彩色多普勒血流显像诊断移植肾动脉重度狭窄

目的探讨彩色多普勒血流显像(CDFI)检查肾动脉与叶间动脉峰值流速之比(简称峰值流速后比)对移植肾动脉重度狭窄的诊断价值.方法 CDFI发现的46例移植肾动脉狭窄(TRAS)患者中,14例接受了动脉造影检查并证实有TRAS者构成研究组.测量7项多普勒血流参数肾动脉主干、髂动脉和叶间动脉收缩期峰值流速(PSV),肾动脉与髂动脉峰值流速之比(简称峰值流速前比)、峰值流速后比、加速时间和阻力指数.并进行了介入治疗前后超声结果的对比分析.结果在14例单个移植肾患者中,血管造影显示13条主肾动脉重度狭窄和2条肾动脉中度狭窄(主、副肾动脉各1条).对于13条重度TRAS,峰值流速后比＞13、肾动脉PSV＞4 m/s、加速时间＞ 0.06 s和阻力指数＜ 0.5 的敏感性分别为100%、69%、92%和54%.采用峰值流速前比＞5来诊断所有13条和11条端-端吻合的重度TRAS,敏感性分别为85%、100%.对获得介入治疗成功的7例患者,介入治疗前后的所有7项多普勒参数差异均具有非常显著性意义.结论 CDFI是血管造影前筛选重度TRAS的良好影像学方法.峰值流速后比＞13能很好地诊断重度TRAS(端-端或端-侧吻合).峰值流速前比＞5对端-端吻合的重度TRAS和加速时间＞ 0.06 s对两种吻合类型的重度TRAS的诊断很有帮助.     

两种动脉重建方式彩超对移植肾远期影响的比较

目的 通过对5年以上供肾动脉与髂外动脉行端侧吻合（EEA）或与髂内动脉行端端吻合（ESA）的移植肾进行二维超声、多普勒血流参数及血肌酐(SCr)的比较，评价两种动脉重建方式的远期效果。方法 根据供肾动脉的不同吻合方式将64名肾移植患者分为髂内动脉端端吻合组和髂外动脉端侧吻合组，采用彩色多普勒超声进行监测，观察移植肾的大小、结构、血流灌注情况、血流动力学参数，进行对比分析。结果 两组移植肾患者的血肌酐(SCr)、移植肾体积、椎体大小、肾皮质厚度、肾动脉内径、移植肾段动脉、叶间动脉、弓形动脉血流及阻力指数差异均无统计学意义(P>0．05)。结论 供肾动脉与髂内动脉端端吻合或与髂外动脉端侧吻合5年以上的移植肾患者在肾功能、二维超声、多普勒血流上没有明显差异。     

两种动脉重建方式对移植肾远期影响的彩色多普勒超声观察

目的:通过对5年以上供肾动脉与髂外动脉端侧吻合或与髂内动脉端端吻合的移植肾进行二维超声、多普勒血流参数及血肌酐(SCr)的比较,评价两种动脉重建方式的远期效果。方法:根据供肾动脉的不同吻合方式将64例肾移植患者分为ESA组和EEA组,采用彩色多普勒超声进行监测,观察移植肾的大小、结构、血流灌注情况、血流动力学参数,进行对比分析。结果:两组移植肾患者的SCr、移植肾体积、锥体大小、肾皮质厚度、肾动脉内径、移植肾段动脉、叶间动脉、弓形动脉血流及阻力指数差异均无统计学意义(P>0.05)。结论:供肾动脉与髂外动脉端侧吻合或与髂内动脉端端吻合5年以上的移植肾患者在肾功能、二维超声、多普勒血流上没有明显差异。     

常规超声和超声造影对移植肾两种动脉重建方式的评价

目的 应用常规超声及超声造影(CEUS)评价肾移植患者供肾动脉与髂内动脉行端端吻合(EEA)或与髂外动脉行端侧吻合(ESA)两种方式的远期效果.方法 根据供肾动脉吻合方式将60名移植肾患者分为EEA组和ESA组,进行二维超声、彩色多普勒超声以及CEUS定量分析的比较.结果 两种动脉重建方式在二维超声和彩色多普勒超声的指标上差异无统计学意义;CEUS定量分析指标上,ESA组略优于EEA组.结论 两种动脉重建方式的血流灌注ESA略优于EEA.     

超声评价移植肾动脉狭窄介入治疗前后的变化

目的探讨彩色多普勒超声对移植肾动脉狭窄（TRAS）介入治疗术前、术后血流动力学改变的观察价值。方法TRAS组患者14例,肾移植术后临床生化及超声检测正常的30例患者为对照组。超声测量其肾动脉主干、段动脉及叶间动脉的收缩期峰值流速（PSV）、阻力指数（RI）及血流加速时间（AT）,分别计算肾动脉分别与段动脉、叶间动脉PSV比值。结果①与对照组比较,TRAS组肾动脉主干狭窄段PSV增快,叶间动脉PSV及RI减小,AT增加,肾动脉主干分别与段动脉、叶间动脉PSV比值增大,差异均有统计学意义（P〈0．05）。②与介入治疗术前比较,TRAS组术后肾动脉主干PSV减低,叶间动脉PSV增高,段动脉PSV减低,叶间动脉RI增高,肾动脉主干分别与段动脉、叶间动脉的PSV比值减低,差异均有统计学意义（P〈0．05）。结论彩色多普勒超声能监测TRAS介入治疗后肾动脉和肾内小动脉流速变化,是筛选诊断的首选方法。     

同种异体肾移植术后早期肾动脉狭窄诊疗的回顾性研究

目的通过单中心移植肾动脉狭窄(TRAS)诊疗的回顾性研究,探讨早期诊断及治疗移植肾动脉狭窄的方法。方法统计本中心同种异体肾移植术后287例患者的临床表现、检验数据及影像学资料,比较TRAS患者与非TRAS患者移植肾超声参数,建立筛查TRAS的超声诊断阈值。比较有症状TRAS患者和无症状TRAS患者介入治疗前后肌酐、血压的变化。结果287例患者中共出现13例TRAS患者。移植肾动脉收缩期峰值流速(PSV)250 cm/s、叶间动脉动脉阻力指数(RI)0.51、移植肾动脉与叶间动脉PSV比值10可以作为筛查TRAS的超声阈值。有症状TRAS患者与无症状TRAS患者经血管腔内血管成形术(PTA)治疗后肌酐、平均动脉压均显著下降(P0.05)。结论在肾移植术后定期随访中监测肾移植血流量和临床表现有助于早期诊断TRAS。移植肾动脉PSV250 cm/s、叶间动脉RI0.51、移植肾动脉与叶间动脉PSV比值10可以作为筛查TRAS的超声阈值。     

超声造影对移植肾动脉狭窄的临床研究

目的探讨超声造影在观察移植肾动脉主干不同狭窄程度中的应用价值。方法经数字减影血管造影(DSA)确诊的25例移植肾动脉狭窄(TRAS)患者,先后使用CDFI及超声造影技术对其进行观察,另随机抽取在临床症状、实验室指标及超声检查确诊移植肾动脉均未见异常的25例正常移植肾患者作为对照组。比较两组移植肾动脉的血流动力学指标,着重观察注入造影剂后移植肾动脉主干及移植肾全貌的灌注情况,并与DSA结果进行比较分析。结果彩色多普勒超声在移植肾动脉狭窄处均可探及五彩镶嵌的高速血流,与超声造影检查显示的狭窄部位及DSA检查结果相符;CDFI显示移植肾动脉管腔狭窄长度及狭窄内径均大于超声造影所见;两组比较差异有统计学意义(P0.01);超声造影所示狭窄长度及狭窄内径与DSA检查两组结果相符(P=0.072),超声造影诊断中、重度狭窄与DSA结果的诊断一致性好(Kappa=0.850);超声造影下移植肾的显像程度随着血流量及灌注压力的递减而同步递减。结论彩色多普勒超声结合超声造影技术能够直观完整地显示移植肾动脉及移植肾内的血流分布情况,对诊断中、重度移植肾动脉狭窄具有较大的临床价值。     

彩色多普勒超声对动脉粥样硬化性肾动脉狭窄的诊断价值

目的评价彩色多普勒超声对动脉粥样硬化性肾动脉狭窄(ARAR)的诊断准确性,并确定其最有效的诊断方法。方法 86例ARAR患者,超声检测其172个肾脏形态学及172条肾动脉血流动力学指标:动脉狭窄处峰值血流速度(PSV)、肾动脉与腹主动脉峰值流速比值(RAR)及叶间动脉加速时间(AT);以肾动脉造影为标准,评价超声诊断ARAS的准确性。结果 172条肾动脉造影:肾动脉37条正常,36条狭窄60%,92条狭窄60%～95%,5条狭窄96%～99%,2条闭塞。超声诊断狭窄≥60%符合率为98.0%。对狭窄≥60%的病变,肾动脉PSV≥180 cm/s的敏感性95.9%,RAR≥3.0的敏感性56.7%,AT0.07 s的敏感性69.1%,肾脏长径的ROC曲线下面积为0.504。肾动脉狭窄96%～99%时,肾动脉PSV180 cm/s,而AT均0.07 s,患处血流较对侧明显变细。闭塞时,肾动脉主干内未见彩色血流信号,如肾内能显示动脉血流,AT0.07 s。结论对于诊断肾动脉狭窄60%～95%的ARAS,肾动脉PSV是最佳指标;对于高度狭窄及闭塞者,两侧动脉的彩色血流对比显示联合AT0.07 s,较单纯血流动力学指标更可靠。     

移植肾初期肾动脉狭窄的超声诊断

目的 探讨肾移植术后初期肾动脉狭窄的超声诊断。方法 回顾分析厦门大学附属翔安医院2019年4月-2021年12月超声科检查的103例肾移植患者的超声及临床资料。结果 共28例超声提示肾主动脉或动脉吻合口血流信号紊乱及PSV增快,PSV>250cm/s。其中11例在术后3个月的超声定期监测中PSV处于稳定增快状态,最终经DSA或CTA检查,动脉吻合口狭窄8例,肾主动脉距吻合口5mm处狭窄1例。另2例PSV增快为肾主动脉成角所致。其余17例在术后3个月的超声定期监测中,PSV逐渐下降,最终PSV≤250cm/s。肾主动脉PSV持续增快病例组9例术后肌酐值下降缓慢未达正常范围;肾动脉PSV逐渐下降组,肌酐值随之降至正常范围。超声显示PSV增快及血流信号紊乱的病例中真性狭窄的比例为32.1%(9/28)。结论 肾移植术后短期内吻合口及其旁软组织增厚水肿可致肾动脉PSV增快及紊乱血流信号,并非一定是真性狭窄。肾移植后初期肾主动脉容易成角导致PSV增快。术后初期应用超声监测肾动脉PSV变化趋势尤为必要,减少侵入性检查。超声监测中结合肌酐值的变化趋势对移植肾动脉狭窄的判定有重要意义。     

彩色多普勒血流显像评价移植肾动脉重度狭窄

采用彩色多普勒血流显像(color Dopplerflow imaging,CDFI)评价移植肾动脉狭窄(transplant renal artery stenosis,TRAS)的多数报道是针对肾动脉内径减小＞50%的狭窄.关于重度TRAS和端-端吻合的TRAS的CDFI诊断报道较少.     

Evaluation of severe transplant renal artery stenosis with Doppler sonography

PURPOSE: To evaluate and determine Doppler criteria for predicting a severe transplant renal artery stenosis (80%-99% diameter reduction) and to compare the Doppler findings in patients with end-to-end and end-to-side anastomosis. METHODS: We performed Doppler sonography on 16 consecutive patients with transplant renal artery stenosis (TRAS) confirmed by digital subtraction arteriography (DSA). Fourteen patients had end-to-end anastomosis, and 2 had end-to-side anastomosis. Eleven patients were re-evaluated with color Doppler sonography within 4 days after intervention. Seven Doppler parameters, including the peak systolic velocity (PSV) in the renal, iliac and interlobar artery, Pre-PSV ratio (the ratio of the PSV in the renal artery to that in the iliac artery), Post-PSV ratio (the ratio of the PSV in the renal artery to that in the interlobar arteries, acceleration time and resistance index, were measured. In the patients with severe TRAS the measurements of these parameters were compared before and after successful intervention. RESULTS: In the 16 patients with a single transplanted kidney, arteriography demonstrated 14 main renal arteries with severe stenosis, and 3 renal arteries with moderate stenosis. When using the cutoff values of Post-PSV ratio >13, renal artery PSV >4 m/sec, acceleration time >0.06 second, and resistance index <0.5 for the detection of all 14 severe stenoses, the sensitivities were 100%, 71%, 93%, and 50%, respectively. For assessing all 14 severe stenoses and 12 severe stenoses of end-to-end anastomosis, the cutoff value of Pre-PSV ratio >5 had sensitivities of 86% and 100%, respectively. Pre-PSV ratios in severe stenoses of end-to-end anastomosis (range, 5.1-11.5) were significantly greater than those recorded in severe stenoses of end-to-side anastomosis (range, 2.8-3.1). Statistically significant differences before and after successful intervention were found for all 7 Doppler parameters in the 7 patients with severe stenosis. CONCLUSIONS: An 80%-99% diameter reduction of the renal artery can be diagnosed based on a Post-PSV ratio >13 for patients with either end-to-end or end-to-side anastomosis. A Pre-PSV ratio >5 for patients with end-to-end anastomosis and acceleration time >0.06 second are helpful in the diagnosis of severe TRAS.     

移植肾肾动脉狭窄的彩色多普勒超声诊断

目的 探讨运用多项彩色多普勒超声（CDUS）指标综合诊断移植肾肾动脉狭窄（TRAS）的的新标准。方法 回顾性分析20例经数字减影血管造影（DSA）证实的TRAS的CDUS指标：移植肾肾动脉收缩期峰值血流速度（PSV）、肾动脉与髂外动脉PSV比值（RIR）、肾动脉与叶间动脉PSV比值（峰值流速后比）和叶间动脉阻力指数（RI）;并与对照组相应指标对比。结果 TRAS组与对照组的上述4项指标之间均存在显著统计学差异（P〈0．001）。新标准具有良好的敏感性（100％）和较高的特异性。结论 新标准能够提高CDUS对TRAS的诊断率。     

Duplex Doppler sonography of transplant renal artery stenosis

PURPOSE: The aim of this study was to evaluate the accuracy of duplex Doppler sonography in diagnosing transplant renal artery stenosis (TRAS) and to determine which parameter is the most reliable for making that diagnosis. METHODS: Over a 3-year period, we sonographically evaluated patients who were referred for investigation of possible TRAS. We investigated the following parameters: peak systolic velocity (PSV) in the external iliac and renal arteries, acceleration time and acceleration in the intrarenal arteries, acceleration time in the renal artery, resistance index, and the ratio of the PSVs in the renal and external iliac arteries. We also used MR angiography and digital subtraction arteriography to verify the degree of stenosis. After the evaluations, the patients were classified into 2 groups, 1 with and the other without significant stenosis (> 50% narrowing of the lumen) on digital subtraction arteriography. We also included a control group of patients who had undergone renal transplantation at least 6 months before, had had a good course after transplantation, had a diastolic blood pressure of 90 mm Hg or less, and were taking a maximum of 1 antihypertensive drug. RESULTS: Our study population consisted of 22 patients suspected to have TRAS (10 without and 12 with confirmed significant stenosis) and 19 control patients. We found statistically significant differences between the mean values of these 3 groups except for the PSV in the iliac artery and the resistance index in the intrarenal arteries. The most accurate parameters to use in diagnosing TRAS were an acceleration time of 0.1 second or higher in the renal and intrarenal arteries, a PSV of greater than 200 cm/second in the renal artery, and a ratio of PSVs in the renal and external iliac arteries of greater than 1.8. CONCLUSIONS: Duplex Doppler sonography is an excellent method for screening patients suspected to have TRAS and can help select which of those patients should undergo digital subtraction arteriography.     

彩色多普勒超声联合超声造影对移植肾动脉狭窄的诊断价值

目的:探讨彩色多普勒超声(color Doppler ultrasonography, CDUS)血流动力学参数联合超声造影(contrast-enhanced ultrasound, CEUS)定量参数对移植肾动脉狭窄(transplant renal artery stenosis, TRAS)的诊断价值。方法:分析2011年9月至2020年5月在复旦大学附属中山医院经DSA或MRA确诊的TRAS患者21例(狭窄组)及同期行肾移植且随访肾功能正常的患者37例(对照组)的CDUS及CEUS资料,比较2组CDUS血流动力学参数[主肾动脉收缩期峰值流速(PSV)、峰值流速后比、叶间动脉阻力指数(RI)]及CEUS定量参数[皮质感兴趣区上升时间(RT)、髓质RT、皮质达峰时间(TTP)、髓质TTP]的差异,分析上述各个参数与TRAS程度间的相关性,并通过ROC曲线分析上述参数单独及联合应用时诊断TRAS的效能。结果:狭窄组主肾动脉PSV、峰值流速后比、皮质RT、髓质RT、皮质TTP及髓质TTP的值均高于或长于对照组,叶间动脉RI低于对照组(P0.05);主肾动脉PSV、叶间动脉RI、峰值流速后比、皮质RT、髓质RT、皮质TTP、髓质TTP与TRAS程度均存在中度相关性(r值分别为0.617、-0.409、0.599、0.600、0.518、0.638、0.648),其中叶间动脉RI与狭窄程度负相关,其余超声参数与狭窄程度正相关(P0.05)。CDUS血流动力学参数总体灵敏度高于CEUS定量参数,总体特异度低于CEUS定量参数;CEUS定量参数(除髓质RT外)的曲线下面积普遍大于CDUS血流动力学参数。主肾动脉PSV2.43 m/s及皮质TTP9.26 s是诊断TRAS的重要参数(P0.05),两者联合诊断TRAS的AUC为0.965、准确度为91.40%,高于所有单一参数。结论:CDUS及CEUS均可用于诊断TRAS,CDUS血流动力学参数联合CEUS定量参数可提高TRAS诊断的准确度,从而在一定程度上减少CDUS疑诊病例不必要的放射性检查。     

Evaluation of severe subclavian artery stenosis by color Doppler flow imaging

This study evaluates the diagnostic value of the hemodynamic parameters of color Doppler flow imaging (CDFI) for severe (70 to 99%) subclavian artery stenosis (SAS) using digital subtraction angiography (DSA) as the reference standard. Two-hundred fifty-two patients with suspected SAS were recruited into the study and examined from June 2005 to December 2009. The degree of stenosis was classified as moderate (50 to 69%) or severe (70 to 99%) stenosis. By using CDFI, the residual diameter (Dr), peak systolic velocity (PSV1) and end diastolic velocity (EDV) at the stenotic vessel segments, as well as the original diameter (Do) and PSV2 of the relative normal segments distal to the stenosis (the segment distal to the poststenotic dilation) were recorded. The diameter stenosis rate (1-Dr/Do) and PSV ratio (PSV1/PSV2) were calculated. Using DSA as the reference standard, the diagnostic values and optimal cutoff values for each parameter for the evaluation of severe (70%-99%) were determined using receiving operating characteristic curve analysis. Among the 252 patients, 109 patients were diagnosed as having severe (70 to 99%) SAS and 143 patients had moderate (50 to 69%) SAS. The optimal cutoff values for PSV1, EDV and the PSV1/PSV2 ratio for evaluating severe (70 to 99%) SAS were PSV1 ≥343 cm/s, EDV ≥60 cm/s and PSV1/PSV2 ≥4.0, respectively. The accuracy for diagnosing SAS with PSV1 (86.1%) was higher than that of EDV (85.7%), PSV1/PSV2 (84.9%) and 1-Dr/Do (80.2%). In addition, when PSV1 was used in combination with EDV and 1-Dr/Do, the accuracy for diagnosing SAS increased from 86.1% to 87.3%. When PSV1 was used in combination with EDV and PSV1/PSV2, the accuracy for diagnosing SAS reached 95.8%. In conclusion, the CDFI hemodynamic parameters of PSV1, EDV and PSV1/PSV2 show good consistency with DSA for diagnosing severe (70 to 99%) SAS, and a combination of these three parameters can ensure even greater accuracy for diagnosing SAS. (E-mail: dryanghua@sohu.com)     

彩色多普勒超声与DSA检测颅外段椎动脉狭窄和发育不良的临床对比研究

目的：与数字减影血管造影（DSA）比较,探讨彩色多普勒超声在颅外段椎动脉狭窄和发育不良诊断中的价值。方法：回顾性分析68例椎动脉狭窄或发育不良患者的彩色多普勒超声和DSA检测结果,进行彩色多普勒超声与DSA两种方法检测椎动脉狭窄或椎动脉发育不良的Kappa一致性检验。结果：彩色多普勒超声检测椎动脉狭窄与DSA检查比较,两种方法一致性较好,然而在检测椎动脉发育不良时,两种方法一致性差。结论：虽然DSA是诊断椎动脉疾病的金标准,但彩色多普勒超声在椎动脉狭窄疾病诊断方面已显示出极大的优越性,推荐彩色多普勒超声作为椎动脉狭窄疾病的初次筛查方法。