超声评估纤维肌性发育不良致肾动脉狭窄  

Ultrasonography for evaluation of renal artery stenosis caused by fibromuscular dysplasia

作　　者：杨志芳[1] 张哲 吉日[1] 于一飞[1] 倪晓枫[1] 胡赟赟[1] 夏蜀珺[1] YANG Zhifang;ZHANG Zhe;JI Ri;YU Yifei;NI Xiaofeng;HU Yunyun;XIA Shujun(Department of Ultrasound,Ruijin Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200025,China)

机构地区：[1]上海交通大学医学院附属瑞金医院超声科,上海200025

出　　处：《中国医学影像技术》2022年第5期730-733,共4页Chinese Journal of Medical Imaging Technology

摘　　要：目的观察超声评估肾动脉纤维肌性发育不良(RA-FMD)致肾动脉狭窄(RAS)的价值。方法回顾性分析18例经临床及肾动脉数字减影血管造影(DSA)确诊的RA-FMD致重度RAS患者、共21条受累肾动脉的灰阶超声表现及多普勒参数,计算超声诊断RAS及累及部位的准确率。结果18例中,10例(10/18,55.56%)患侧肾脏较健侧肾脏缩小≥15 mm;15例(15/18,83.33%)肾皮质回声无明显改变,3例(3/18,16.67%)皮质回声稍增强。超声显示20条受累肾动脉,检出率为95.24%(20/21),定位诊断狭窄部位的准确率为85.00%(17/20)。4例经DSA证实合并狭窄后瘤样扩张及小动脉瘤形成,超声诊断其中3例为段动脉狭窄但均未显示肾内动脉瘤,1例提前分支或副肾动脉近肾门处狭窄可能。结论超声可较准确地判断RAS及狭窄部位,但需结合临床确诊RA-FMD。Objective To observe the value of ultrasonography for evaluating renal artery stenosis(RAS)caused by renal artery fibromuscular dysplasia(RA-FMD).Methods Renal gray-scale ultrasonic manifestations and Doppler parameters of 18 patients with clinically diagnosed severe RAS caused by RA-FMD and proved with renal arterial digital subtraction angiography(DSA)were retrospectively observed.A total of 21 renal arteries were involved.The accuracy of ultrasonography for diagnosing RAS and localization of the stenosis were calculated.Results Among 18 patients,10(10/18,55.56%)were found with shrunk kidney on the affected side more than 15 mm compared with the healthy side kidney.No obvious changes of the renal cortical echo was detected in 15 cases(15/18,83.33%),while slightly enhanced cortical echoes were noticed in 3 cases(3/18,16.67%).Ultrasound showed 20 involved renal arteries,with a detection rate of 95.24%(20/21)and an accuracy rate of 85.00%(17/20)for localization of the stenosis.Among 4 patients with post-stenotic aneurysm expansion or small aneurysm formation confirmed by DSA,3 were diagnosed as segmental artery stenosis but not showed intrarenal aneurysm with ultrasonography,and 1 patient was diagnosed with the possibility of early branch or accessory renal artery stenosis near the renal hilum.Conclusion Ultrasound could accurately evaluate RAS and localize the stenosis,while RA-FMD needed to be diagnosed combined with clinical information.

关 键 词：纤维肌性发育不良 肾动脉 超声检查 

分 类 号：R543.5[医药卫生—心血管疾病] R445.1[医药卫生—内科学]