| Background and objective: Atherosclerosis induced renal artery stenosis can result in ischemic nephronia, which has severe prognosis and complication. With the development of the intravascular interventional therapy, intracavitary therapy of renal artery stenosis has increasingly evoked extensive emphasis. Percutaneous transluminal renal angioplasty(PTRA) and percutaneous transluminal renal angioplasty stenting (PTRAS) are the main measures of treating renal artery stenosis. However ,at present, there is no convenient ,accurate and atraumatic detective method to judge and estimate the post-therapy hemodynamics of renal artery. And angiography is still needed to identify the vascular open after interventional therapy. The objective of this research is to observe the hemodynamic change of pre-and- post therapy in renal artery stenosis with atraumatic Color Doppler Flow Imaging (CDFI), and, discuss the correlative parameter of Color Doppler Flow which forecast the value of blood pressure and renal function after the intervention.Methods: 46 patients (male 33 and female 13) received PTRA and PTRAS because of atherosclerotic renal artery stenosis , the average age is 62±19 years. Among them, 21 patients had different grade of renal function lesion, renal angiography verified 64 renal artery stenosis in 46 patients, among them, 57 renal artery received PTRAS, 11 patients received bilateral PTRAS, and 35 patients received unilateral PTRAS (including a solitary kidney), 6 renal artery receivedPTRA. This research were divided into two steps: ①all the patients undertook ultrasonography in the two-five days of the pre-and -post angioplasty and investigated the instant hemodynamic change;② re-examination was inspected in 1～10 months after intervention to follow up ultrasonography and the change of renal function and blood pressure. The quantitative analysis index of the Color Doppler ultrasound included peak systolic velocity of main renal artery (PSV), intra-renal early contraction accelerating time (AT), early contraction acceleration (AC), resistant index (RI). According to whether exist the early contraction notch or not ,or the appearance of the tardus-parvus, waveshape were divided into 0-4 five grades (Ograde: abnormal waveshape; 1 grade: uncertain waveshape; 2-4grades:normal waveshape). According to the pre-surgery RI and AC of intra-renal interlobar artery, patients were divided into 2 categories. The first category were separated into two groups by RI, the first group RI≤0.80, the second group RI>0.80 ; the second category were separated into two groups by AC: the first group AC ≥ 3m/s~2 ,the second group AC<3m/s~2. The blood pressure change of post-surgery: ①curing: stop using all the hypotensive drugs and BP< 140 /90 mm Hg; ② improvement: using the same or less hypotensive drugs with the pre-surgery, the systolic blood pressure decrease <140 mm Hg or the diastolic blood pressure decrease <90 mm Hg; or if using the same or less hypotensive drugs than the pre-surgery, the diastolic blood pressure decrease > 15 mm Hg; ③inefficacy: can not reach the standard of①or ②. The post-surgery evaluation of the renal function: The post-surgery evaluation of the renal function: 1) improvement: Cr decrease ≥16. 7 μmol/L 2) stabilization: Cr decrese< 16. 7 μ mol/L 3) Cr increase ≥ 16. 7 μmol/L. The data was analyzed with Stata 7.0 software.Results: 1, The flow rate of the main renal artery decreased from 278.6±96.7cm/s tol43.6±35.1cm/s, AT in intra-renal decreased from 0.078±0.043s to 0.031±0.006s, AC increased from 2.29±2.01m/s~2 to 6.97±2.45m/s~2, the above indexes had the significant difference between pre- and- post therapy (P<0.01 ) .RI was 0.73±0.14 pre-intervention and 0.79±0.12 after intervention, it had nosignificant difference between pre- and- post therapy (P > 0.05).2,Before intervention, 55 renal artery (86%) PSV>180cm/s, 31 renal artery(48%) AT>0.07s, 50 renal artery (78%) AC<3m/s~2, however, after the surgery, the quantity of these renal artery are obviously decreased, there was significant difference between pre- and post therapy (P<0.001) . Before angioplasty,51 renal artery (80%) had abnormal shape in waveshape, while 7 renal artery (11%) had abnormal shape after surgery. There was significant difference between pre-and-post therapy (P<0.05 ). Both the post-surgery changes of the PSV,AT, AC and waveshape grade improvement demonstrated the improvement of hemodynamics.3 ,In 64 suffering kidneys, there are 17 shorten kidneys(27%). Before angioplasty the length of kidneys is 10.57±1.02cm and the parenchyma of kidneys is 1.52± 0.09cm.The length and the parenchyma of suffering kidneys which is in first,third,sixth,ninth months after angioplasty are not significant difference comparewith them before angioplasty(P> 0.05).4,The average systolic blood pressure decreased from 25.74±2.56Kpa to 18.35± 2.69 Kpa and the average diastolic blood pressure decreased from 15.37±2.41 Kpa to 10.96±2.53 Kpa after stent treatment(P < 0.01). The serum creatitine is 143.1±32.4umol/L before angioplasty, it is 128.7±24.5 umol/L 9 months later, there was not significant difference between the two groups. 5, In the 46 patients, 32 ones had RI<0.80,27 patients (84%) had normal or improved post-surgery blood pressure, and among the 14 patients whose RI>0.80, 7 patients (50%) had improved blood pressure, there was significant difference between the two groups (P<0.01) .6,Before therapy, 21 patients had different damage on renal function, 10 had RI<0.80,l 1 had RI>0.80, in the RI<0.80 group,5 patients (50%) had improved renal function after the interventional therapy, in the RI>0.80 group, 3 patients(27%) had improved renal function after the interventional therapy. There wasno significant difference between the two groups (P>0.05) . 7, No relativity was found between the blood pressure, renal function improvement and AC after the interventional therapy. In the 10 patients whose AC≥3m/s~2, 7 patients (70%) had the blood pressure improved, while in the 35 patients whose AC<3m/s~2. 24 patients (67%) had the blood pressure improved(P>0.05) . In the 21 patients with the renal function lesion, 5 patients (56%) in the 9 patients whose AC≥3m/s~2 renal function were improved, and the other 4 patients (44%) renal function were deteriorated; in the 12 patients whose AC< 3m/s~2, 3 patients (25%) renal function were improved, 9 patients (75%) renal function were deteriorated (P>0.05) . Conclusion:1,As an atraumatic detect method, Color Doppler ultrasound have important value on the evaluation of hemodynamic changes before and after angioplasty.2, Angioplasty can cure Renovascular hypertension effectively and the curative effect is more satisfactorily.3,RI has the significance on the forecasting the blood pressure improvement after angioplasty, while has no significance on the forecasting the renal function improvement.4,AC has no significance on the evaluation of curative effect of angioplasty.Background and objective: Ultrasonography for renal artery is influenced by many factors and its achievement ratio is an important factor that affects the accuracy of diagnosis. Contrast-enhanced ultrasonography (CEUS) can compensate the drawbacks of the insufficient color signal of renal artery blood flow. It can display clearly the color signal of the blood flow of intra-and- extra renal artery and can improve the blood signal. SonoVue is the second generation new-style ultrasound contrast agent. The purpose of this research is to discuss the ultrasonography role on diagnosing renal artery stenosis by observing the renal artery color signal reinforced by SonoVue.Methods: 11 patients (8 male and 3 female, age 51±17years), who were suspected to have renal artery stenosis and could not diagnose definitely by basic imaging, were examined by CEUS. Sequoia 512 color Doppler ultrasound device and CPS software was used. SonoVue. 1.5ml was injected rapidly via antebrachium vein and 5ml normal saline was injected subsequently. Before CEUS , all the patients were examined by basic imaging. Their renal artery blood flow were observed and divided into 0~3 grades. According to the width of color Doppler flow imaging's filling blood flow, the degree of renal artery stenosis was determined by inner diameter stenosis ratio. The results were compared with the angiography. Results: About 8 ~ 15s after injecting SonoVue, the images of renal artery were increased and immediately reached the highest degree. The average reinforcing time was 530 ±32s. After CEUS, 20 renal arteries were displayed and reinforced color blood flow signal were all observed. In 4 patients who have unilateral kidney shrank, one patient's renal artery did not display and the contrast agent could not be observed in this kidney. Ultrasonography showed 12 renal artery stenosis. In one case, the basic imaging showed bilateral renal artery stenosis,while the CEUS showed normal. In another case, the basic imaging showed left renal artery stenosis, while the CEUS showed bilateral renal artery stenosis. In another case, the basic imaging showed normal, after CEUS the left renal artery stenosis is not definite, while the angiography diagnosed as mild stenosis. After CEUS, the width of four renal artery blood flow became narrowly evidently, they were 0.18cm ,0.25cm ,0.27cm and 0.29cm respectively,and their shapes were uneven. Four renal artery color blood flow were thin locally, with the narrow width is 0.32～0.56cm and non-narrow is 0.82～0.94cm. To determine the degree of renal artery stenosis by inner diameter stenosis, the results showed relatively high consistency with X-ray angiography. Compared with angiography, the sensitivity of basic imaging was 70%, the specificity was 0, the coincidence was 58.3%; the sensitivity of opacification imaging was 90%, the specificity was 100%, the coincidence was 91.7%. Compared with basic imaging, the CEUS has higher sensitivity, specificity and coincidence. Conclusion: 1. The CEUS of renal artery improves the display of renal artery, enhance theveracity which US diagnosis renal artery stenosis consumedly; 2.Compared with CDFI, the CEUS of renal artery has improved highly the sensitivity and specificity on the diagnosing renal artery stenosis ; 3.The CEUS of renal artery can easily diagnose midrange from moderate to severe renal artery stenosis, even renal artery obstruction; but the value for mild stenosis needs further discussion.4.The results of CEUS of renal artery showed high consistency with the results of angiography. CEUS has the merit which is lower hurt and repetitive. But CEUS is limited by ultrasonic device and phsical condition of patients, and can not replace the angiography of renal artery completely.
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