Ultrasonography of the Kidney：A Pictorial Review

文獻(xiàn)翻譯：腎臟聲像圖綜述（下部）

Abstract

Ultrasonography of the kidneys is essential in the diagnosis and management of kidney-related diseases. The kidneys are easily examined, and most pathological changes in the kidneys are distinguishable with ultrasound. In this pictorial review, the most common findings in renal ultrasound are highlighted.

摘要

因?yàn)槟I臟超聲檢查方便,，而且聲像圖上組織結(jié)構(gòu)變化明顯,，所以診斷腎臟相關(guān)疾病的時(shí)候，腎臟超聲檢查是至關(guān)重要的一環(huán),。這篇腎臟超聲圖像綜述主要介紹最突出的幾種腎病類型。

RenalCalculi

Even though US has a lowersensitivity and specificity than CT for the detection of urolithiasis, US, if available, is recommendedas the initial imaging modality in patients with renal colic and suspected urolithiasis [26,27]. US has no risk ofradiation, is reproducible and inexpensive, and the outcome is notsignificantly different for patients with suspected urolithiasis undergoing initial US examcompared to patients undergoing initial CT exam [26,28].

腎結(jié)石

超聲檢測泌尿系結(jié)石的敏感性和特異性均低于CT,，但是超聲沒有輻射,、重復(fù)性好，價(jià)格低廉,，所以常用于首診腎絞痛和疑似結(jié)石患者,。數(shù)據(jù)顯示，對于泌尿系結(jié)石的首次檢查,，超聲和CT結(jié)果沒有顯著差異,。

Renalstone located at the pyelouretericjunction with accompanying hydronephrosis.

腎盂輸尿管交界處結(jié)石伴腎積水。

Centrally-locatedstone with posterior shadowing. No hydronephrosis ispresent. Measurement of kidney length on the US image is illustrated by ‘+’ anda dashed line.

位于腎中央的結(jié)石,，伴有聲影,，不伴腎積水。

Staghorncalculi filling the entire collecting system and creating pronounced shadowing.

鹿角狀結(jié)石充滿整個(gè)集合系統(tǒng),，伴顯著聲影,。

ChronicKidney Disease

US is useful for diagnostic and prognostic purposes in chronic kidney disease.Whether the underlying pathologic change is glomerular sclerosis, tubularatrophy, interstitial fibrosis or inflammation, the result is often increasedechogenicity of the cortex. The echogenicity of the kidney should be related tothe echogenicity of either the liver or the spleen . Moreover, decreased renal size and cortical thinning are also often seenand especially when disease progresses . However,kidney size correlates to height, and short persons tend to have small kidneys;thus, kidney size as the only parameter is not reliable.

慢性腎病

超聲應(yīng)用于慢性腎臟疾病的診斷和預(yù)后評價(jià)。正常腎臟的回聲強(qiáng)度與肝或脾相近,。無論病理變化是腎小球硬化,、腎小管萎縮、間質(zhì)纖維化抑或炎癥,，其表現(xiàn)往往是皮質(zhì)回聲增強(qiáng),。此外,，隨著疾病的進(jìn)展，?？梢娔I萎縮和皮質(zhì)變薄,。（腎臟大小與身高有關(guān)，矮的人往往腎臟較??；因此，不能將腎臟大小當(dāng)作唯一標(biāo)準(zhǔn)）

Chronicrenal disease caused by glomerulonephritis with increased echogenicity andreduced cortical thickness. Measurement of kidney length on the US image isillustrated by ‘+’ and a dashed line.

腎小球腎炎導(dǎo)致的慢性腎病,，顯示腎回聲增強(qiáng)和腎皮質(zhì)變薄,。

Nephroticsyndrome. Hyperechoickidney without demarcation of cortex and medulla.

腎病綜合征

腎皮質(zhì)與腎髓質(zhì)分界不清。

Chronicpyelonephritis with reduced kidney size and focal cortical thinning.Measurement of kidney length on the US image is illustrated by ‘+’ and a dashedline.

慢性腎盂腎炎,，腎臟萎縮伴局灶性皮質(zhì)變薄,。

End-stagechronic kidney disease with increased echogenicity, homogenous architecturewithout visible differentiation between parenchyma and renal sinus and reducedkidney size. Measurement of kidney length on the US image is illustrated by ‘+’and a dashed line.

晚期慢性腎臟疾病

腎臟回聲增強(qiáng)，萎縮,，結(jié)構(gòu)均勻,，腎實(shí)質(zhì)和腎竇無法區(qū)分。

AcuteRenal Injury

Theacute changes in the kidney are often examined with US as the first-linemodality, where CT and magnetic resonance imaging (MRI) are used for thefollow-up examinations and when US fails to demonstrate abnormalities [31]. Inevaluation of the acute changes in the kidney, the echogenicity of the renalstructures, the delineation of the kidney, the renal vascularity, kidney sizeand focal abnormalities are observed (Figure 26 and Figure 27). CT is preferredin renal traumas, but US is used for follow-up, especially in the patientssuspected for the formation of urinomas [32] (Figure 28).

急性腎損傷

腎臟急性病變通常首選超聲檢查,，當(dāng)超聲無法診斷時(shí),，再輔以CT和MRI。觀察腎臟急性病變包括：腎臟結(jié)構(gòu)的回聲,、腎區(qū)的劃分,、腎血管血流、腎臟大小和局灶性病變,。

腎創(chuàng)傷首選CT,，超聲用于進(jìn)一步檢查，尤其是疑似urinomas（未能找到中文意思）的患者,。

Acutepyelonephritis with increased cortical echogenicity and blurred delineation ofthe upper pole.

急性腎盂腎炎

皮質(zhì)回聲增強(qiáng),，腎上極輪廓不清。

Postoperativerenal failure with increased cortical echogenicity and kidney size. Biopsyshowed acute tubular necrosis.

術(shù)后腎功能衰竭,，皮質(zhì)回聲增強(qiáng),，腎臟增大?；顧z顯示急性腎小管壞死,。

Renaltrauma with laceration of the lower pole and subcapsularfluid collection below the kidney.

腎損傷

腎下極裂傷伴包膜下積液。

Sonographyis the modality of choice for guidance when performing intervention in thekidney, whether it is kidney biopsy, percutaneous nephrostomy or abscessdrainage. Historically, thermal ablation of renal tumors is performed under CTguidance, as the risk of injuring neighboring intestines during the US-guidedprocedure was considered too high due to poor identification of the movingbowels [4,23]. However, recent guidelines for renal interventional US includeradiofrequency, microwave and cryoablation withUS as the ideal imaging guide [33,34].

超聲引導(dǎo)下腎穿刺適用于腎臟活檢,、經(jīng)皮腎造口術(shù),、膿腫引流等。

由于難以識(shí)別腸管蠕動(dòng)，超聲引導(dǎo)下的操作容易傷及鄰近腸子,，所以以往的腎腫瘤消融治療是在CT引導(dǎo)下進(jìn)行。

然而,，最近的腎超聲介入指南認(rèn)為射頻,、微波和冷凍消融術(shù)使用超聲引導(dǎo)更合理。

(A)Percutaneous nephrostomy tube placed through a calyx in the lower pole of akidney with hydronephrosis.

(B)The pigtail catheter is placed in the dilated calyx.

Thetube in (A) and the pigtail in (B) are marked with white arrows.

（A）經(jīng)皮腎造瘺管通過腎盞到達(dá)腎下極積水處,。 （B）導(dǎo)管被放置在擴(kuò)張腎盞中,。

CEUScan evaluate microvasculature, which color Doppler US is unable to detect. Inrenal US examination, CEUS can be used to differentiate tumor and pseudotumor,such as prominent columns of Bertin. Pseudotumorsenhance as adjacent renal tissue. The use of CEUS is recommended in specialcases to distinguish between cystic and hypovascularizedsolid lesions, to characterize complex cysts, abscesses, traumatic lesions andischemic lesions . Solid malignant tumors in the kidney do not exhibit specificenhancement patterns like some liver lesions, and no valid enhancement criteriabetween benign and malignant renal lesions have been proposed. However, CEUS isused in some patients after ablation of renal cell carcinoma to evaluatecontrast uptake in the treated area.

超聲造影可以評估微血管。在腎臟超聲檢查時(shí),，超聲造影可用于區(qū)分腫瘤和假性囊腫（如突出的腎柱）,。假性囊腫可以增強(qiáng)相鄰腎組織的回聲。在特殊情況下,，建議利用超聲造影來區(qū)分囊腫和血管增生型實(shí)性病變,，使復(fù)雜囊腫、膿腫,、外傷性損傷和缺血性病變更容易區(qū)分,。

腎臟實(shí)性惡性腫瘤不像肝臟病變那樣，有特定的增強(qiáng)模式,，良性和惡性腎損害沒有一個(gè)增強(qiáng)的標(biāo)準(zhǔn)。不過,，腎細(xì)胞癌消融后的患者可用超聲造影評估治療區(qū)域的造影劑攝取量。

Renalcell carcinoma successfully treated with thermal ablation, as no contrastenhancement is seen.

腎細(xì)胞癌熱消融治療成功,，未見對比增強(qiáng),。

Unspecificcortical lesion on CT is confirmed cystic and benign with contrast-enhancedultrasound (CEUS) using image fusion.

非特異性皮質(zhì)病灶

CT顯示為囊腫

超聲造影圖像融合顯示為良性病灶。

Elastography is aUS method to visualize the elasticity of tissue. Preliminary reports on US elastography usedon transplanted kidneys to evaluate cortical fibrosis have been publishedshowing promising results.

超聲彈性成像技術(shù)讓組織的彈性變得“可見”,。彈性成像技術(shù)用來評估移植腎的皮質(zhì)纖維化程度已經(jīng)有了初步的報(bào)告，成果值得期待,。

Strainelastography of anormal kidney. Red depicts soft areas, and blue depicts hard areas relative tothe entire elastographyimage. Note that the medulla is softer than the cortex. A color bar is shown tothe left of the image, where ‘S’ and ‘H’ denote soft and hard tissue,respectively.

正常腎臟的應(yīng)變彈性

紅為相對軟區(qū),，藍(lán)為相對硬區(qū)（髓質(zhì)比皮質(zhì)柔軟）。

顏色條：S-軟,，H-硬

Conclusions

RenalUS is a versatile and useful examination. US is an accessible, inexpensive andfast aid for decision-making in patients with renal symptoms and for guidancein renal intervention. However, renal US has certain limitations, and othermodalities, such as CT and MRI, should always be considered as supplementaryimaging modalities in the assessment of renal disease.

腎臟超聲憑借自身優(yōu)勢,，與CT、MRI互相取長補(bǔ)短，輔助臨床診斷與治療,。

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（本文來源于“超聲”公眾號，英語,、圖片為文獻(xiàn)原文,，中文為黃文宇翻譯、發(fā)布）

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