| Objective1. Through the observation of different components of small renal calculi (maximum diameter is respectively lmm,2mm,3mm) in vitro porcine kidney in the two-dimensional ultrasound, color Doppler twinkling artifacts and Pulsed Doppler spectrum of high amplitude reentry, to look for the common part of the different components of small calculi In the performance of ultrasound, In order to draw the best diagnosis method of small renal calculi (less than 3mm) On sonography.2. Through the observation of different components of small renal calculi (maximum diameter is respectively lmm,2mm,3mm) In vitro porcine kidney in the two-dimensional ultrasound, color Doppler twinkling artifacts and Pulsed Doppler spectrum of high amplitude reentry, to look for the difference of the different components of small calculi In the performance of ultrasound, Judging the composition of the small calculus by the differences On sonography, to help to prevent and treat the clinical small renal calculi early.Materials and methods1. Experimental materials Calcium oxalate calculi, two water calcium hydrogen phosphate, six water magnesium ammonium phosphate, carbonate apatite, anhydrous uric acid, fresh pig kidneys, pig’s belly meat (4-5cm), the paper clip.2. Experimental method①Each component of kidney stones are made of maximum diameter of 3mm, 2mm, 1mm, and be put in the renal calices of porcine kidney respectively, with a paper clip for positioning. And The pig’s belly meat about 4. Ocm-5. Ocm thick is selected to cover on the surface of the porcine kidney;②Fixing an experienced physician; the surrounding environment, lights etc are consistent;③Ultrasound ScanningAll scans were performed on a Philips iU22 ultrasound scanner using an abdominal probe (frequency 3.5MHz). Firstly the gray-scale ultrasound images were scanned and storred. Then the ultrasound images of the color Doppler and pulsed Doppler were scanned. when the stable images of twinkling artifact and high amplitude spectrum display, storring the images. A grain of small stones was scanned each time. Five grains of small stones with the same components and sizes would be scanned. In the experiment, the scanning machine settings, the distance from the probe to the stone were fixed.3. Analysis of statistical dataBy using the software of SPSS19.0 Chi square test to analyze the datas. Results1. Ultrasonic color Doppler twinkling artifacts and spectral Doppler high amplitude reentrant spectrum can improve the diagnostic rate of small renal calculi.But there is no difference compared with the two-dimensional ultrasound in the rate of diagnosis for 1mm small renal calculi. Table 1 data analysis shows, all small stones were no posterior acoustic shadowing and comet tail sign; all small stones appear twinkling artifact rate was 53%, and high amplitude reentrant spectrum rate was 40%, both higher than the two-dimensional ultrasound diagnostic rate. Among all the different components of 1mm stones, the twinkling artifact rate was 25%, Among 2mm, the rate was 60%, Among 3mm, the rate was 80%. Table 2,75 small stones acoustic shadow group compare with the twinkling artifact group (P<0.05)with statistical significance; 75 small stones acoustic shadow group compared with high amplitude reentrant spectrum (P<0.05)with statistical significance;Compared with the two-dimensional ultrasound, the ultrasound color Doppler twinkling artifact and high amplitude reentrant spectrum of the Doppler can improve the diagnostic rate of small renal calculi. Table 3,25 small stones(lmm) acoustic shadow group compare with the twinkling artifact group (P>0.05)with no statistical significance;25 small stones(lmm) acoustic shadow group compared with high amplitude reentrant spectrum (P>0.05)with no statistical significance;There is no comparative significance between the two-dimensional ultrasound and the ultrasound color Doppler twinkling artifact and the high amplitude reentrant spectrum of the Doppler in the diagnosis of small renal calculi. Table 4,25 small stones(2mm) acoustic shadow group compare with the twinkling artifact group (P<0.05)with statistical significance; 25 small stones (2mm) acoustic shadow group compared with high amplitude reentrant spectrum (P<0.05)with statistical significance;The ultrasound color Doppler twinkling artifact and the Doppler frequency of high amplitude reentrant spectrum can diagnose 2mm small renal calculus, and can improve the diagnostic rate. Table 5,25 small stones(3mm) acoustic shadow group compare with the twinkling artifact group (P<0.05)with statistical significance; 25 small stones (3mm) acoustic shadow group compared with high amplitude reentrant spectrum (P<0.05)with statistical significance;The ultrasound color Doppler twinkling artifact and the high amplitude reentrant spectrum can improve 3mm small renal calculus’diagnostic rate.2. The two-dimensional ultrasound, the color Doppler twinkling artifact and high amplitude reentrant spectrum judge the small stone composition. Table 1 shows, the color Doppler twinkling artifact rate of the calcium oxalate stone (1mm,2mm,3mm) is 67%, and the high amplitude reentrant spectrum rate is 67%; The color Doppler twinkling artifact rate of Two water calcium hydrogen phosphate(lmm,2mm,3mm) is 100%, and the high amplitude reentrant spectrum rate is 33%; The color Doppler twinkling artifact rate of Six water magnesium ammonium phosphate(lmm,2mm,3mm) is 33%, and the high amplitude reentrant spectrum rate is 33%; The color Doppler twinkling artifact rate of Carbonate apatite (lmm,2mm,3mm) is 0%, and the high amplitude reentrant spectrum rate is 0%; The color Doppler twinkling artifact rate of Anhydrous uric acid(lmm, 2mm,3mm) is 67%, and the high amplitude reentrant spectrum rate is 67%; Among the various components of 1mm small stones, only two water calcium hydrogen phosphate appears Twinkling artifact; Among all the 2mm small stones of various components with twinkling artifact, only two water calcium hydrophosphate was no exploration of high amplitude reentrant spectrum; The 3mm calcium oxalate stones showed short rod in two dimensional ultrasonographic image with no peripheral "halo" syndrome;The 3mm two phosphate dihydrate, the 3mm six water magnesium ammonium phosphate, the 3mm anhydrous uric acid calculi showed patchy with the obvious "halo" syndrome;Their echo was a bit lower than calcium oxalate. Among the 3mm small stones of different components, only carbonated apatite was no exploration of twinkling artifact; Also we can find from the 3mm small stones with different components in the experiment that the twinkling artifact of uric acid is more obvious than others, especially than calcium oxalate calculus. (see the figure)Conclus ions1.The ultrasonic color Doppler twinkling artifacts and the spectral Doppler high amplitude reentrant spectrum can improve the diagnostic rate of small renal calculi, so that significantly can reduce the misdiagnosis and missed diagnosis; But there is no difference compared with the two-dimensional ultrasound in the rate of diagnosis for lmm small renal calculi.2. According to the two-dimensional ultrasound, the color Doppler twinkling artifact and the high amplitude reentrant spectrum, we can preliminary judge parts of the small stone compositions, but it still needs further study. |
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