流速指标对肾动脉狭窄的诊断价值  

Diagnostic value of velocity parameters for detecting renal artery stenosis

作　　者：李建初[1] 姜玉新[1] 蔡胜[1] 张抒扬[2] 戴晴[1] 吕珂[1] 齐振红[1] 

机构地区：[1]中国医学科学院中国协和医科大学北京协和医院超声科,北京100730 [2]中国医学科学院中国协和医科大学北京协和医院心内科,北京100730

出　　处：《中华超声影像学杂志》2004年第12期902-906,共5页Chinese Journal of Ultrasonography

摘　　要：目的　探讨流速指标对内径减少≥ 5 0 %的肾动脉狭窄 (RAS)的诊断价值和确定最佳阈值。方法　经彩色多普勒血流显像 (CDFI)检查后并进行肾动脉造影的 187条肾动脉构成研究组。测量肾动脉峰值流速(PSV)、肾动脉与腹主动脉PSV比率 (RAR)、肾动脉与叶间动脉PSV比率 (RIR)和叶间动脉PSV。肾动脉造影显示肾动脉内径减少≥ 5 0 %者定为RAS。使用ROC曲线 (receiveoperatingcharacteristiccurves)分析确定最佳诊断指标。计算这些流速指标不同阈值的敏感性、特异性、阳性预测值和阴性预测值。结果　肾动脉造影共显示180条主肾动脉和 7条副肾动脉 ,其中 13条完全闭塞和 93条内径减少 5 0 %～ 99% (大动脉炎性 3 0条 ,纤维肌性发育不良性 2 1条 ,动脉粥样硬化性 42条 )。肾动脉CDFI探测成功率为 96% (180 / 187)。ROC曲线分析结果显示RIR是最好的流速指标。RIR >5、肾动脉PSV >15 0cm /s、RAR >2、叶间动脉PSV <2 5cm/s的敏感性依次分别为 88%、81%、70 %、74%。RIR >5与叶间动脉PSV <15cm /s提供了最好的结合 ,敏感性为 91% ,特异性为87%。结论　对于RAS的诊断 ,RIR是最好的流速指标 ,叶间动脉PSV是最差的流速指标 ,RAR >3能够比较自信地诊断RAS。注意肾动脉PSV的影响因素并联合各类流速指标有助于减少误诊。Objective To evaluate the diagnostic value of velocity parameters for the detection of renal artery stenosis(RAS) (diameter reduction≥50%) and to determine the useful cutoffs for these parameters.Methods A study group was composed of 187 renal arteries that were detected by color Doppler flow imaging and were referred to renal arteriography afterwards.Four Doppler parameters,including the peak systolic velocity(PSV) in the renal artery and the interlobar artery,RAR (a ratio of the PSV in the renal artery to that in the aorta),and RIR (a ratio of the PSV in the renal artery to that in the interlobar artery) were measured.Arteries were considered stenosed on renal arteriography if there was a diameter reduction of greater than 50%.Statistical analysis to determine the best parameter for predicting a RAS was performed with receiver operating characteristic curves.The sensitivity,specificity,and negative and positive predicting values at various cutoffs were calculated.Results In the 187 renal arteries, which included 180 main renal arteries and 7 accessory renal arteries demonstrated by renal arteriography,there were 13 occlusion and 93 stenoses.Among the 93 stenoses,30 were caused by Takayasu arteritis,21 by fibromuscular dysplasia and 42 by atherosclerosis.Doppler examination was technically successful in 96% of renal arteries (180/187).Receiver operating characteristic analysis showed that RIR was the best parameter.When using the cutoff values of RIR>5,renal artery PSV>150 cm/s ,RAR>2,interlobar artery PSV<25 cm/s for the detection of RAS,the sensitivities were 88%,81%,70% and 74%,respectively.Combining RIR>5 and interlobar artery PSV <15 cm/s provided the best combination of parameters with a sensistivity and specificity at 91%and 87%,respectively.Conclusions For the detection of RAS,RIR is the best indicator in the four velocity parameters,while the interlobar artery PSV is the worst one.RAR>3 can diagnose a RAS with confidence.Paying attentions to influential factors of renal artery PSV and combining

关 键 词：PSV 肾动脉造影 诊断价值 RAS 肾动脉狭窄 CDFI 敏感性 内径 流速 显示 

分 类 号：R445.1[医药卫生—影像医学与核医学]