肾静脉栓塞的彩色多普勒超声征象及其诊断价值

Color Doppler ultrasonography of renal vein embolism and its diagnostic value

目的通过与增强CT对比分析,探讨彩色多普勒超声在肾静脉栓塞疾病中的诊断价值。方法选取2014年1月至2017年9月在北京协和医院就诊的经手术病理或随访证实的40例45侧肾静脉栓塞患者,其中,15例20侧肾静脉血栓及25例25侧肾静脉癌栓,均行彩色多普勒超声及增强CT检查,总结肾静脉栓塞的超声表现,包括栓塞病灶的位置、受累静脉管腔及管壁特点、侧支形成情况及彩色多普勒表现。超声与增强CT诊断肾静脉血栓及癌栓的准确率比较采用χ2检验。结果彩色多普勒超声对肾静脉血栓及癌栓的诊断准确性分别为85%、84%,CT增强扫描的诊断准确性依次分别为100%、96%,差异均无统计学意义(P均>0.05)。肾静脉栓塞的主要超声征象有:(1)肾静脉管腔扩张伴实性成分填充;(2)主干内血流中断或充盈缺损;(3)肾内无明显静脉血流信号或血流信号分布稀疏。结论彩色多普勒超声与增强CT在诊断肾静脉栓塞上有较好的一致性,超声可作为评估肾静脉栓塞的重要影像学方式,结合病史能为肾静脉栓塞提供较为可靠的诊断依据。

Objective Explore the diagnostic value of color Doppler ultrasonography in renal vein embolism compared with contrast-enhanced CT. Analyze and summarize the sonographic features and reasons of misdiagnosis of renal vein embolism. Methods Reports of color Doppler ultrasonography and contrast-enhanced CT in 15 patients with 20 renal vein thrombosis and 25 patients with 25 renal vein tumor thrombosis were retrospectively analyzed. We summarized the sonographic features including the location of emboli, the lumen and wall of the involved veins, the information of collateral circulation and the color Doppler sonographic features. Results The diagnostic accuracy of renal vein thrombosis and tumor thrombosis were 85% and 84% for ultrasound, 100% and 96% for contrast-enhanced CT, the difference was not statistically significant （all P〉0.05）. The typical sonographic features include （1） Expansion of the renal vein and full of solid echogenicity; （2） No flow signals or flow filling defect in renal veins; （3） No or sparse venous flow signal in the involved kidney. Conclusions Color Doppler ultrasonography and contrast-enhanced CT have a good consistency in the diagnosis of renal vein embolism. Color Doppler ultrasonography can be used as an important imaging method to evaluate the renal vein embolism, which can combine medical history and provide a more reliable basis for the diagnosis of renal vein embolism.