肾静脉血栓形成的彩色多普勒超声征象及其诊断价值

目的 探讨肾静脉血栓形成（RVT）的彩色多普勒超声征象及其诊断价值。方法 回顾性分析9例RVT患者的彩色多普勒超声结果，观察肾结构、肾内血流信号的分布、肾静脉主干回声和血流充盈情况，测量段动脉或叶间动脉阻力指数。结果 肾静脉主干血栓形成9例（其中1例累及双侧），肾内小静脉血栓形成1例。肾静脉主干血栓形成表现为肾静脉主干充满实性回声或条索状回声，管腔内完全或部分血流充盈缺损，67％表现为肾内无或稀少静脉血流；肾内小静脉血栓形成表现为受累区肾结构模糊，无静脉血流信号。肾内动脉舒张期反向波预测RVT的敏感性为30％（3／10），余7侧RVT患者肾内动脉RI均升高（范围0．74～0．96，平均0．84）。结论 彩色多普勒超声可作为本病首选影像学检查方法，有助于临床迅速采取治疗措施和进行随访观察。

Color Doppler ultrasonography appearances of renal vein thrombosis and its diagnostic value

Objective To evaluate color Doppler ultrasonography appearances of renal vein thrombosis (RVT) and its diagnostic value.Methods Nine patients of RVT were analyzed retrospectively.Renal architecture,distributions of intrarenal blood signals,echogenicity and blood fullness in main renal veins were observed.Resistive index (RI) was recorded from the waveform of segmental or interloblar artery.Results Eight patients showed thrombus within the main renal veins (one patient involved both of kidneys),and one patient showed thrombus within small intrarenal veins.The appearances of the main renal vein thrombosis include full of echogenicity or echogenic streaks and completely or partial filling defect within the main renal veins,and no or a little intrarenal venous signals in 67% of cases. The characteristics of the intrarenal vein thrombosis included obscure renal architecture and no intrarenal venous signals within the involved part of the kidney. When reversed diastolic flow was used as a sign of RVT,intrarenal arterial Doppler analysis had a sensitivity of 30% (3/10),increased RI (mean, 0.84 ; range, 0.74 - 0.96 ) were found in other 7 patients. Conclusions Color Doppler ultrasonography can be the first imaging modality for RVT and is helpful for rapid clinical therapy and follow-up.The accurate diagnostic criteria are echogenicity and filling defect within renal vein.However,the diagnostic sensitivity of intrarenal arterial reversed diastolic flow is low.