超声造影诊断肾动脉狭窄的临床研究超声造影诊断肾动脉狭窄的临床研究超声造影诊断肾动脉狭窄的临床研究超声造影诊断肾动脉狭窄的临床研究

目的 探讨超声造影对肾动脉狭窄的诊断价值.方法 对临床疑有肾动脉狭窄的9例患者共17条肾动脉（1例患者一侧肾切除）行经静脉超声造影检查,超声造影前均先行常规超声检查,根据彩色多普勒血流信号、肾动脉峰值流速、肾动脉与肾动脉开口处腹主动脉的峰值流速比值、肾内叶间动脉血流加速时间、收缩早期加速度判断肾动脉是否存在狭窄,并与血管造影结果对比.结果 静脉注射超声造影剂8～15 s后肾动脉显影并达到最大强度,增强平均时间为（530±32）s.超声造影后有16条肾动脉显示,均观察到彩色血流信号增强,超声造影显示8条肾动脉狭窄,其中1条肾动脉造影后狭窄不明确,血管造影后确诊为轻度狭窄;不显影的1条被证实为闭塞.以血管造影为标准,超声造影诊断肾动脉狭窄与血管造影的吻合系数Kappa=0.882,P＜0.01;常规超声诊断肾动脉狭窄与血管造影的吻合系数Kappa=0.414,P＜0.05.结论 超声造影有助于提高肾动脉狭窄的血流显示,在诊断肾动脉狭窄方面,与常规超声相比,超声造影与血管造影结果显示出更好的一致性.

The clinical study on renal artery stenosis diagnosed by contrast enhanced ultrasonography

Objective To evaluate the value of renal artery stenosis diagnosed by the contrast enhanced ultrasonography（CEUS）. Methods A total of nine patients（6 male and 3 female） , who were suspected to have renal artery stenosis including 17 renal arteries （one case with one-side nephrectomy） were examined by CEUS. The mean age was 51± 16 years. The contrast pulse sequencces （CPS）software was used. The acoustic contrast agent was injected rapidly via antebrachium vein. All the patients were examined by conventional uhrasonography before CEUS . The criteria of renal artery stenosis depended on the indexes including the signals of CDFI,the peak systolic velocity （PSV）, the ratio of PSV of renal artery and aorta （RAR） ,the accelerated time of interlobar artery and the early systolic acceleration . The results were compared with the angiography. Results About 8-15 s after injecting the contrast , the images of renal artery were developed and immediately reached the highest degree. The mean reinforcing time was 530 -＋ 32 s. After CEUS, 16 renal arteries were displayed and the reinforced color blood flow signals were observed. The CEUS showed 8 renal arteries stenosis and one ambiguous renal artery was diagnosed as low-grade stenosis by angiography. One had blockage in the renal artery disappear compared with angiography. The measure of agreement Kappa between conventional uhrasonography and angiography was 0.882, P 〈 0.01. Meanwhile, the measure of agreement Kappa between CEUS and angiography was 0. 414, P 〈 0.05. Conclusion The CEUS greatly improved the signals of CDFI in the diagnosis of renal artery stenosis and showed higher consis- tency with the results of angiography compared to that of traditional uhrasonography.