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中华医学超声杂志（电子版）

中华医学超声杂志（电子版） ›› 2021, Vol. 18 ›› Issue (06) : 543 -553. doi: 10.3877/cma.j.issn.1672-6448.2021.06.003

所属专题： 总编推荐； 指南共识；

专家共识

肾动脉狭窄的超声诊断专家共识
中华医学会超声医学分会血管与浅表学组   
  • 收稿日期:2021-03-16 出版日期:2021-06-01
  • 基金资助:
    国家自然科学基金(60971050，60671026，61971448); 北京市自然科学基金(Z111107066411017)

Expert consensus on ultrasound diagnosis of renal artery stenosis

Superficial Organ and Vascular Ultrasound Group of Society of Ultrasound in Medicine of Chinese Medical Association   

  • Received:2021-03-16 Published:2021-06-01
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中华医学会超声医学分会血管与浅表学组. 肾动脉狭窄的超声诊断专家共识[J]. 中华医学超声杂志（电子版）, 2021, 18(06): 543-553.

Superficial Organ and Vascular Ultrasound Group of Society of Ultrasound in Medicine of Chinese Medical Association. Expert consensus on ultrasound diagnosis of renal artery stenosis[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2021, 18(06): 543-553.

表1 RAS的血流动力学超声诊断直接指标的选择和应用推荐
直接指标 应用价值 备注
PSV 多数研究推荐，准确性最高的指标 确保准确测量，避免全身及局部干扰因素，通过峰值流速前比及后比指标校正
EDV 敏感度、特异度较差，不推荐 -
RAR 可校正由全身因素引起的肾动脉PSV异常 腹主动脉存在病变时不推荐使用
RRR 推荐用于肾动脉中远段狭窄 RRR计算方法及诊断阈值均与狭窄位置相关
RSR 推荐用于肾动脉起始处狭窄 RSR有可能受肾动脉中远段狭窄射流的影响，不推荐应用于肾动脉中远段狭窄
RIR 推荐指标 推荐用于RAS狭窄率≥50%的诊断
图1 不同类型肾内动脉频谱收缩早期加速时间（AT）的测量方法（箭头所示为AT的测量终点）。图a~d为正常频谱，图a为频谱呈单峰，仅有收缩早期波峰；图b为频谱呈双峰，第一峰大于第二峰；图c为频谱呈双峰，第一峰小于第二峰；图d为频谱仅有顺应性波峰。图e，f为异常频谱，为同侧肾动脉主干狭窄所致，收缩早期波峰消失，呈小慢波，AT测量终点为频谱最高点
图2 肾动脉狭窄诊断流程图
表2 CTA、CE MRA、non-CE MRA及DSA主要特点比较
方法 电离辐射 外源性对比剂 检查时间 是否为有创性操作 诊断钙化的敏感度 RAS的诊断效率 临床应用现状 功能性评价
CTA 有 含碘对比剂 短 否 高 高 广泛应用 可观察肾脏的大小、皮质厚度，可根据肾实质强化时间及程度大致判断肾脏功能
CE MRA 无 含钆对比剂 较长 否 低 高 较广泛 与CTA类似，且可结合特殊扫描序列，评估肾实质氧合情况
non-CE MRA 无 无 较长 否 低 高 有限应用 可观察肾脏的大小、实质厚度；可结合特殊扫描序列评估肾实质氧合情况
DSA 有 含碘对比剂 长 是 一般 高，多作为研究的金标准 不作为诊断首选，多在检查同时进行治疗 可结合血流动力学测量；可观察肾脏的大小、皮质厚度、灌注情况
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