超声造影和数字剪影血管造影对肾动脉狭窄的诊断价值比较

Diagnostic value of contrast-enhanced sonography and digital subtraction angiography for renal artery stenosis

目的比较超声造影(CEUS)和数字减影血管造影(DSA)对肾动脉狭窄(RAS)的诊断价值。方法回顾性纳入2017年9月至2018年8月在北京医院诊治的57例疑似RAS患者,记录其114条肾动脉的CEUS和DSA检查结果。根据RAS狭窄程度分为轻度(30%~50%)、中度(50%~69%)和重度(70%~99%),分析CEUS对轻、中和重度RAS的诊断价值。结果57例疑诊RAS患者中,男31例、女26例,年龄40~85岁,平均为(57±9)岁,均有高血压史。114条肾动脉中,DSA确诊RAS71条(62.3%)[轻度34条(29.8%),中度23条(20.2%),重度14条(12.3%)]。CEUS与DSA诊断轻度RAS的敏感度、特异度、准确度、阳性预测值和阴性预测值分别为85.3%、97.3%、91.5%、96.7%和87.8%;诊断中度RAS的敏感度、特异度、准确度、阳性预测值和阴性预测值分别为82.6%、97.9%、92.9%、95.0%和92.2%;诊断重度RAS的敏感度、特异度、准确度、阳性预测值和阴性预测值分别为85.7%、98.2%、95.8%、92.3%和96.5%。CEUS和DSA诊断RAS有高吻合度(kappa值0.92)。结论CEUS能清楚地显示轻、中和重度RAS,特别适用于肾损伤的患者。

Objective To evaluate the diagnostic value of contrast-enhanced ultrasound (CEUS) and digital subtraction angiography (DSA) for renal artery stenosis (RAS). Methods Fifty-seven hypertensive patients suspected for RAS admitted in Beijing Hospital from September 2017 to August 2018 were enrolled. All 114 renal arteries were assessed by CEUS and DSA. RAS was subdivided into low-(30%-50%), moderate-(50%-69%) and high-grade (70%-99%) subgroups. The sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) were compared between CEUS and DSA results. Results Fifty-seven hypertensive patients (31 males, mean age 57.1 years) involving 114 renal arteries were included. Overall, DSA identified RAS in 71(62.3%) renal arteries, mild RAS, 34(29.8%);moderate RAS, 23(20.2%);severe RAS, 14(12.3%). With CEUS, the sensitivity, specificity, accuracy, PPV and NPV for detecting mild-grade RAS were 85.3%, 97.3%, 91.5%, 96.7% and 87.8%;for detecting moderate-grade RAS were 82.6%, 97.9%, 92.9%, 95.0% and 92.2%;for detecting high-grade RAS were 85.7%, 98.2%, 95.8%, 92.3% and 96.5%. The measure of agreement kappa was 0.92 between CEUS and DSA. Conclusion CEUS is a safe and accurate method for the diagnosis and severity classification of RAS, especially those with kidney injury.