实时灰阶超声造影在诊断肾动脉狭窄中的初步临床应用

The clinical value of contrast-enhanced sonographic imaging for the evaluation of renal artery stenosis

目的:探讨实时灰阶超声造影在诊断肾动脉狭窄中的临床应用价值。方法:对临床怀疑有肾动脉狭窄患者29例(男性13例,女性16例)共40条肾动脉依次行彩色超声多普勒、超声造影及数字减影血管造影检查。彩色多普勒超声通过血流信号,狭窄处收缩期流速、狭窄处收缩期流速与腹主动脉流速之比、肾叶间动脉收缩期流速及加速时间来判断肾动脉有无狭窄,而超声造影(contrast-enhanced ultrasound,CEUS)与数字减影血管造影(digital subtraction angiography,DSA)均以狭窄处的直径狭窄度来判断肾动脉的狭窄程度。以DSA诊断结果作金标准,对比彩色超声多普勒(color Doppler ultrasound,CDU)及CEUS诊断肾动脉狭窄的一致性、灵敏度、特异度、准确度及约登指数。结果:常规超声与DSA诊断肾动脉狭窄程度的一致性系数Kappa值为0.434(P<0.01),CEUS与DSA的诊断肾动脉狭窄程度一致性系数Kappa值为0.743(P<0.01),CEUS诊断肾动脉狭窄的一致性要高于常规超声。以DSA诊断结果为金标准,将40条肾动脉分为轻-中度狭窄组与重度狭窄组(包括闭塞),常规超声诊断重度动脉狭窄(包括闭塞)的灵敏度为72.7%(16/22),特异度为83.3%(15/18),准确度为77.5%(31/40),约登指数为0.56,CEUS诊断重度肾动脉狭窄(包括闭塞)灵敏度为90.9%(20/22),特异度为88.9%(16/18),准确度为90.0%(36/40),约登指数为0.79。结论:超声造影作为一种快速的、无辐射性及无肾毒性的影像学方法,在诊断肾动脉狭窄及判断肾动脉狭窄程度中有很高的临床应用价值。

Objective：To explore the clinical value of the color Doppler ultrasound and contrast-enhanced ultrasound in the diagnosis of renal artery stenosis（RAS）.Methods：A total 29 patients（13male and 16femal）,who were suspected to have renal artery stenosis including 40 renal arteries were enrolled.All patients were examined by color Doppler ultrasound,contrast-enhanced ultrasound（CEUS） and digital subtraction angiography（DSA） in sequence.The criteria of renal artery stenosis depended on the indexes including the signals of color Doppler ultrasound,the peak systolic velocity（PSV）,the ratio of PSV of renal artery and aorta（RAR）and the accelerated time of interlobar artery（ATF）.The criteria of renal artery stenosis depended on the diameter stenosis rate of CEUS and DSA.We regard the results of DSA as the gold standard.The results of conventional ultrasound and CEUS were compared with the DSA results.Results：The measure of agreement Kappa between conventiona ultrasound and angiography was 0.434 （P ＜ 0.01）.The measure of agreement Kappa between CEUS and angiography was 0.710（P ＜ 0.01）.We devided 40 renal stenosis arteries into two groups：the mild to moderate stenosis group and the severe stenosis group （including occlusion arteries）.The sensitivity,specificity and accuracy of color doppler ultrasound were 72.7％ （16/22）,83.3％ （15/18） and 77.5％ （31/40）respectively,those of CEUS were 90.9 ％ （20/22）,88.9％ （16/18） and 90％ （36/40）,respectively.Conclusion：CEUS is an accurate,non-invasive,non-renal toxity method for the diagnosis of severe RAS in patients and the judgements of the RAS degree.