胃肠超声造影联合灰阶超声造影在肾动脉狭窄诊断中的应用价值

目的探讨胃肠超声造影联合灰阶超声造影对肾动脉的显示率及在肾动脉狭窄诊断中的应用价值。方法选取临床疑诊肾动脉狭窄患者28例共56条肾动脉,行常规经腹CDFI检测肾动脉主干,测量峰值流速,计算肾动脉与腹主动脉峰值流速比值(RAR)判断肾动脉是否狭窄,行胃肠超声造影联合声诺维(SonoVue)及实时灰阶造影匹配成像技术(CnTI)造影检测肾动脉主干,测量肾动脉内径并判断是否狭窄,比较常规超声与胃肠超声造影联合灰阶超声造影对肾动脉狭窄诊断情况。结果常规超声检查肾动脉主干全程显示率60.7%(34/56),胃肠超声造影联合灰阶超声造影检查肾动脉主干全程显示率98.2%(55/56),二者比较差异有统计学意义(Wilcoxon W=2570.00,P0.01)。常规超声准确诊断肾动脉狭窄14条,误诊3条,漏诊13条,诊断符合率为71.4%,敏感性51.8%,特异性89.6%,假阳性率17.6%,假阴性率33.3%;胃肠超声造影联合灰阶超声造影准确诊断肾动脉狭窄26条,漏诊1条,诊断符合率为98.2%,敏感性96.2%,特异性100%,假阳性率0,假阴性率3.3%。两种方法诊断肾动脉狭窄效能比较差异均有统计学意义(P0.05)。结论与常规超声比较,胃肠超声造影联合灰阶超声造影能显著提高肾动脉的显示率及肾动脉狭窄的诊断率。

Application value of combined gastrointestinal and intravenous contrast-enhanced ultrasonography in diagnosis of renal artery stenosis

Objective To explore the application value of combined gastrointestinal and intravenous contrast-enhanced ultrasonography（CEUS）in the detection rate of renal artery and the diagnosis of renal artery stenosis. Methods Twenty-eight patients（total 56 renal arteries）with suspected renal artery stenosis underwent combined gastrointestinal（oral water-konjac flour mixture）and intravenous CEUS（intravenous SonoVue）,with real-time gray-scale contrast tuned imaging（CnTI）.The renal artery trunk was detected,and the Vmax of renal artery and the renal-aortic ration（RAR）were measured by Color Doppler Flow Imaging（CDFI）to evaluate the renal artery stenosis. The results were compared with those of X-ray renal arteriography. Results The detection rate of renal artery using CDFI and combined gastrointestinal and intravenous CEUS were 60.7%（34/56）and 98.2%（55/56）,respectively（Wilcoxon W=2570.00,P0.01）. Fourteen renal artery stenosis were accurately detected using CDFI,3 renal arteries were misdiagnosed and 13 renal arteries were missed diagnosis. The diagnostic accordance rate,sensitivity,specificity,false positive rate and false negative rate were 71.4%,51.8%,89.6%,17.6% and 33.3%,respectively. While 26 renal artery stenosis were accurately diagnosed using combined gastrointestinal and intravenous CEUS,and 1 renal artery was missed diagnosis. The diagnostic accordance rate,sensitivity,specificity,false positive rate and false negative rate were 98.2%,96.2%,100%,0 and 3.3%,respectively（χ2=4.27,P0.05）. Conclusion Compared with CDFI,combined gastrointestinal and intravenous CEUS can improve the detection rate of renal artery and diagnosis rate of renal artery stenosis.