容易和肾结石混淆的超声征象.ppt
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Sonographic Mimics of Renal Calculi
J Ultrasound Med 23:1361-1367 ? 0278-4297
容易和肾结石混淆的超声征象
丁香园超声版 xihuansushi
Bright Reflectors Within the Kidney
? Figure 1. Renal arterial system. Note the proximity of the segmental artery divisions and the relationship of the arcuate arteries to the bases of the renal pyramids.
?
肾脏动脉系统。肾段动脉与锥体基底部的弓状动脉的关系。
Vascular Reflectors segmental artery
? Figure 2. A and B, Coronal sections of the kidney. Arrows mark a segmental artery. C, Renal Doppler image showing the profuse vascular nature of the kidney. 箭头显示肾段动脉。
?
Vascular Reflectors Arcuate Arteries
? Figure 3. Arcuate artery (arrow). Note its orthogonal relationship to the ultrasound beam and its double-channel appearance. 弓状动脉。与超声束垂直，呈双管状。光斑位于锥体的基底部，这个地方正好是弓状动脉。
Nonvascular Reflectors: Prominent Papillae 肾乳头
? Figure 4. Renal pyramids肾脏锥体. Echogenic tips of the renal pyramids肾锥体顶端乳头处回声增强 as seen in mild hydronephrosis也可看到轻度的肾盂积水 are shown.
? These structures can also appear echogenic in conditions such as 很多疾病可以导致这种表现early medullary nephrocalcinosis早期的 肾髓质钙质沉着 (Anderson-Carr progression),2 papillary necrosis乳头坏死, medullary sponge kidneys髓质海绵肾, infection病毒感染 with Cytomegalovirus or Candida albicans, and medullary fibrosis 髓质的纤维变性.
Nonvascular Reflectors: Prominent Papillae
? Figure 5. Transient pyramidal echogenicity暂时性锥体回声增强. These images of an 8-day-old neonate show the characteristic appearance of transient pyramidal echogenicity due to the precipitation of Tamm-Horsefall proteins. These findings disappeared by 6 weeks of age. 一8天大新生儿出现这种表现，这是由于TH蛋白沉积导致的，大约5周后这种表现消失。
Reflectors Within the Renal Parenchyma 肾脏实质内
? Figure 6. A, Milk of calcium cyst钙乳囊肿. Note the echogenic material that has settled to the dependent portion of the cyst after the patient was moved to a decubitus position. 强回声出现在囊肿的后方，病人转换体位后强回声的位置发生了变化。B, Milk of calcium cyst with reverberation echoes囊肿后方的回声混响效应.
Junctional Parenchymal Line
? junctional parenchymal defect 肾脏实质交界处缺陷：常见于右肾皮质，是由于胚胎期不完全的发育所致，超声可呈现线样或三角形的强回声，可能会被误认为结石或强回声的肿瘤。
Angiomyolipomas
? Figure 8. Angiomyolipoma肾脏错构瘤(血管肌脂瘤). Note the echogenic area in the upper pole of the right renal cortex. 强回声出现在肾脏上极的皮质内。
Foreign Bodies异物
? Figure 9. Foreign body. A Foley catheter bulb弗利氏导尿管, placed during nephrostomy肾造口术, is shown within the right renal pelvis.
超声诊断肾脏结石的标准值
? Expecting to be able to detect submillimeter calculi on sonography is fraught with danger, and many false-positive diagnoses may be made. Five millimeters appears to be the cutoff size at which we can confidently expect to see renal calculi. Under experimental conditions, some authors have reported sensitivity of 2 mm, but most consider 5 to 7 mm to be the smallest visible size on sonography. For detection of smaller stones, diagnostic confidence levels vary with operator expertise, machine sophistication, stone location, and patient anatomy. The sensitivity of sonography for diagnosing small renal stones varies from 24% to 96%. Helical CT has consistently been shown to have superior sensitivity.
? 5mm被认为是诊断结石的标准。由于设备分辨率的提升，有人认为是2mm，但这也增加了假阳性率。小结石的诊断与操作者的经验、仪器的调节、结石的位置和病人的身体情况有很大的关系。超声诊断小结石的敏感性差别很大，从24%到96%。
谢谢大家
? 知识有限，不对之处还请大家指正。
? 个人感觉，当超声发现肾脏有强回声的结构时应该首先明确这种结构是出现在肾脏的哪个区域，然后据此判断，这样应该有助于诊断和鉴别诊断。
Sonographic Mimics of Renal Calculi
J Ultrasound Med 23:1361-1367 ? 0278-4297
容易和肾结石混淆的超声征象
丁香园超声版 xihuansushi
Bright Reflectors Within the Kidney
? Figure 1. Renal arterial system. Note the proximity of the segmental artery divisions and the relationship of the arcuate arteries to the bases of the renal pyramids.
?
肾脏动脉系统。肾段动脉与锥体基底部的弓状动脉的关系。
Vascular Reflectors segmental artery
? Figure 2. A and B, Coronal sections of the kidney. Arrows mark a segmental artery. C, Renal Doppler image showing the profuse vascular nature of the kidney. 箭头显示肾段动脉。
?
Vascular Reflectors Arcuate Arteries
? Figure 3. Arcuate artery (arrow). Note its orthogonal relationship to the ultrasound beam and its double-channel appearance. 弓状动脉。与超声束垂直，呈双管状。光斑位于锥体的基底部，这个地方正好是弓状动脉。
Nonvascular Reflectors: Prominent Papillae 肾乳头
? Figure 4. Renal pyramids肾脏锥体. Echogenic tips of the renal pyramids肾锥体顶端乳头处回声增强 as seen in mild hydronephrosis也可看到轻度的肾盂积水 are shown.
? These structures can also appear echogenic in conditions such as 很多疾病可以导致这种表现early medullary nephrocalcinosis早期的 肾髓质钙质沉着 (Anderson-Carr progression),2 papillary necrosis乳头坏死, medullary sponge kidneys髓质海绵肾, infection病毒感染 with Cytomegalovirus or Candida albicans, and medullary fibrosis 髓质的纤维变性.
Nonvascular Reflectors: Prominent Papillae
? Figure 5. Transient pyramidal echogenicity暂时性锥体回声增强. These images of an 8-day-old neonate show the characteristic appearance of transient pyramidal echogenicity due to the precipitation of Tamm-Horsefall proteins. These findings disappeared by 6 weeks of age. 一8天大新生儿出现这种表现，这是由于TH蛋白沉积导致的，大约5周后这种表现消失。
Reflectors Within the Renal Parenchyma 肾脏实质内
? Figure 6. A, Milk of calcium cyst钙乳囊肿. Note the echogenic material that has settled to the dependent portion of the cyst after the patient was moved to a decubitus position. 强回声出现在囊肿的后方，病人转换体位后强回声的位置发生了变化。B, Milk of calcium cyst with reverberation echoes囊肿后方的回声混响效应.
Junctional Parenchymal Line
? junctional parenchymal defect 肾脏实质交界处缺陷：常见于右肾皮质，是由于胚胎期不完全的发育所致，超声可呈现线样或三角形的强回声，可能会被误认为结石或强回声的肿瘤。
Angiomyolipomas
? Figure 8. Angiomyolipoma肾脏错构瘤(血管肌脂瘤). Note the echogenic area in the upper pole of the right renal cortex. 强回声出现在肾脏上极的皮质内。
Foreign Bodies异物
? Figure 9. Foreign body. A Foley catheter bulb弗利氏导尿管, placed during nephrostomy肾造口术, is shown within the right renal pelvis.
超声诊断肾脏结石的标准值
? Expecting to be able to detect submillimeter calculi on sonography is fraught with danger, and many false-positive diagnoses may be made. Five millimeters appears to be the cutoff size at which we can confidently expect to see renal calculi. Under experimental conditions, some authors have reported sensitivity of 2 mm, but most consider 5 to 7 mm to be the smallest visible size on sonography. For detection of smaller stones, diagnostic confidence levels vary with operator expertise, machine sophistication, stone location, and patient anatomy. The sensitivity of sonography for diagnosing small renal stones varies from 24% to 96%. Helical CT has consistently been shown to have superior sensitivity.
? 5mm被认为是诊断结石的标准。由于设备分辨率的提升，有人认为是2mm，但这也增加了假阳性率。小结石的诊断与操作者的经验、仪器的调节、结石的位置和病人的身体情况有很大的关系。超声诊断小结石的敏感性差别很大，从24%到96%。
谢谢大家
? 知识有限，不对之处还请大家指正。
? 个人感觉，当超声发现肾脏有强回声的结构时应该首先明确这种结构是出现在肾脏的哪个区域，然后据此判断，这样应该有助于诊断和鉴别诊断。
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