2021肾结石的超声诊断

1、肾结石的超声诊断Sonographic Mimics of Renal CalculiDurr-e-Sabih, MBBS, MSc, Ali Nawaz Khan, MBBS, FRCP , FRCR,Marveen Craig, RDMS, Joseph A. Worrall, MD, RDMSObjectives.T o review sonographic findings that can mimic renal calculi. Methods.We comment on a number of echoes that can mimic renal calculi. Result

2、s.There are a number of sonographic renal artifacts, vascular and nonvascular, that may confound a correct diagnosis. Conclusions.Awareness of these potential artifacts will result in a more specific sonographic examination and will accurately guide the referring physician toward appropriate patient

3、 treatment. The importance of other imaging modalities is also emphasized to ensure that a correct diagnosis is obtained whenever the sonographic findings are inconclusive. Key words:renal artifacts; renal calculi; sonography.Received November 24, 2021, from the Multan Institute of Nuclear Medicine

4、and Radiotherapy,Nishtar Hospital, Multan, Pakistan (D.-e.-S.); North Manchester General Hospital, Manchester, England (A.N.K.); author/consultant, Tucson Arizona, USA (M.C.); and The Fairbanks Clinic, Fairbanks, Alaska,USA (J.A.W.). Revision requested January 22, 2021.Revised manuscript accepted fo

5、r publication June 1,2021.Many individuals from all over the world helped in the preparation of this review. All are members of a medical imaging ultrasound discussion group,which can be accessed at /doc/9fb0e135eefdc8d376ee3290.html/group/medicalimaging. In particular, we tha

6、nk the following members: Anatoly Garkusha, MD (Ukraine), for sharing his philosophy on how find-ings are sometimes “created”; Chitra Arun Kamath,MD (India), for suggesting causes for some of the potential artifacts seen on renal sonography; Fazeel Uz Zaman, MD (Pakistan), for suggesting maneu-vers

7、to increase the sensitivity of sonographic stone diagnosis; Gunjan Puri, MD (India), for suggesting causes for some of the artifactual echoes on renal sonography; Latha Natarajan, MD (India), for superb knowledge of differential diagnoses in all things related to sonography; Ravi Kadasne, MD (United

8、 Arab Emirates), for images, especially the image of the milk of calcium cyst used in this review; and Rochita V. Ramanan, MD (India), for insight into how radiologists approach the clinical question of flank pain.Address correspondence and reprint requests to Marveen Craig, RDMS, 11510 N Charoleau

9、Dr,Tucson, AZ, 85735 USA.E-mail: cramar25/doc/9fb0e135eefdc8d376ee3290.html.AbbreviationsCT , computed tomographyenal calculous disease is a frequent cause of lum-bar pain, but an incorrect diagnosis of renal cal-culous disease can have important clinical implications for the

10、patient. If lumbar pain iserroneously ascribed to the presence of a renal calculus,the patient may be deprived of appropriate treatment.Proper sonographic technique usually allows visualiza-tion of most calculi larger than 5 mm. When imaging smaller renal calculi; however, recognition and diagnos-ti

11、c accuracy are less clear, and such stones may be missed or misdiagnosed because of the presence of many inher-ently bright intrarenal noncalculous echoes. This review concentrates on those bright echoes that represent sono-graphic artifacts, normal or common (anatomic) renal structures that may mim

12、ic renal calculi.Bright Reflectors Within the KidneyNormal or calcified renal vessels are the most notable and common causes of intrarenal bright echo reflectors.1The kidneys are among the most vascular organs within the body; they can even be considered to form physiologic arteriovenous shunts. The

13、 renal volume of both kidneys is approximately 300 mL, and they are perfused by the equiv-alent of 25% of cardiac output, which can be up to 1.5 L.It is not surprising that, with so many vessels, some may present orthogonally to an ultrasound beam and may appear more echogenic than the background pa

14、renchy-ma, and some of these normal vessels, imaged at just the right angle, may appear as small, brightly reflective “specks.”? 2021 by the American Institute of Ultrasound in Medicine ? J Ultrasound Med 2021; 23:13611367 ? 0278-4297/04/$3.50RSome of these renal vessels appear in pre-dictable locat

15、ions and in a recognizable pattern,thus allowing their identification as “nonstones.”A brief review of renal vascular anatomy shows that each renal artery divides into 5 segmental arteries, with each segmental artery subsequent-ly dividing into interlobar arteries. Segmental arteries often cross the

16、 papillae at right angles,with the division frequently occurring very near the medullary pyramids. The interlobar arteries travel along the sides of the renal pyramids and,at the level of the pyramidal base, give off parallel arcuate arteries (Figure 1). The vessels location and configuration sugges

17、t their true identity.Bright intrarenal reflectors can be subdivided into vascular and nonvascular causes.Vascular ReflectorsSegmental ArteriesThe division of the segmental arteries into the interlobar arteries can be seen as regularly spaced, tiny echogenicities at the periphery of the renal sinus.

18、 Their similarity in size and their regular spacing are often the clues to their correct identification. In addition, bright echogenicities are sometimes noted at the tips of the medullary pyramids. These echo patterns, too, may have vascular origins (Figure 2).Arcuate ArteriesOften visible as tiny

19、threadlike echogenicities,the arcuate arteries travel along the base of the medullary pyramids, and their similar sizes and locations suggest their true identity (Figure 3).Sinus VesselsA number of small transversely oriented echogenicities, some with a “tramline” or “rail-road track” appearance, ca

20、n be encountered.They most likely represent echo reflections from the sinus vessels.Nonvascular Reflectors: Prominent PapillaeThe apexes of the medullary pyramids project into the minor calyces and can appear promi-nent in mild hydronephrosis with calyceal dilata-tion (Figure 4). These structures ca

21、n also appear echogenic in conditions such as early medullary nephrocalcinosis (Anderson-Carr progression),2papillary necrosis, medullary sponge kidneys,infection with Cytomegalovirus or Candida albi-cans , and medullary fibrosis. An important cause of a transient increase in medullary echogenicity

22、in neonates is precipitation of T amm-Horsefall proteins (Figure 5).Reflectors Within the Renal ParenchymaMilk of Calcium CystsCalcium salts typically collect in simple renal cysts, usually in a calyceal diverticulum, but the salts can accumulate in cysts occurring in poly-cystic renal disease as we

23、ll. The “milk of calci-um” is typically seen as an echogenic layer of intracystic material, which reverberates and sometimes gravitates to the dependent portion of the cyst (Figure 6).3In some cases, calcified material may completely fill the cysts, making diagnosis difficult.4,5However, the presenc

24、e of reverberation artifacts is diagnostically helpful.Renal Cortical CalcificationThere are a variety of causes that produce renal cortical calcification, shown as increased cortical echogenicity and shadowing, and that may mimic calculi. Some of these causes include acute tubular necrosis, chronic

25、 glomeru-lonephritis, Alport syndrome, oxalosis, rejected renal transplants, and chronic neoplastic hyper-calcemia.1362J Ultrasound Med 2021; 23:13611367Sonographic Mimics of Renal CalculiFigure 1.Renal arterial system. Note the proximity of the seg-mental artery divisions and the relationship of th

26、e arcuate arter-ies to the bases of the renal pyramids.Durr-e-Sabih et alABCJ Ultrasound Med 2021; 23:136113671363Sonographic Mimics of Renal CalculiJ Ultrasound Med 2021; 23:13611367 1364Durr-e-Sabih et alABBAJ Ultrasound Med 2021; 23:136113671365Sonographic Mimics of Renal CalculiFigure 9. Foreign

27、 body. A Foley catheter bulb, placed during nephrostomy, is shown within the right renal pelvis.References1.Gould RJ, Rochester D, Panella JS. Sonographicdemonstration of renal arterial calcification simulat-ing multiple renal calculi. Urology 1985; 25:330331.2.Patriquin H, Robitaille P. Renal calci

28、um deposition inchildren: sonographic demonstration of the Anderson-C arr progression. AJR Am J Roentgenol 1986; 146:12531256.3.Patriquin H, Lafortune M, Filiatrault D. Urinary milkof calcium in children and adults: use of gravity-dependent sonography. AJR Am J Roentgenol 1985;144:407413.4.Melekos M

29、D, Kosti PN, Zarakovitis IE, DimopoulosPA. Milk of calcium cysts masquerading as renal cal-culi. Eur J Radiol 1998; 28:6266.5.Ohyabu Y, Sameshima H, Matuoka K, Noda S, Eto K.Milk of calcium renal stone: a case report. Hinyokika Kiyo 1989; 35:481484.6.Dalla Palma L, Pozzi-Mucelli R, Stacul F. Present

30、-dayimaging of patients with renal colic. Eur Radiol 2021;12:256257.7.Kimme-Smith C, Perrella RR, Kaveggia LP, Cochran S,Grant EG. Detection of renal stones with real-time sonography: effect of transducers and scanning parameters. AJR Am J Roentgenol 1991; 157:975980.8.Chau WK, Chan SC. Improved son

31、ographic visual-ization by fluid challenge method of renal lithiasis in the nondilated collecting system: experience in seven cases. Clin Imaging 1997; 21:276283.1366J Ultrasound Med 2021; 23:136113679.Juul N, Holm-Bentzen M, Rygaard H, Holm HH.Ultrasonographic diagnosis of renal stones. Scand J Uro

32、l Nephrol 1987; 21:135137.10.Sheafor DH, Hertzberg BS, Freed KS, et al.Nonenhanced helical CT and US in the emergency evaluation of patients with renal colic: prospective comparison Radiology 2021; 217:792797.11.Gaucher O, C ormier L, Deneuville M, Regent D,Mangin P, Hubert J. Which is the best perf

33、orming imaging method for demonstrating residual renal calculi? Prog Urol 1998; 8:493501.12.Becker-Gaab C, Perouansky M, Zrenner M, zurNieden J. Sonographic diagnosis of kidney calculi: comparative study of ultrasound, excretory urogra-phy and computer tomography in 310 patients.Digitale Bilddiagn 1

34、986; 6:128134.13.Soyer P, Levesque M, Lecloirec A, Arcangioli O,Heddadi M, Debroucker F. Evaluation of the role of echography in the positive diagnosis of renal colic secondary to kidney stone. J Radiol 1990; 71:445450.14.Sinclair D, Wilson S, T oi A, Greenspan L. The evalu-ation of suspected renal colic: ultrasound scan ver-sus excretory urography. Ann Emerg Med 1989;18:556559.15.Fowler KA, Locken JA, Duchesne JH, WilliamsonMR. US for detecting renal calculi with nonen-hanced CT as a reference standard. Radiology 2021;222:109113.16.Bats-Baril WL, Frymoyer JW. The economics of spinaldisorders