摘要
目的 探讨彩色多普勒血流显像 (CDFI)检查肾动脉与叶间动脉峰值流速之比 (简称峰值流速后比 )对移植肾动脉重度狭窄的诊断价值。方法 CDFI发现的 46例移植肾动脉狭窄 (TRAS)患者中 ,14例接受了动脉造影检查并证实有TRAS者构成研究组。测量 7项多普勒血流参数 :肾动脉主干、髂动脉和叶间动脉收缩期峰值流速 (PSV) ,肾动脉与髂动脉峰值流速之比 (简称峰值流速前比 )、峰值流速后比、加速时间和阻力指数。并进行了介入治疗前后超声结果的对比分析。结果 在 14例单个移植肾患者中 ,血管造影显示 13条主肾动脉重度狭窄和 2条肾动脉中度狭窄 (主、副肾动脉各 1条 )。对于 13条重度TRAS ,峰值流速后比 >13、肾动脉PSV >4m/s、加速时间 >0 .0 6s和阻力指数 <0 .5的敏感性分别为10 0 %、69%、92 %和 5 4%。采用峰值流速前比 >5来诊断所有 13条和 11条端 端吻合的重度TRAS ,敏感性分别为 85 %、10 0 %。对获得介入治疗成功的 7例患者 ,介入治疗前后的所有 7项多普勒参数差异均具有非常显著性意义。结论 CDFI是血管造影前筛选重度TRAS的良好影像学方法。峰值流速后比 >13能很好地诊断重度TRAS(端 端或端 侧吻合 )。峰值流速前比 >5对端 端吻合的重度TRAS和加速时间>0 .0 6s对两种吻合类型的重度TRAS的诊断?
Objective To evaluate the diagnostic value of the POST-PSV ratio (a ratio of the peak systolic velocity in the renal artery to that in the interlobar arteries) for the detection of a severe transplant renal artery stenosis(TRAS).Methods Of 46 patients with suspected TRAS indicated by color Doppler flow imaging (CDFI), a study group of 14 patients were referred to DSA and confirmed to have a TRAS. Seven Doppler parameters, including the peak systolic velocity (PSV) in the renal artery, iliac artery and interlobar artery, PRE-PSV ratio (a ratio of the PSV in the renal artery to that in the iliac artery), POST-PSV ratio, acceleration time and resistance index were measured. The Doppler sonographic results before and after intervention were compared. Results In the 14 patients with single transplant kidney, DSA demonstrated 13 main renal arteries with severe stenosis and 2 renal arteries (1 main and 1 accessory renal artery) with moderate stenosis. When using the cutoff values of POST-PSV ratio >13, renal artery PSV >4 m/s, acceleration time > 0.06 s and resistance index < 0.5 for the detection of all 13 severe stenoses, the sensitivities were 100%, 69%, 92% and 54%, respectively. For assessing all 13 severe stenoses and 11 severe stenoses of end-end anastomosis, the cutoff value of PRE-PSV ratio greater than 5 had sensitivities of 85% and 100%. Statistically significant differences were identified between all 7 Doppler parameters in the 7 patients with severe stenosis before and after successful intervention. Conclusions CDFI is an excellent screening tool for detection of severe TRAS. An 80%-99% diameter reduction can be well diagnosed based on POST-PSV ratio >13 for patients with either end-to-end or end-to-side anastomosis. PRE-PSV ratio >5 for patients with end-to-end anastomosis and acceleration time > 0.06 s are very helpful in diagnosis of severe TRAS.
出处
《中华超声影像学杂志》
CSCD
2004年第4期273-277,共5页
Chinese Journal of Ultrasonography
