实时灰阶谐波超声造影诊断肾动脉狭窄的初步研究

Preliminary experience of contrast-enhanced real-time harmonic gray scale imaging in the diagnosis of renal artery stenosis

目的评价实时灰阶谐波超声造影诊断肾动脉狭窄的临床价值。方法肾动脉狭窄患者16例,包括4例肾动脉支架置入术后者。超声造影剂使用SonoVue。所有患者均接受彩色多普勒超声与谐波造影两种检查方法。诊断结果分3级:①不能得到诊断结果;②可疑诊断;③诊断明确。检查结果与数字减影血管造影术、CT、MRI等结果相对照。结果彩色多普勒超声明确诊断的有8例(50.0%),可疑诊断5例(31.3%),不能得到诊断结果3例(18.7%)。结合谐波造影检查后明确诊断13例(81.3%),可疑诊断2例(12.5%),不能得到诊断结果1例(6.2%)。常规彩色多普勒超声诊断的敏感性63.6%(7/11),特异性40.0%(2/5),准确性56.3%(9/16);谐波造影诊断的敏感性83.3%(10/12),特异性100%(4/4),准确性87.5%(14/16)。结论谐波造影能够更直观地显示血管管壁与管腔的边界,进而可直观地反映流道的变化,有助于肾动脉狭窄的诊断。

Objective To evaluate the diagnosis value of contrast-enhanced real-time harmonic gray scale imaging in the diagnosis of renal artery stenosis. Methods Sixteen patients with renal artery stenosis including 4 patients after stent placement were enrolled. Ultrasound contrast agent SonoVue was used. All patients were examined with conventional color Doppler sonography and real-time harmonic gray scale imaging. The diagnostic results were divided into three scales： ① no diagnosis result; ② doubted diagnosis; ③ unequivocal diagnosis. The results were compared with those of digital subtraction angiography, CT and MRI. Results Unequivocal diagnosis were achieved in 50.0%（8/16） patients, doubted diagnosis in 31.3%（5/16）, no diagnostic result in 18.7%（3/16） on conventional color Doppler sonography; the ratio was 81.3% （13/16）, 12.5% （2/16）, 6.2% （1/16）, respectively on contrast-enhanced real-time harmonic gray scale imaging. The sensitivity, specificity and accuracy of conventional color Doppler scanning were 63.6% （7/11）, 40.0% （2/5） and 56.3% （9/16）, respectively; those of real-time harmonic gray scale imaging were 83.3% （10/12）, 100% （4/4） and 87.5% （14/16）, respectively. Conclusions Contrast-enhanced real-time harmonic gray scale imaging depicts the margin of the vascular lumen and outer wall directly. Therefore real-time harmonic gray scale imaging may be more helpful in the diagnosis of renal artery stenosis.