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Ultrasonography of the Kidney：A Pictorial Review 文献翻译：肾脏声像图综述（下部） Abstract Ultrasonography of the kidneys is essential in the diagnosis and management of kidney-related diseases. The kidneys are easily examined, and most pathological changes in the kidneys are distinguishable with ultrasound. In this pictorial review, the most common findings in renal ultrasound are highlighted. 摘要 因为肾脏超声检查方便，而且声像图上组织结构变化明显，所以诊断肾脏相关疾病的时候，肾脏超声检查是至关重要的一环。这篇肾脏超声图像综述主要介绍最突出的几种肾病类型。 RenalCalculi Even though US has a lowersensitivity and specificity than CT for the detection of urolithiasis, US, if available, is recommendedas the initial imaging modality in patients with renal colic and suspected urolithiasis [26,27]. US has no risk ofradiation, is reproducible and inexpensive, and the outcome is notsignificantly different for patients with suspected urolithiasis undergoing initial US examcompared to patients undergoing initial CT exam [26,28]. 肾结石 超声检测泌尿系结石的敏感性和特异性均低于CT，但是超声没有辐射、重复性好，价格低廉，所以常用于首诊肾绞痛和疑似结石患者。数据显示，对于泌尿系结石的首次检查，超声和CT结果没有显著差异。 Renalstone located at the pyelouretericjunction with accompanying hydronephrosis. 肾盂输尿管交界处结石伴肾积水。 Centrally-locatedstone with posterior shadowing. No hydronephrosis ispresent. Measurement of kidney length on the US image is illustrated by ‘+’ anda dashed line. 位于肾中央的结石，伴有声影，不伴肾积水。 Staghorncalculi filling the entire collecting system and creating pronounced shadowing. 鹿角状结石充满整个集合系统，伴显着声影。 ChronicKidney Disease US is useful for diagnostic and prognostic purposes in chronic kidney disease.Whether the underlying pathologic change is glomerular sclerosis, tubularatrophy, interstitial fibrosis or inflammation, the result is often increasedechogenicity of the cortex. The echogenicity of the kidney should be related tothe echogenicity of either the liver or the spleen . Moreover, decreased renal size and cortical thinning are also often seenand especially when disease progresses . However,kidney size correlates to height, and short persons tend to have small kidneys;thus, kidney size as the only parameter is not reliable. 慢性肾病 超声应用于慢性肾脏疾病的诊断和预后评价。正常肾脏的回声强度与肝或脾相近。无论病理变化是肾小球硬化、肾小管萎缩、间质纤维化抑或炎症，其表现往往是皮质回声增强。此外，随着疾病的进展，常可见肾萎缩和皮质变薄。（肾脏大小与身高有关，矮的人往往肾脏较小；因此，不能将肾脏大小当作唯一标准） Chronicrenal disease caused by glomerulonephritis with increased echogenicity andreduced cortical thickness. Measurement of kidney length on the US image isillustrated by ‘+’ and a dashed line. 肾小球肾炎导致的慢性肾病，显示肾回声增强和肾皮质变薄。 Nephroticsyndrome. Hyperechoickidney without demarcation of cortex and medulla. 肾病综合征 肾皮质与肾髓质分界不清。 Chronicpyelonephritis with reduced kidney size and focal cortical thinning.Measurement of kidney length on the US image is illustrated by ‘+’ and a dashedline. 慢性肾盂肾炎，肾脏萎缩伴局灶性皮质变薄。 End-stagechronic kidney disease with increased echogenicity, homogenous architecturewithout visible differentiation between parenchyma and renal sinus and reducedkidney size. Measurement of kidney length on the US image is illustrated by ‘+’and a dashed line. 晚期慢性肾脏疾病 肾脏回声增强，萎缩，结构均匀，肾实质和肾窦无法区分。 AcuteRenal Injury Theacute changes in the kidney are often examined with US as the first-linemodality, where CT and magnetic resonance imaging (MRI) are used for thefollow-up examinations and when US fails to demonstrate abnormalities [31]. Inevaluation of the acute changes in the kidney, the echogenicity of the renalstructures, the delineation of the kidney, the renal vascularity, kidney sizeand focal abnormalities are observed (Figure 26 and Figure 27). CT is preferredin renal traumas, but US is used for follow-up, especially in the patientssuspected for the formation of urinomas [32] (Figure 28). 急性肾损伤 肾脏急性病变通常首选超声检查，当超声无法诊断时，再辅以CT和MRI。观察肾脏急性病变包括：肾脏结构的回声、肾区的划分、肾血管血流、肾脏大小和局灶性病变。 肾创伤首选CT，超声用于进一步检查，尤其是疑似urinomas（未能找到中文意思）的患者。 Acutepyelonephritis with increased cortical echogenicity and blurred delineation ofthe upper pole. 急性肾盂肾炎 皮质回声增强，肾上极轮廓不清。 Postoperativerenal failure with increased cortical echogenicity and kidney size. Biopsyshowed acute tubular necrosis. 术后肾功能衰竭，皮质回声增强，肾脏增大。活检显示急性肾小管坏死。 Renaltrauma with laceration of the lower pole and subcapsularfluid collection below the kidney. 肾损伤 肾下极裂伤伴包膜下积液。
Sonographyis the modality of choice for guidance when performing intervention in thekidney, whether it is kidney biopsy, percutaneous nephrostomy or abscessdrainage. Historically, thermal ablation of renal tumors is performed under CTguidance, as the risk of injuring neighboring intestines during the US-guidedprocedure was considered too high due to poor identification of the movingbowels [4,23]. However, recent guidelines for renal interventional US includeradiofrequency, microwave and cryoablation withUS as the ideal imaging guide [33,34]. 超声引导下肾穿刺适用于肾脏活检、经皮肾造口术、脓肿引流等。 由于难以识别肠管蠕动，超声引导下的操作容易伤及邻近肠子，所以以往的肾肿瘤消融治疗是在CT引导下进行。 然而，最近的肾超声介入指南认为射频、微波和冷冻消融术使用超声引导更合理。 (A)Percutaneous nephrostomy tube placed through a calyx in the lower pole of akidney with hydronephrosis. (B)The pigtail catheter is placed in the dilated calyx. Thetube in (A) and the pigtail in (B) are marked with white arrows. （A）经皮肾造瘘管通过肾盏到达肾下极积水处。 （B）导管被放置在扩张肾盏中。
CEUScan evaluate microvasculature, which color Doppler US is unable to detect. Inrenal US examination, CEUS can be used to differentiate tumor and pseudotumor,such as prominent columns of Bertin. Pseudotumorsenhance as adjacent renal tissue. The use of CEUS is recommended in specialcases to distinguish between cystic and hypovascularizedsolid lesions, to characterize complex cysts, abscesses, traumatic lesions andischemic lesions . Solid malignant tumors in the kidney do not exhibit specificenhancement patterns like some liver lesions, and no valid enhancement criteriabetween benign and malignant renal lesions have been proposed. However, CEUS isused in some patients after ablation of renal cell carcinoma to evaluatecontrast uptake in the treated area. 超声造影可以评估微血管。在肾脏超声检查时，超声造影可用于区分肿瘤和假性囊肿（如突出的肾柱）。假性囊肿可以增强相邻肾组织的回声。在特殊情况下，建议利用超声造影来区分囊肿和血管增生型实性病变，使复杂囊肿、脓肿、外伤性损伤和缺血性病变更容易区分。 肾脏实性恶性肿瘤不像肝脏病变那样，有特定的增强模式，良性和恶性肾损害没有一个增强的标准。不过，肾细胞癌消融后的患者可用超声造影评估治疗区域的造影剂摄取量。 Renalcell carcinoma successfully treated with thermal ablation, as no contrastenhancement is seen. 肾细胞癌热消融治疗成功，未见对比增强。 Unspecificcortical lesion on CT is confirmed cystic and benign with contrast-enhancedultrasound (CEUS) using image fusion. 非特异性皮质病灶 CT显示为囊肿 超声造影图像融合显示为良性病灶。
Elastography is aUS method to visualize the elasticity of tissue. Preliminary reports on US elastography usedon transplanted kidneys to evaluate cortical fibrosis have been publishedshowing promising results. 超声弹性成像技术让组织的弹性变得“可见”。弹性成像技术用来评估移植肾的皮质纤维化程度已经有了初步的报告，成果值得期待。 Strainelastography of anormal kidney. Red depicts soft areas, and blue depicts hard areas relative tothe entire elastographyimage. Note that the medulla is softer than the cortex. A color bar is shown tothe left of the image, where ‘S’ and ‘H’ denote soft and hard tissue,respectively. 正常肾脏的应变弹性 红为相对软区，蓝为相对硬区（髓质比皮质柔软）。 颜色条：S-软，H-硬
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