超声造影评估伴副肾动脉患者肾脏血流灌注的初步研究

Assessment of renal blood perfusion in patients with accessory renal artery by contrast-enhanced ultrasound:a preliminary study

目的应用超声造影技术探讨存在副肾动脉是否影响肾脏的局部血流灌注。方法回顾性分析2019年9月至2021年12月在北京医院行肾动脉超声造影检出存在副肾动脉的31例患者(共33个肾脏)的超声影像资料,并分析肾脏不同部位(上极、中部、下极)的肾皮质血流灌注。获得时间-强度曲线(TIC)和相关参数,包括峰值强度(PE)、流入相曲线下面积(WiAUC)、上升时间(RT)、局部平均过渡时间(mTTl)、达峰时间(TTP)、流入相斜率(WiR)、流入相灌注指数(WiPI)、流出相曲线下面积(WoAUC)、流入相和流出相曲线下面积(WiWoAUC)、下降时间(FT)、流出相斜率(WoR),比较肾脏不同部位以上各项灌注相关参数以及主肾动脉和副肾动脉的血流动力学参数是否存在差异,评估存在副肾动脉肾脏不同部位的血流灌注情况。结果副肾动脉较主肾动脉管径细,差异具有统计学意义[(3.2±0.7)mm vs(4.6±0.7)mm,P<0.001],两者的血流动力学指标收缩期峰值流速(PSV)、阻力指数(RI)和加速时间(AT)差异均无统计学意义(P均>0.05)。在上极、中部和下极肾皮质血流灌注参数的比较中,上极WiWoAUC略高于中极(P=0.041),其他参数差异均无统计学意义(P均>0.05)。结论副肾动脉的存在对肾脏局部的血流灌注影响不大,但仍需更多研究结果证实。

Objective To explore whether accessory renal artery affects the local blood perfusion of the kidney by contrast-enhanced ultrasound.Methods The ultrasound data of 31 patients(33 kidneys in total)with accessory renal artery detected by contrast-enhanced ultrasound at Beijing Hospital from September 2019 to December 2021 was retrospectively analyzed,and renal cortical blood perfusion in different parts of the kidney(upper,middle,and lower poles)was analyzed to obtain time-intensity curve and related parameters,including peak enhancement,wash-in area under the curve(AUC),rise time(RT),mean transit time-local,time to peak,wash-in rate,wash-in perfusion index,wash-out AUC,wash-in and wash-out AUC(WiWoAUC),fall time,and wash-out rate.By comparing the blood perfusion related parameters of different parts of the kidneys and the hemodynamic parameters of the main renal artery and the accessory renal artery,the blood perfusion of the kidneys with accessory renal artery was evaluated.Results The vascular diameter of the accessory renal artery was significantly smaller than that of the main renal artery[(3.2±0.7)mm vs(4.6±0.7)mm,P<0.001].The hemodynamic indexes of the main renal artery and the accessory renal artery,such as peak systolic velocity,resistance index,and acceleration time,had no statistical differences(P>0.05).When comparing renal cortical blood perfusion parameters of the upper,middle,and lower poles,the WiWoAUC of the upper pole was slightly higher than that of the middle pole(t=0.041),and there was no significant difference in other parameters(P>0.05).Conclusion The existence of accessory renal artery has little effect on the local blood perfusion of the kidney,but more research is needed to confirm this finding.