腎動脈狹窄之靜脈注射數位化贅影消減血管攝影術

Intravenous Digital Subtraction Angiography of Renal Artery Stenosis

張晉民(Jinn-Ming Chang) ； 黃賢正(Suen-Tseng Huang) ； 王石甫(Shih-Pu Wang) ； 張茂松(Mau-Song Chang) ； 謝明仁(Ming-Jen Hsieh) ； 楊建芳(Chien-Fang Yang) ； 于俊(Chun Yu) ； 張遵(Tsuen Chang)

《中華放射線醫學雜誌》 13卷1期 (1988/03) Pp. 63-70

摘要

榮民總醫院放射線部自民國75年1月至民國75年12月止，對56位高壓患者實施靜脈注射數位化贅影消減血管攝影術（intravenous digital subtraction angiography，以下簡稱IVDSA）來偵測有無腎動脈狹窄。對於此56位患者乃依據下列條件而選擇(1)40歲以下之高血壓患者。(2)大於40歲而且不易控制之高血壓息者。(3)患者無嚴重的心，腎功能不全。這56位患者，除了5位影像不良外，其餘51位患者中，有21位呈現腎動脈狹窄，所佔之比例為21/51(24.5%)。其中有13位IVDSA陽性患者，同時亦實施動脈注射數位化贅影消減血管攝影術（intraarterial digital subfraction angiography，以簡稱IBDSA）），我們以IADSA為基準(base line)，得出IVDSA對腎動脈狹窄診斷的靈敏度(Sensitivity)為92%，特異性(Specificity)為86%陽性預估值(positive predictive value)為85%陰性預估值(negative predictive value)為92%，其中假陽性(falsepostive)2例，假陰性1例。在此13位接受IVDSA及IADSA之患者，從影像分析，將腎動脈狹窄的程度分為四級：①正常。②輕度：＜50%。③中度：50%~80%。④高度：＞80%。我們比較出IVDSA與IADSA對狹窄程度之一致性(agreemet)可達88%。同時13位患者中有10位患者並實施囊擴張術(Percutaneors transluminal renal angioplasty, PTRA)其成功率為90%而初期血壓之控制約為80%

關鍵字

靜脈注射數位化贅影消減血管攝影術 ； 動脈注射數位化贅影消減血管攝影數

並列摘要

Twenty-one cases with renal artery stenosis had been detected by IVDSA from 51 hypertensive patients. The sensitivity and specificity of IVDSA were 92% and 86% as comparing with the baseline results of JADSA. The experience from our present study indicats that IVDSA has a high sensitive rate of demonstrating renal artery stenosis, if the IVDSA is technically successful. It can directly and effectively provide the responsible abnormality, as opposed to conventional excretory rapid sequence urography.
As comparing the conventional aortorenohraphy, the procedure of IVDSA has several advantages, such as less morbidity and quick performance for outpatients.
The reliability of IVDSA in detecting renal artery stenosis had a high agreement (88%) with that of IVDSA in our study. For these reasons, IVDSA now should be the initial screening radiologic procedure in the evaluation of hypertensive patient of renovascular etiology, and by this manner, the PTRA or surgical revascularization for renal artery stenosis can be planned earlier.

並列關鍵字

intravenous digital subtraction angiography ； intraarterial digital subtraction angiography