitsma AJ, van Asten WN, et al. Echo-Doppler diagnosis of renal allograft artery stenosis. Clin Transplant, 1995, 9:383-389.
1 de Oliveira SIRS,Widman A,Molnar LJ,et al.Color Doppler ultrasound:a new index improves the diagnosis of renal artery stenosis.Ultrasound Med Biol,2000,26:41-47.8
2 Landwehr P,Schindler R,Heinrich U,et al.Quantification of vascular stenosis with color Doppler flow imaging:in vitro investigation.Radiol,1991,178:701-704
3 Chain S,Luciardi H,Feldman G,et al.Diagnostic role of new Doppler index in assessment of renal artery stenosis.Cardiovascular Ultrasound,2006,4:4
4 Li JC,Wang L,Jiang YX,et al.Evaluation of renal artery stenosis with velocity parameters of Doppler sonography.J Ultrasound Med,2006;25:735-742
5 Rabbia C,Valpreda S.Duplex scan sonography of renal artery stenosis.Int Angiol 2003;22:101-115.
6 Spies KP,Fobbe F,EI-Bedewi M,Wolf KJ,Distler A,Schulte KL.Color-coded duplex sonography for noninvasive diagnosis and grading of renal artery stenosis.Am J Hypertens 1995;8:1222-1231.
7 Nchimi A,Biquet JF,Brisbois D,et al.Duplex ultrasound as first-line screening test for patients suspected of renal artery stenosis:prospective evaluation in high-risk group.Eur Radiol 2003;13:1413-1419.
8 van der Hulst VP,van Baalen J,Kool LS,et al.Renal artery stenosis:endovascular flow wire study for validation of Doppler US.Radiology,1996,200:165-168.
9 尚云鹏,姜玉新,荣雪余,等.彩色多普勒超声诊断肾动脉粥样硬化性狭窄.中国医学影像技术,2001,17:75-77.
10 House MK,Dowling RJ,King P,et al.Using Doppler sonography to reveal renal artery stenosis:an evaluation of optimal imaging parameters.Am J Roentgenol,1999,173:761-765.
11 李建初,张缙熙,周墨宽,等.彩色多普勒超声对肾动脉狭窄的评价.中华超声影像学杂志,1996,4:159-161.
12 李建初,腹主动脉及其主要分支疾病的多普勒超声诊断.见李建初,袁光华,柳文仪主编:血管和浅表器官彩色多普勒超声诊断学(第1版).北京:中国协和医科大学出版社,1999.134.
13 Soares GM,Murphy TP,Singha MS,et al.Renal artery duplex ultrasonogrphy as a screening and surveillance tool to detect renal artery stenosis:a comparison with current references standard imaging.J Ultrasound Med,2006,25:293-298
14 Conkbayir I,Yucesoy C,Edguer T,Yanik B,Yasar Ayaz U,Hekimoglu B.Doppler sonography in renal artery stenosis.An evaluation of intrarenal and extrarenal imaging parameters.Clin Imaging 2003;27:256-260
15 Napoli V,Pinto S,Bargeilini I,et al.Duplex ultrasonographic study of the renal arteries before and after renal artery stenting.Eur Radiol,2002,12:796-803.
16 Krumme B,Blum U,Schwertfeger E,et al.Diagnosis of renovascular disease by intra- and extrarenal Doppler scanning.Kidney International,1996,50:1288-1292.
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1 Ripolles T,Aliaga R,Morote V,et al.Utility of intrarenal Doppler ultrasound in the diagnosis of renal artery stenosis.Euro J Radiol 2001;40:54-63.
2 Schwerk WB,Restrepo IK,Stellwaag M,Klose K J,Schade-Brittinger C.Renal artery stenosis:grading with image-directed Doppler US evaluation of renal resistive index.Radiology 1994;190:785-790.
3 Bude RO,Rubin JM.Detection of renal artery stenosis with Doppler sonography:it is more complicated than originally thought(editorial).Radiology 1995;196:612-613.
4 Burdick L,Airoldi F,Marana I,et al.Superiority of acceleration and acceleration time over pulsatility and resisitance indices as screening tests for renal artery stenosis.J Hypertension 1996;14:1229-1235.
5 Stavros AT,Parker SH,Yakes WF,et al.Segmental stenosis of the renal artery:pattern recognition of tardus and parvus abnormalities with duplex sonography.Radiology 1992;184:487-492. Demirpolat G,Ozbek SS,Parildar M,Oran I,Memis A.Reliability of intrarenal Doppler sonographic parameters of renal artery stenosis.J Clin Ultrasound 2003;31:346-351.
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12 Conkbayir I,Yucesoy C,Edguer T,Yanik B,Yasar Ayaz U,Hekimoglu B.Doppler sonography in renal artery stenosis.An evaluation of intrarenal and extrarenal imaging parameters.Clin Imaging 2003;27:256-260.
13 高敬,Kazam E.Whalen JP,杨晓玲.彩色多普勒超声检测自体肾和移植肾的肾动脉狭窄.中国医学影像技术,2003,19:307-310.
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4 Ripolles T,Aliaga R,Morote V,et al.Utility of intrarenal Doppler ultrasound in the diagnosis of renal artery stenosis.Eur J Radiol,2001,40:54-63.
5 Schwerk WB,Restrepo IK,Stellwaag M,et al.Renal artery stenosis:grading with image-directed Doppler US evaluation of renal resistive index.Radiology,1994,190:785-790.
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7 Li JC,Wang L,Jiang YX,et al.Evaluation of renal artery stenosis with velocity parameters of Doppler sonography.J Ultrasound Med,2006;25:735-742
8 Spies KP,Fobbe F,El-Bedewi M,Wolf KJ,Distler A,Schulte KL.Color-coded duplex sonography fbr noninvasive diagnosis and grading of renal artery stenosis.Am J Hypertens 1995;8:1222-1231.
9 秦卫,王芳,王梅,等.彩色多普勒超声在动脉粥样硬化性肾动脉狭窄诊断中的应用.中华超声影像学杂志,2005,7,508-511.
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15 Burdick L,Airoldi F,Marana I,et al.Superriority of acceleration and acceleration time over pulsatility and resistance indices as screening tests for renal artery stenosis.Journal of Hypertension,1996,14:1229-1235.
16 Lafortune M,Patriquin H,Demeule E,et al.Renal arterial stenosis:slowed systole in the downstream circulation-experimental study in dogs.Radiology,1992,184:475-478.
17 Palatresi S,Longari V,Airoldi F,et al.Usefulness and limits of distal echo-Doppler velocimetric indices for assessing renal hemodynamics in stenotic and non-stenotic kidneys.J Hypertens.2001,19:1489-1496.
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26 Qanadli SD, Soulez G, Therasse E, et al. Detection of renal artery stenosis:prospective comparison of captopril-enhances Doppler sonography,captopril-enhaced scintigraphy, and MR angiography. AJR Am J Roentgenol, 2001,5:1123-1129.
1.De Morais RH,Muglia VF,Mamere AE,et al,Duplex Doppler sonography in transplant renal artery stenosis.J Clin Ultrasound 2003;31:135
2.Fervenza FC,Lafayette RA,Alfrey EJ,et al,Renal artery stenosis in kidney transplants.AJKD 1998;31:142-148
3.Clerbaux G,Goffette P,Pirson Y,et al.Two kidney-transplant women with therapy-resistant hypertension:diagnostic error of a renal artery stenosis.Nephrol Dial Transplant 2003;18:1401-1404
4.Loubeyre P,Cahen R,Grozel F,et al.Transplant renal artery stenosis:evaluation of diagnosis with magnetic resonance angiography compared with color duplex sonography and angiography.Transplantation 1996;62:446-450
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