多模态超声一体化评估重度肾动脉狭窄  

Multimodal Ultrasound Integrated Assessment of Severe Renal Artery Stenosis

作　　者：王明月[1] 勇强 张蕾[3] 田菊[1] Wang Mingyue;Yong Qiang;Zhang Lei;Tian Ju(Department of General Ultrasound,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China;Shunyi Women's and Children's Hospital of Beijing Children's Hospital,Capital Medical University,Beijing 101300,China;Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China)

机构地区：[1]首都医科大学附属北京安贞医院综合超声科,北京市100029 [2]首都医科大学附属北京儿童医院顺义妇儿医院,北京市101300 [3]首都医科大学附属北京天坛医院,北京市100070

出　　处：《中国超声医学杂志》2024年第3期305-309,共5页Chinese Journal of Ultrasound in Medicine

摘　　要：目的 探讨重度肾动脉狭窄(RAS)患者多模态超声一体化评估的临床应用价值。方法 选取经数字减影血管造影(DSA)确诊的肾动脉粥样硬化致重度RAS患者48例,按肾动脉狭窄程度,将96条肾动脉分为重度狭窄组(n=60)及非重度狭窄组(n=36),采用常规超声结合超声造影(CEUS)技术检测两组肾动脉起始段血流束宽度、流速及叶间动脉流速、血流阻力指数(RI)、加速时间(AT),分析肾皮质血流灌注时间-强度曲线(TIC)及相关参数,包括达峰时间(TTP)、峰值强度(PI)、上升支斜率(Grad)、平均渡越时间(MTT)、曲线下面积(AUC)、上升支面积及下降支面积,比较分析两组间上述各参数的差异及其诊断效能,并以数字减影血管造影(DSA)结果为金标准,绘制重度RAS患者超声造影定量参数的受试者工作特征(ROC)曲线,得到最佳诊断点及最灵敏指标,与核素动态显像技术诊断结果进行一致性分析。结果 (1)重度RAS患者肾动脉起始血流束宽度、叶间动脉流速、肾内血流灌注PI、Grad、AUC、上升支面积、下降支面积较非重度RAS患者小(P<0.05),而肾动脉起始流速、叶间动脉AT、肾内血流灌注TTP、MTT较非重度RAS患者大(P<0.05),但叶间动脉RI两组间无统计学意义(P>0.05)。(2)重度RAS患者肾皮质血流灌注各参数的ROC曲线分析结果显示:以DSA为金标准,肾动脉重度狭窄患者最佳诊断点为PI≤21.1 dB、TTP≥5.4 s、MTT≥17 s、Grad≤5、AUC≤397.05 dB·s、上升支面积≤58.2 dB·s、下降支面积≤363.35 dB·s,其中TTP为最敏感指标。(3)以核素动态显像诊断肾血流灌注结果作为金标准,超声造影(CEUS)诊断重度RAS患者肾血流灌注诊断符合率为86.5%,灵敏度为61.1%,特异度为92.3%,误诊率为7.7%,漏诊率为38.9%,阳性预测值为64.7%,阴性预测值为91.1%,两种检测方法一致性尚可(Kappa值为0.546,P<0.001)。结论 多模态超声检查可一体化评估肾动脉狭窄引起的肾脏微循环变�Objective To explore the clinical application value of multi-mode ultrasound integrated assessment in patients with severe renal artery stenosis(RAS).Methods 48 patients with severe RAS caused by renal athero sclerosis confirmed by digital subtraction angiography(DSA) were selected.According to the degree of renal artery stenosis,96 renal arteries were divided into severe stenosis group(n=60) and non-severe stenosis group(n=36).Conventional ultrasound combined with contrast-enhanced ultrasound(CEUS) was used to detect the width and velocity of blood flow in the initial segment of renal artery,the velocity of interlobar artery,the resistance index(RI) of blood flow and the acceleration time(AT) of the two groups.Meanwhile,the renal cortex blood perfusion time-intensity curve(TIC) and related parameters were analyzed,including time to peak(TTP),peak intensity(PI),ascending branch slope(Grad),mean transit time(MTT),area under the curve(AUC),ascending branch area and descending branch area.The differences of the above parameters between two groups and their diagnostic efficacy were compared and analyzed.Taking DSA results as the gold standard,the receiver operating characteristic(ROC) curve of quantitative parameters of contrast-enhanced ultrasound in patients with severe RAS was drawn,and the best diagnostic point and the most sensitive index were obtained.The results of ultrasound were consistent with those of radionuclide dynamic imaging.Results(1)The width of the initial blood flow bundle,the velocity of interlobar artery,the PI,Grad,AUC,the area of ascending branch and descending branch of renal artery in patients with severe RAS were smaller than those in patients with non-severe RAS(P<0.05).However,the initial flow velocity of renal artery,AT of interlobar artery,TTP and MTT of renal blood perfusion were higher than those of patients with non-severe RAS(P<0.05),but there was statistically non significant between the two groups in interlobar artery RI(P>0.05).(2)ROC curve analysis of renal cortex blood perfusio

关 键 词：肾动脉重度狭窄 肾血流灌注 超声造影 

分 类 号：R445.1[医药卫生—影像医学与核医学] R692[医药卫生—诊断学]