肾动脉分支异常伴或不伴肾动脉狭窄的超声漏误诊分析

目的探讨超声诊断肾动脉分支异常伴或不伴肾动脉狭窄的漏误诊原因。 方法选取2018年1月1日至2019年12月25日于北京协和医院经CT血管造影（CTA）检查诊断为肾动脉分支异常的80例患者共103个肾的超声检查结果，与CTA检查结果进行对比分析，重点讨论肾动脉分支异常伴或不伴肾动脉狭窄的漏误诊原因。 结果在CTA诊断的103个肾中，27个为肾动脉变异合并狭窄，76个仅为肾动脉分支异常不伴肾动脉狭窄。在肾动脉变异合并狭窄的27个肾中，2个超声正确诊断（检出率为7.4%），均由高年资超声医师检查；25个超声诊断不全面或漏诊，其中15个由低年资超声医师检查，10个由高年资超声医师检查。仅肾动脉分支异常的76个肾中，9个超声正确诊断（检出率为11.8%），其中8个高年资超声医师检查，1个由低年资超声医师检查；67个超声漏诊，其中24个由低年资超声医生检查，43个由高年资超声医师检查。 结论肾动脉分支变异伴或不伴肾动脉狭窄的超声检出率较低，超声检出水平与工作年限可能有一定关系，提示在超声医师临床实践及教学培训过程中，注意强化对肾动脉分支异常的全面认识，将有助于提高超声检查对肾动脉分支异常这类疾病的检出率及诊断水平。

Causes of missed diagnosis or misdiagnosis of abnormal renal artery branch with or without renal artery stenosis by ultrasonography

ObjectiveTo explore the causes of missed diagnosis or misdiagnosis of renal artery branch abnormality with or without renal artery stenosis by ultrasound. MethodsThe ultrasound examination results for a total of 103 kidneys of 80 patients diagnosed with renal artery branch abnormalities by CT angiography (CTA) at Peking Union Medical College Hospital from January 1, 2018 to December 25, 2019 were selected for comparative analysis. The causes of missed or misdiagnosis of renal artery branch abnormalities with or without renal artery stenosis were evaluated. ResultsOf the 103 kidneys, 27 were diagnosed with renal artery variability and stenosis and 76 were diagnosed with renal artery branch abnormalities by CTA. Of the 27 cases of renal artery variability with stenosis, 2 (7.4%) were diagnosed correctly by senior ultrasound sonographers, and 25 were inaccurately diagnosed or missed by ultrasound (15 by junior sonographers and 10 by senior sonographers). Of the 76 cases of renal artery branch abnormalities, 9 (11.8%) were correctly diagnosed by ultrasound (8 by senior sonographers and 1 by junior sonographer), and 67 were missed by ultrasound (24 by junior sonographers and 43 by senior sonographers). ConclusionThe detection rate of renal artery branch variation with or without renal artery stenosis by ultrasound is low, and the ultrasound detection rate may correlate with the working experience of sonographers. This finding suggests that in the clinical practice and teaching training of sonographers, strengthening the comprehensive understanding of renal artery branch abnormalities will help improve the detection rate and ultrasound diagnosis level.