肾动脉及副肾动脉狭窄超声诊断及漏误诊分析

Analysis of Ultrasonic Diagnosis and Missed Diagnosis of Renal Artery and Accessory Renal Artery Stenosis

目的探讨彩色多普勒超声(彩超)检查在肾动脉及副肾动脉狭窄诊断中的应用价值。方法对我院收治的肾动脉及副肾动脉狭窄33例的彩超声像图表现进行回顾性分析,并与计算机断层扫描血管成像(CTA)检查结果进行对比,重点讨论彩超检查漏误诊肾动脉及副肾动脉狭窄的原因。结果本组CTA检查明确诊断副肾动脉狭窄23例,肾动脉并副肾动脉狭窄8例,肾动脉狭窄2例。彩超检查正确诊断副肾动脉狭窄23例,将CTA检查诊断为肾动脉并副肾动脉狭窄的8例副肾动脉狭窄漏诊,将CTA检查诊断为肾动脉狭窄的2例误诊为副肾动脉狭窄。以狭窄处收缩期血流峰速度(PSV)为指标,诊断副肾脉狭窄18例,漏诊6例;以肾段动脉或叶间动脉血流加速度、加速时间结合肾及副肾动脉血流速度为指标,诊断肾动脉及副肾动脉狭窄15例,误漏诊各2例。误漏诊的10例均经CTA检查明确诊断。结论彩超检查诊断肾动脉及副肾动脉狭窄的敏感性低于CTA检查,但仍是此类疾病筛查、诊断及鉴别诊断的重要检查方法之一。

Objective To evaluate the role of color doppler ultrasound in diagnosis of renal artery and accessory renal ar- tery stenosis. Methods The son0graphie appearance of color doppler ultrasound in 33 patients with renal artery and accessory renal artery stenosis were retrospectively analyzed, and were compared with imagings of CT angiography （CTA）. The misdiagnosed causes of renal artery and accessory renal artery stenosis by ultrasonography were emphatically discussed. Results The 23 patients having accurately diagnosed as having accessory renal artery stenosis by CTA, g patients with renal artery and accessory renal artery steno- sis and 2 patients having renal artery. The 23 patients were accurately diagnosed as having accessory renal artery stenosis by color doppler ultrasound, 8 patients were diagnosed as having renal artery and accessory renal artery stenosis by CTA results, accessory renal artery stenosis missed diagnosis, and 2 patients were misdiagnosed as having accessory renal artery stenosis who were first di- agnosed as having renal artery stenosis by CTA results. 18 patients were diagnosed as having accessory renal artery stenosis, and 6 patients missed diagnosis by peak systolic velocity （PSV） of stenosis station as having index; 15 patients were diagnosed as having renal artery and accessory renal artery stenosis, 2 missed diagnosis, and 2 missed diagnosed by blood flow acceleration and accelera- ting time of segmental renal artery or interlobar arteries combined with blood flow velocity of renal artery and accessory renal artery as diagnosis indexes. The 10 patients who missed diagnosis were all confirmed with diagnosis by CAT. Conclusion Ultrasound is an important method in diagnosis, screening and differential diagnosis of accessory renal artery stenosis, although its sensitivity is lower than that by CTA.