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Doppler ultrasound of the kidneys
Normal anatomy of the kidney
• :
Renal parenchyma
cortex
Renal sinus:
arteries,veins, lymphatic,
collecting system
Renal h...
Anatomy of renal arteries
• RRA: Usually passes posterior to inferior vena cava
• LRA: Usually courses posterior to left r...
Arterial blood supply to the Kidney
Segmental artery
Apical, upper, middle, lower, posterior
Interlobular artery
Between r...
Left-sided IVC
Normal anatomy of
IVC
Anomalous left-sided IVC
Indications of Renal
Doppler Ultrasound
1-Renal Artery Stenosis
2-Renal Artery Thrombosis
3-Renal Artery Emboli
4-Renal vein thrombosis
5-Aneurysm & Pseudo Aneury...
Gray scale imaging first
Kidneys
renal length
Echogenicity of renal cortex
Thickness of renal cortex
Masses
hydronephrosis...
Normal kidney
Longitudinal section Cross section
.
Renal capsule: echogenic line
Renal parenchyma: outer cortex & inner me...
Renal Dimensions
Length: 9 – 14 cm (longitudinal section)
Width: 4 – 6 cm (cross section)
Depth: 4 – 6 cm (cross section)
...
Classification of renal parenchymal echogenicity
4 types based of US appearance
Hypoechoic compared to liver
Isoechoic com...
Kidney parenchyma compared to liver
parenchyma
Hypoechoic Isoechoic
Hyperechoic
Congenital Normal Variant
• Dromedary Hump
• Fetal Lobulation
• Prominent column of bertin
• Junctional Parenchymal defect...
Dromedary hump Fetal lobulation
Common renal variation
Focal bulge on lateral border of left kidney
Result from adaptation...
Sites for pulsed Doppler of renal arteries
• Aorta
• Ostium of main renal artery
• Trunk of main renal artery
• Hilum of k...
Transverse scan with probe angulations
Main renal arteries
Normal right renal artery
Transverse gray scale image
Right main renal artery
Transverse color Doppler image
Right main re...
Normal left renal artery
Gray scale image Color Doppler image
Proximal main left renal artery Proximal main left renal art...
Axial scan in left lateral decubitus
Using right kidney as acoustic window
Right main renal artery & vein
Color Doppler US...
Axial scan in right lateral decubitus
Using left kidney as acoustic window
Schematic drawing
Left main renal artery & vein...
Pulsed Doppler of renal veins
Right renal vein
Resembles pulsed Doppler of IVC
Triphasic waveform
Left renal vein
Little m...
Limits in visualization of main renal
arteries
• Obesity
• Overlying bowel gas
• Dyspnea
• Shadowing from arterial calcifi...
Angle of insonation
Difficulty in case of tortuous or curved renal artery
Correct angleIncorrect angle
Adjustment of Doppler control
Low flow settings
• Lowest pulse repetition frequency without
aliasing
• Small color box
• G...
Normal segmental & interlobar renal arteries
Normal segmental renal arteries (long arrows)
Color Doppler image of the kidn...
Normal kidney
Power Doppler
• Increases sensitivity to low flow
• Less angle-dependent
• Good visualization of the entire
...
Normal pulse Doppler waveform
Renal segmental artery
• Sharp systolic upstroke
• Low resistance waveform
• Continuous forw...
Early systolic notch
Some normal waveforms have early systolic notch
Measuring to point of PSV results in
prolonged AT & A...
Extrasystole
Correct RI calculated in normal sinusoidal rhythm
Spectral Doppler of renal arteries
Normal values
• PSV < 180 cm/sec
• Renal Aortic Ratio (RAR) < 3
• Resistive index (RI) ...
Why we want permanent
everything
in a temporary life.
Doppler ultrasound of the Kidney
Doppler ultrasound of the Kidney
Doppler ultrasound of the Kidney
Doppler ultrasound of the Kidney
Doppler ultrasound of the Kidney
Doppler ultrasound of the Kidney
Doppler ultrasound of the Kidney
Doppler ultrasound of the Kidney
Doppler ultrasound of the Kidney
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Doppler ultrasound of the Kidney

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Doppler ultrasound of the Kidney

  1. 1. Doppler ultrasound of the kidneys
  2. 2. Normal anatomy of the kidney • : Renal parenchyma cortex Renal sinus: arteries,veins, lymphatic, collecting system Renal hilum: Concave, renal sinus
  3. 3. Anatomy of renal arteries • RRA: Usually passes posterior to inferior vena cava • LRA: Usually courses posterior to left renal vein
  4. 4. Arterial blood supply to the Kidney Segmental artery Apical, upper, middle, lower, posterior Interlobular artery Between renal pyramids Glomerular arteriole Main renal artery Arcuate artery Between cortex & medulla
  5. 5. Left-sided IVC Normal anatomy of IVC Anomalous left-sided IVC
  6. 6. Indications of Renal Doppler Ultrasound
  7. 7. 1-Renal Artery Stenosis 2-Renal Artery Thrombosis 3-Renal Artery Emboli 4-Renal vein thrombosis 5-Aneurysm & Pseudo Aneurysm 6-Arterio-venous communications 7-Renal mass 8-Hypertension in Young age
  8. 8. Gray scale imaging first Kidneys renal length Echogenicity of renal cortex Thickness of renal cortex Masses hydronephrosis renal calculi Aorta Plaque – thrombus – dissection – aneurysm
  9. 9. Normal kidney Longitudinal section Cross section . Renal capsule: echogenic line Renal parenchyma: outer cortex & inner medulla pyramid Central sinus complex: high echogenicity (vessels, fat, fibrous tissue)
  10. 10. Renal Dimensions Length: 9 – 14 cm (longitudinal section) Width: 4 – 6 cm (cross section) Depth: 4 – 6 cm (cross section) Appropriate renal volume 231 ± 50 ml Cortical thickness: 8 – 10 mm Parenchymal thickness: 14 – 18 mm
  11. 11. Classification of renal parenchymal echogenicity 4 types based of US appearance Hypoechoic compared to liver Isoechoic compared to liver Hyperechoic compared to liver Isoechoic to renal sinus Normal Normal Pathological Pathological Grade 0 Grade I Grade II Grade III
  12. 12. Kidney parenchyma compared to liver parenchyma Hypoechoic Isoechoic Hyperechoic
  13. 13. Congenital Normal Variant • Dromedary Hump • Fetal Lobulation • Prominent column of bertin • Junctional Parenchymal defect • Hypoechoic renal sinus
  14. 14. Dromedary hump Fetal lobulation Common renal variation Focal bulge on lateral border of left kidney Result from adaptation of renal surface to adjacent spleen Easily differentiated from renal mass by Doppler
  15. 15. Sites for pulsed Doppler of renal arteries • Aorta • Ostium of main renal artery • Trunk of main renal artery • Hilum of kidney • Upper pole of kidney • Middle pole of kidney • Lower pole of kidney
  16. 16. Transverse scan with probe angulations Main renal arteries
  17. 17. Normal right renal artery Transverse gray scale image Right main renal artery Transverse color Doppler image Right main renal artery
  18. 18. Normal left renal artery Gray scale image Color Doppler image Proximal main left renal artery Proximal main left renal artery
  19. 19. Axial scan in left lateral decubitus Using right kidney as acoustic window Right main renal artery & vein Color Doppler USSchematic drawing
  20. 20. Axial scan in right lateral decubitus Using left kidney as acoustic window Schematic drawing Left main renal artery & vein Color Doppler US Zubarev AV. Eur Radiol 2001 ; 11 : 1902 – 1915.
  21. 21. Pulsed Doppler of renal veins Right renal vein Resembles pulsed Doppler of IVC Triphasic waveform Left renal vein Little modulation Wall artifact due to systolic peak
  22. 22. Limits in visualization of main renal arteries • Obesity • Overlying bowel gas • Dyspnea • Shadowing from arterial calcifications • Cardiac arrhythmias • Poor angle of Doppler insonation • Accessory renal arteries (small size) Expert sonographers detect 80 – 90% of main RA CEUS improves success rate to 95%
  23. 23. Angle of insonation Difficulty in case of tortuous or curved renal artery Correct angleIncorrect angle
  24. 24. Adjustment of Doppler control Low flow settings • Lowest pulse repetition frequency without aliasing • Small color box • Greatest gain without background noise • Lowest wall filter • High color priority
  25. 25. Normal segmental & interlobar renal arteries Normal segmental renal arteries (long arrows) Color Doppler image of the kidney Moukaddam H et al. Ultrasound Clin 2007 ; 2 : 455 – 475. Normal inter-lobar renal arteries (short arrows)
  26. 26. Normal kidney Power Doppler • Increases sensitivity to low flow • Less angle-dependent • Good visualization of the entire renal vascular tree Zubarev AV. Eur Radiol 2001 ; 11 : 1902 – 1915.
  27. 27. Normal pulse Doppler waveform Renal segmental artery • Sharp systolic upstroke • Low resistance waveform • Continuous forward diastolic flow
  28. 28. Early systolic notch Some normal waveforms have early systolic notch Measuring to point of PSV results in prolonged AT & AI Excellent negative predictive value of stenosis > 60%
  29. 29. Extrasystole Correct RI calculated in normal sinusoidal rhythm
  30. 30. Spectral Doppler of renal arteries Normal values • PSV < 180 cm/sec • Renal Aortic Ratio (RAR) < 3 • Resistive index (RI) < 0.70 • ∆ RI (right – left) < 0.05 • Acceleration Time (AT) < 0.07 sec • Acceleration Index (AI) > 3.5 m/s2
  31. 31. Why we want permanent everything in a temporary life.

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