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Transducer position
Fig. 2 Power Doppler US image of the both normal renal arteries.
Main renal arteries Abdominal transverse section
a
Fig. 4 Color Doppler imaging of the left renal artery and vein from
the left flank using the kidney as an acoustic window
Normal findings
When the origins of renal arteries are imaged with color
Doppler in the transverse position, the first segment of
the right renal artery has flow directed toward the
transducer, then represented in red color. Color change
is detected shortly after the origin, where the direction
of flow goes posteriorly. Most of the course of the ves-
b sels is then displayed in blue.
Fig. 3 a Color Doppler US image in oblique longitudinal section. If the origins of renal arteries are imaged in the ob-
Hypoplasia of the right renal artery. b Same patient. Correlative lique longitudinal section, right RA passes directly to-
conventional angiography ward the transducer from the aorta and is colored red,
whereas left RA courses away from the transducer and
is blue (Fig. 5).
An alternative method of imaging the origins of RA is On color Doppler examination, flow within the renal
the use of an oblique longitudinal approach with the pa- vein is opposite in color to that within the renal artery.
tient in a 45 right anterior oblique position (Fig. 1). The Power Doppler can delineate a better image of the
transducer should be placed in the right subcostal posi- proximal RA without the absence of flow in the arterial
tion to obtain longitudinal view of the right kidney. Then segments that run horizontal to the US beam, but with
the probe should be moved in a medial direction follow- loss of directional and velocity information. Power
ing the course of the right renal vein from the hilum to the Doppler provides superb visualization of the entire re-
inferior vena cava. The transducer is angled until the nal vascular tree from the main RA to the arcuate ar-
aorta, together with the origins of both RA, appears. The teries and beyond. The segmental renal branches lie
disadvantage of this approach is that only the origins of within the echogenic renal hilum. Interlobar arteries can
the vessels are shown. Nevertheless, this projection is be visualized lateral to the renal pyramids, and the arc-
best for determining whether accessory arteries, aplasia, uate vessels run behind the renal pyramids parallel to
or hypoplasia (Fig. 3) of the renal arteries are present. the renal cortex. With power Doppler several further
The left renal artery and vein also can be seen from generations of vessels (the interlobular arteries) are
the left flank, using the kidney itself as an acoustic win- seen radiating to the renal capsule (Fig. 6).
1905
Fig. 5 Color Doppler imaging of the both renal arteries and the Fig. 7 Spectral Doppler US image from the right renal artery in
aorta. Longitudinal section. Right renal artery shown as red, left normal subjects. Note small spike that occurs at the end of systolic
renal artery shown as blue rise. This feature is seen only in the normal main renal artery
a
Fig. 10 Spectral Doppler waveform from the stenotic area in the
right RA. Increased peak systolic velocities are seen
b
Fig. 9 a Power Doppler US image of the right renal artery with
echogenic plaque inside the vessel close to the origin. b Same pa-
tient. Correlative conventional angiography with the plaque in the
origin of the right RA
Fig. 11 Color Doppler imaging of the right RAS. Mosaic flow is
seen within the stenotic area
a criterion for RAS 50 %, and > 1.8 m/s for stenosis
60 % (Fig. 10). Comparison of the velocities in the aorta
with those in the renal arteries, the so-called renal/aortic Distal criteria analyze the flow changes induced by
ratio (RAR), is also helpful. A PSV in the renal artery the stenosis at the level of intrarenal vessels. Patients
three times higher than the aortic PSV indicates the with severe renal artery stenosis commonly present with
presence of RAS [16]. The use of the ratio (RAR) in- pathologic intrarenal signals, the so-called tardus-par-
stead of the absolute peak systolic value is preferable vus waveform, first described by Handa et al. [17]. Tar-
since hypertension itself can cause an increase of peak dus means slow and late and parvus means small and
systolic flow velocities within all vessels of the hyper- little. Tardus refers to the fact that systolic acceleration
tensive patient. The second criterion is the presence of of the waveform is slowed, with consequent increase in
poststenotic turbulences; these are seen as a widening of time to reach the systolic peak. Parvus refers to the fact
the Doppler trace at spectral analysis of signals at the that the systolic peak is of low height, indicating slowed
stenosis and as a mosaic color pattern on the color velocity (Fig. 12). Poststenotic systolic peak are round-
Doppler image (Fig. 11). ed with lengthened systolic rise time (or slow systolic
1908
Table 3 Criteria for RAS. (From [29]). PSV peak systolic velocity; Doppler signals over time after intravenous injection of
RAR renal/aortic ratio; AT acceleration time; AI acceleration; RI a bolus of contrast medium. This technique produces
resistive index
time±intensity curves, which, in renal artery stenosis,
Main RA have area under the curve larger than in normal kidneys
PSV in stenotic area > 1.8 m/s [34]. In severe stenosis, furthermore, there is also a de-
RAR > 3.0
lay in the wash-in phase of the curve. At present, how-
Intrarenal arteries ever, only preliminary results have been presented in
ESP Absent
the literature, and further studies are needed before the
AT > 0.07 s
AI < 3 m/s introduction of this technique in clinical practice.
RI > 0.8
DRI (left±right) > 5%
Renal vein thrombosis
Renal vein thrombosis may occur in up to 40 % in dehy-
sory renal arteries are usually missed on Doppler stud- drated or septic infants [35]. In native kidneys, renal vein
ies, and stenosis of these may also cause hypertension. thrombosis starts in small intrarenal veins in situations of
Also, Doppler studies may be insensitive in patients faulty coagulation mechanism and slowed flow [36]. The
with mild stenosis; thus, the role of Doppler sonography post-glomerular circulation, because of slow flow, is par-
as a screening test in hypertensive patients remains ticularly prone to thrombosis. In adults it most common-
controversial. At present, its use cannot be separated ly appears in association with renal disease including
from a careful clinical evaluation of the patient popula- glomerulonephritis, systemic lupus erythematosus, di-
tion. Given its technical difficulties, it has to be em- abetus mellitus, nephrotic syndrome, in severe hypo-
ployed in patients well selected based on clinical criteria volemic shock, and following kidney transplantation.
of high probability of having RAS. The US features are non-specific, and only renal en-
Ultrasound contrast agents have recently added new largement, with decreased echogenicity in the early
possibilities to color and duplex Doppler in the detection stages followed by an increase in cortical reflectivity can
of RAS [30, 31]. They have been shown to increase the be detected [37]. Doppler US cannot accurately diagnose
percentage of diagnostic examinations in analyses of thromboses of intraparenchymal veins. The presence of
main renal arteries [30]. With echo enhancers a renewal venous Doppler signals within the kidney or renal vein,
of interest in Doppler studies of the main renal arteries is in fact, does not exclude the diagnosis of a thrombosis
occurring. Ultrasound contrast agents increase the in- involving only one of the many intraparenchymal veins.
tensity of the Doppler signals, thus producing more rapid In fact, although in acute renal vein thrombosis, the
and complete visualization of the intrarenal and extra- whole kidney is underperfused, and although only arte-
renal arteries [29]. Contrast agents have application in rial signals can be seen at the renal hilum, it must be re-
cases where the Doppler signal is difficult to obtain, ei- membered that venous collaterals develop rapidly, and
ther because of signal attenuation by overlying tissue or when this happens venous signals are re-established.
because of a weak signal [12]. Missouris et al. [32] suggest Then, the presence of parenchymal venous flow does not
that renal duplex scanning using contrast enhancement is exclude RVT, as collateral flow develops very quickly,
a promising new non-invasive technique in screening particularly in children (Fig. 13) [38]. Color Doppler can
patients with suspected RAS. Contrast enhancement be accurate for diagnosing chronic renal vein thrombosis
produces more reproducible spectral waveforms, im- when the main renal vein can be directly visualized, and
proves accuracy, and halves the examination time [32]. A flow signals cannot be detected in it [38].
recent study by Claudon et al. [33] showed that the num- Renal vein thrombosis can be caused also from tu-
ber of examinations with successful results increased mor involvement in patients with renal cell carcinoma
following enhanced Doppler US examination compared (RCC). Color Doppler sonography is accurate in dem-
with nonenhanced Doppler US, including patients with onstrating tumor thrombus in the renal veins. The US
obesity or renal dysfunction. Moreover, the agreement vascular features include distension of the renal vein,
between US data and angiography in RAS was higher full of echogenic material (Fig. 14). The presence of ar-
with enhanced Doppler US. They have shown that con- terial Doppler signals within the thrombus allows un-
trast media decrease examination time but do not cause equivocal demonstration of tumor involvement of the
an increase in sensitivity [33]. vessel. In patients with renal transplant, with complete
Contrast media for US do not undergo renal filtra- thrombosis of the veins of the allograft, reduction of di-
tion or tubular excretion and can be, on the whole, con- astolic flow in RA and reversal of flow in diastole with
sidered as purely vascular tracers. A new interesting distended renal vein and absence of flow signals from
application of these agents in suspected RAS is quanti- the renal vein have been reported as pathognomonic
fication of the renal enhancement of color or power signs of renal vein thrombosis [39].
1910
Fig. 13 Chronic thrombosis of the right renal vein. Absence of Fig. 15 Color Doppler imaging of the abdominal infrarenal aneu-
flow in the main right renal vein. Collateral flow is clearly seen rysm. Aneurysm arises below the origins of both renal arteries
Aneurysms
Aneurysms due to atherosclerosis usually occur in the
infrarenal aorta and common iliac arteries; however,
they are also found in the renal arteries. Most renal ar-
tery aneurysms have been found in persons 50±70 years
of age. Renal artery aneurysms can cause rupture,
thrombosis, embolization, and dissection [42]. Color
Doppler US provides an effective, non-invasive means
of diagnosing renal artery aneurysm. Aneurysms may
be identified along the course of the main renal artery as
an outpouching containing color flow. Slow velocities
and a whirling pattern of flow can usually be observed
on Doppler studies.
Color Doppler US can provide a quick, easy way in
demonstration of aneurysmal dilatations of the vascular
wall in the abdominal aorta. Most fusiform and saccular
aneurysms of the aorta arise below the level of renal ar-
Fig. 14 Power Doppler US image of the thrombosed right renal teries, but it is nevertheless important to determine
vein whether the renal vessels are involved, since this alters
patient management. Aortic dissection may extend into
a renal artery, thus interrupting renal blood flow. Scan-
In very lean, but otherwise healthy subjects, the left ning along the longitudinal approach is the best way to
renal vein can become compressed between the aorta demonstrate the relationships between the aneurysm
and the superior mesenteric artery, resulting in the so- and RA (Fig. 15).
called nutcracker syndrome (renal vein entrapment
syndrome) [40]. Kim et al. proposed that a cut-off value
of greater than 5.0 for the ratio of antero-posterior di-
Arteriovenous fistulas
ameter and the ratio of peak velocity (both the AP di-
ameter and PV being measured at hilar and aorto-mes- Both congenital and postbiopsy renal AV fistulae can be
enteric sites of the left renal vein) be used as a criterion diagnosed on color Doppler examination. The most fre-
in diagnosing nutcracker syndrome [41]. quent cause of AV fistula in both the native and trans-
planted kidney is complication of percutaneous biopsy
[43]. Small fistulas are not visible by conventional US,
1911
a
Fig. 16 Arteriovenous postbiopsy fistula of the kidney. Spectral
Doppler waveform shows low-resistance afferent artery spectrum.
(Courtesy of L. E. Derchi, Genova)
Renal allografts
The examination technique for renal allografts is much due to possible stenosis and occlusions. Using superfi-
easier than that for native kidneys, due to the superficial cial probes and Power Doppler mode, flow within the
location of the transplanted organ. The examination of cortical region of the whole kidney should be studied.
the transplanted kidney should be performed using su- Intrarenal resistance indices (RI, PI) should be sampled.
perficial 7.5-MHz probes to study cortical perfusion and Arteriovenous fistula and false aneurysms could be
abdominal convex 3.5-MHz probes for direct visualiza- found after biopsy in transplanted kidney
tion of the deeper structures such as transplanted artery In normal transplants the values of RI is less than 0.71,
and vein. and shows a slight decrease toward the periphery. A re-
The allograft vascular imaging protocol should in- duced diastolic flow velocity associated with an increase
clude visualization of the anastomotic region to exclude in intrarenal resistance index can be detected in acute
vascular stenosis, anastomotic aneurysms, or false an- and chronic rejection reactions, urinary obstruction, ar-
eurysms. Also accurate detection of the course and flow teriosclerosis of the vasculature, and acute tubular ne-
in the transplanted artery and vein should be performed crosis [45, 46, 47]. The significance of the changes in RI
1912
a a
b
Fig. 21 a A 3D US angiography of the right renal arteries and
aorta. Accessory renal artery is clearly seen. b Same patient: cor-
relative conventional angiography
b
Fig. 20 a A 3D US angiography of the right kidney. Maximum in- the B-mode volumetric data. Combination with contrast
tensity projection image demonstrates accessory renal artery. b A agents provides the potential to image the whole vascu-
3D volume-rendering image of the left kidney. Accessory left renal lar renal network and, through special measurement
artery
technique (Flash Echo), to estimate vascular volume
and transit time, parameters which relate directly to tis-
sue perfusion (Fig. 18).
In clinical practice, the enhanced US signal provided One of the promising and rapidly developing tech-
by contrast agents can reduce the number of technically niques is three-dimensional US angiography [63, 64, 65,
nondiagnostic cases, as well as the number of false-neg- 66, 67]. Three-dimensional US can overcome some
ative results. drawbacks of 2D US and can provide the angiogram-like
With additional use of contrast agents and phase in- images of both, renal arteries and the entire aorta
version harmonic imaging the whole course of the renal (Fig. 19). Careful freehand scanning with a smooth, lin-
arteries could be imaged without motion or aliasing ar- ear translation, or sector sweep, can acquire 3D data sets
tifacts. Harmonic ultrasound with contrast agents added in a single breath-hold. Different approaches can be used
blood flow morphology maps within the background of to acquire 3D data sets of renal vessel: anterior or ante-
1914
rolateral, for evaluation of both RA and entire aorta; and of accessory renal arteries [68]. Three-dimensional US
coronal for visualization of renal vasculature, main RA, angiography can enhance the possibility of 2D US in
and entire aorta. After acquisition of 3D data, postpro- evaluation of accessory renal arteries. An angiogram-
cessing is performed using maximum and minimum in- like image of 3D US angiography is becoming an excel-
tensity projections (MIP or MinIP) to obtain angiogram- lent alternative to conventional angiography (Fig. 21).
like 3D images for further analysis (Fig. 20). We believe This method is promising as the primary study for ac-
that 3D US angiography has the potential to become ex- cessory RA and for determining the relationships of the
cellent for screening in evaluation of accessory renal ar- origins of the RA to abdominal aneurysms, and can be
teries especially in children, young adults, patients with the preferred technique for patients with a contraindi-
renal failure, allergy to iodinated contrast agents, fear of cation to conventional angiography.
ionizing radiation, or arterial catheterization. Magnetic Further developments of computing power, wide-
resonance angiography, with its high cost and less avail- spread diffusion of state-of-the-art US machines, ma-
ability, should be reserved for problem cases. trix-array transducers, harmonic imaging techniques
It is known that accessory renal arteries are found and reconstruction algorithms for surface and volume
frequently. Previous researchers have reported poor rendering will lead real-time 3D US scans to become
ability of color Doppler US to depict accessory renal routine in clinical practice.
arteries [15]. Contrast agents and harmonic imaging
may have a role to play in future and increase the sen- Acknowledgements I am grateful for all the help provided by L.
sitivity and specificity of color Doppler US in detection Derchi during preparation of this article.
References
1. Bakker J, Beek FJ, Beutler JJ et al. 8. Zoller WG, Hermans H, Bogner JR 16. House MK, Dowling RJ, King P et al.
(1998) Renal artery stenosis and acces- et al. (1990) Duplex sonography in the (1999) Using Doppler sonography to
sory renal arteries: accuracy of detec- diagnosis of renovascular hypertension. reveal renal artery stenosis: an evalua-
tion and visualization with gadolinium- Klin Wochenschr 68: 830±834 tion of the optimal imaging parameters.
enhanced breath-hold MR angiogra- 9. Postma CT, van Aalen J, de Boo T et al. Am J Roentgenol 173: 761±765
phy. Radiology 207: 497±504 (1992) Doppler US scanning in the de- 17. Handa N, Fukunaga R, Uehara A et al.
2. Korst MB, Joosten FB, Postma CT et al. tection of renal artery stenosis in hy- (1986) Echo-Doppler velocimeter in
(2000) Accuracy of normal-dose Con- pertensive patients. Br J Radiol 65: the diagnosis of hypertensive patients:
trast-enhanced MR angiography in as- 857±860 the renal artery Doppler technique. Ul-
sessing renal artery stenosis and acces- 10. Robertson R, Murphy A, Dubbins PA trasound Med Biol 12: 945±952
sory renal artery stenosis and accessory (1988) Renal artery stenosis: the use of 18. Patriquin HB, Lafortune M, Jequeier J
renal arteries. Am J Roentgenol 174: duplex ultrasound as a screening tech- et al. (1992) Stenosis of the renal artery:
629±634 nique. Br J Radiol 61: 196±201 assessment with Doppler sonography.
3. Neri E, Caramella D, Bisogni C et al. 11. Berland LL, Koslin DB, Routh WD Radiology 184: 479±485
(1999) Detection of accessory renal ar- et al. (1990) Renal artery stenosis: pro- 19. Lafortune M, Patriquin H, Demeule E
teries with virtual vascular endoscopy spective evaluation of diagnosis with et al. (1992) Renal arterial stenosis: slo-
of the aorta. Cardiovasc Intervent Ra- color duplex US compared with angi- wed systole in the downstream circula-
diol 22: 1±6 ography. Work in progress. Radiology tion: experimental study in dogs. Radi-
4. Beregi J-P, Elkohen M, Deklunder G 174: 421±424 ology 184: 475±478
et al. (1996) Helical CT angiography 12. Cosgrove D (1997) Why do we need 20. Bude RO, Rubin JM, Platt JF et al.
compared with arteriography in the de- contrast agents for ultrasound? Clin (1990) Pulsus tardus: its cause and po-
tection of renal artery stenosis. Am J Radiol 51 (Suppl):1±4 tential limitations in detection of arte-
Roentgenol 167: 495±501 13. Debatin JF, Spritzer CE, Grist TM et al rial stenosis. Radiology 134: 779±784
5. Platt JF, Rubin JM, Ellis JH (1989) (1991) Imaging of the renal arteries: 21. Bude RO, Rubin JM (1995) Detection
Distinction between obstructive and value of MR angiography. Am J of renal artery stenosis with Doppler
nonobstructive pyelocaliectasis with Roentgenol 157: 981±990 sonography: it is more complicated than
duplex Doppler sonography. Am J 14. Soulez G, Oliva V, Turpin S et al. (2000) originally thought. Radiology 196:
Roentgenol 153: 997±1000 Imaging of renovascular hypertension: 612±613
6. McGahan JP, Goldberg BB (1998) Di- respective values of renal scintigraphy, 22. Stavros AT, Parker SH, Yakes WF, et al.
agnostic ultrasound. A logical ap- renal Doppler US, and MR angiogra- (1992) Segmental stenosis of the renal
proach. Lippincott Raven, Philadel- phy. Radiographics 20: 1355±1368 artery: pattern recognition of tardus
phia, pp 1288: 793 15. Cobelli F de, Venturini M, Vanzulli A and parvus abnormalities with duplex
7. Krumme B, Kirschner T, Gondolf D et al. (2000) Renal arterial stenosis: sonography. Radiology 184: 487±492
et al. (1994) Altersabhanigkeit des in- prospective comparison of color Dop- 23. Rene PC, Oliva VL, Bui BT et al.
trarenalen Resistance Index (RI) bei pler ultrasound and breath-hold, three- (1995) Renal artery stenosis: evaluation
essentiellen Hypertonikern. Bildge- dimensional, dynamic, gadolinium-en- of Doppler US after inhibition of an-
bung Imaging (Suppl) 2: 55 hanced MR angiography. Radiology giotensin-converting enzyme with Cap-
214: 373±380 topril. Radiology 196: 675±679
1915
24. Kaplan-Pavlovic S, Nadja C (1998) 39. Baxter GM, Morley P, Dall B (1991) 54. Baxter GM, Ireland H, Moss J et al.
Captopril renography and duplex Dop- Acute renal vein thrombosis in renal (1995) Color Doppler US in renal
pler sonography in the diagnosis of ren- allografts: new Doppler ultrasonic find- transplant artery stenosis: which Dop-
ovascular hypertension. Nephrol Dial ings. Clin Radiol 43: 125 pler index? Clin Radiol 50: 618±622
Transplant 13: 313±317 40. Wendel RG, Crawford ED, Hehman 55. Grenier N, Douws C, Morel D et al.
25. Krumme B, Blum U, Schwertferger E KN et al. (1980) The nutcracker phe- (1991) Detection of vascular complica-
et al. (1996) Diagnosis of renovascular nomenon: an unusual cause for renal tions in renal allografts with color Dop-
disease by intra- and extrarenal Dop- bleeding of unknown origin. J Urol 123: pler flow imaging. Radiology 178:
pler scanning. Kidney Int 50: 1288±1296 761±763 217±223
26. Kliewer MA, Tupler RH, Carroll BA 41. Kim SH, Cho SW, Kim HD et al. (1996) 56. Trillaud H, Merville P, Linh PTL et al.
et al. (1993) Renal artery stenosis: Nutcracker syndrome: diagnosis with (1998) Color Doppler sonography in
analysis of Doppler waveform parame- Doppler US. Radiology 198: 93±97 early renal transplantation follow-up:
ters and tardus-parvus pattern. Radiol- 42. Dong Q, Schoenberg SO, Carlos RC resistive index measurements versus
ogy 189: 779±787 et al. (1999) Diagnosis of renal vascular power Doppler sonography. Am J
27. Schwerk WB, Restrepo IK, Stellwaag disease with MR Angiography. Radio- Roentgenol 171: 1611±1615
M et al. (1994) Renal artery stenosis graphics 129: 1535±1554 57. Krumme B (1994) Farbkodierte Du-
grading with image-directed Doppler 43. Middleton WD, Kellman GM, Melson plexsonographie in der Diagnostic von
US evaluation of renal resistive index. GL et al. (1989) Postbiopsy renal trans- Nierenarterienstenosen nach allogener
Radiology 190: 785±790 plant arteriovenous fistulas: color Dop- Nierentransplantation. In: Keller E,
28. Halpern EJ, Deane CR, Needleman L pler US characteristics. Radiology 171: Krumme B (eds) Farbkodierte Duplex-
et al. (1995) Normal renal artery spec- 253±257 sonographie in der Nephrologie.
tral Doppler waveform: a closer look. 44. Takebayashi S, Aida N, Matsui K Springer, Berlin Heidelberg New York
Radiology 196: 667±673 (1991) Arteriovenous malformations of 58. Huber S, Steinbach R, Sommer O et al.
29. Lavopierre AM, Dowling RJ, Little AF the kidneys: diagnosis and follow-up (2000) Contrast-enhanced power Dop-
et al. (2000) Ultrasound of the renal with color Doppler sonography in 6 pa- pler harmonic imaging: influence on vi-
vasculature. Ultrasound Quarterly 16: tients. Am J Roentgenol 157: 991±995 sualization of renal vasculature. Ultra-
123±132 45. Taylor KJW, Morse SS, Rigsby CM sound Med Biol 26: 1109±1115
30. Melany ML, Grant EG (1997) Clinical (1987) Vascular complications in renal 59. Sehgal CM, Arger PH, Pugh CR et al.
experience with sonographic contrast allografts. Detection with Dupplex (1998) Comparison of power Doppler
agents. Semin Ultrasound CT MR 18: Doppler US. Radiology 162: 31±38 and B-scan sonography for renal imag-
3±12 46. Harris DC, Antico V, Allen S et al. ing using a sonographic contrast agent.
31. Dowling RJ, House MK, King PM et al. (1989) Doppler assessment in renal J Ultrasound Med 17: 751±756
(1999) Contrast-enhanced Doppler ul- transplantation. Transplant Proc 21: 60. Martinoli C, Crespi G, Bertolotto M
trasound for renal artery stenosis. Aus- 1895±1896 et al. (1996) Interlobular vasculature in
tralas Radiol 43: 206±209 47. Fluckiger F, Steiner S, Horn M et al. renal transplants: a Power Doppler US
32. Missouris CG, Allen MC, Balen FG (1990) Farbkodierte Dupplexsonogra- study with MR correlation. Radiology
et al. (1996) Non-invasive screening for phie und Widerstandsindex bei Nieren- 200: 111±117
renal artery stenosis with ultrasound transplantation mit Dysfunktion. Fort- 61. Claudon M, Grenier N (1997) Technol-
contrast enhancement. J Hypertens 14: schr Rontgenstr 153: 692±697 ogy advances in renal sonography. Di-
519±524 48. Mallek R, Mostbeck G, Kain R et al. agn Imaging Europe:31±37
33. Claudon M, Plouin PF, Baxter GM (1990) Vaskulare Nierentransplantat- 62. Clautice-Engle T, Jeffrey R (1997) Re-
et al. (2000) Renal arteries in patients at abstossung ± Ist eine duplexsonogra- nal hypoperfusion: value of power
risk of renal arterial stenosis: multicen- phische Diagnose moglich? Fortschr Doppler imaging. Am J Roentgenol
ter evaluation of the echo-enhancer SH Rontgenstr 152: 283±286 168: 1227±1231
U 508A at Color an spectral Doppler 49. Meyer M, Paushter D, Steinmuller D 63. Keberle M, Jenett M, Beissert M et al.
US. Radiology 214: 739±746 (1990) The use of duplex Doppler ul- (2000) Three-dimensional power Dop-
34. Lencioni RA, Pinto S, Napoli V et al. trasonography to evaluate renal al- pler sonography in screening for carotid
(1999) Detection of renal artery stenos- lograft dysfunction. Transplantation 50: artery disease. J Clin Ultrasound 28:
is by time±intensity analysis of renal 974±978 441±451
enhancement curve at harmonic power 50. Claudon M, Blum AG, Martin Bertaux 64. Lees W (1999) Three- and 4-dimen-
Doppler imaging: a pilot clinical study. A et al. (1995) Kidney transplantation sional ultrasound imaging. Med Mundi
Radiology 213: 363±364 follow-up: value of power Doppler l43: 23±30
35. Clark RA, Colley DP (1980) Radiolog- sonography. Radiology 197: 496 65. Merz E (1997) Current technical possi-
ical evaluation of renal vein thrombosis. 51. Leichtman A, Sorrell K, Wombolt D bilities of 3D ultrasound in gynaecology
CRC Crit Rev Diagn Imaging 13: et al. (1989) Duplex imaging of the re- and obstetrics. Ultraschall Med 18:
337±344 nal transplant. Transplant Proc 21: 190±195
36. Gonzales R, Schwarts S, Sheldon C 3607±3610 66. Shields LE, Lowery C, Deforge C et al.
et al. (1982) Bilateral renal vein throm- 52. Deane C, Cairns H, Walters H et al. (1998) 3-Scape real time 3D imaging for
bosis in infancy and childhood. Urol (1990) Diagnosis of renal transplant ar- ultrasound. Electromedica 66: 84±88
Clin Am 9: 279±283 tery stenosis by color Doppler ultra- 67. Weismann N Ä (2000) 3D expands hori-
37. Scoutt LM, Brown JM, Hammers LW sonography. Transplant Proc 22: 1395 zons in daily clinical practice. Diagn
(1997) Color Doppler evaluation of the 53. Alvarez G, Gonzalez-Molina M, Ca- Imaging (Suppl):12±15
native kidney. Appl Radiol:9±23 bello M et al. (1991) Pulsed and contin- 68. Sandrick K (2000) 3D ultrasound: more
38. Rosenfeld AT, Zeeman RK, Kronen JJ uous Doppler evaluation of renal dys- than just a pretty picture. Diagn Imag-
et al. (1980) Ultrasound in experimen- function after kidney transplantation. ing (Suppl):2±8
tal and clinical renal vein thrombosis. Eur J Radiol 12: 108±112
Radiology 137: 735