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The Resistive Index in Renal Doppler Sonography: Where Do We Stand?

Mitchell E. Tublin1, Ronald O. Bude2 and Joel F. Platt2

1 Department of Radiology, University of Pittsburgh School of Medicine, 200 Lothrop St., Pittsburgh, PA 15213.
2 Department of Radiology, University of Michigan Medical School, 130 Catherine Rd., M4101 MS1, Box 0624, Ann Arbor, MI 48109.



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Fig. 1. Normal resistive index in 25-year-old healthy woman. Color Doppler sonogram is used to identify inter-lobar artery (arrow); waveform is maximized using lowest pulse repetition frequency possible.

 


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Fig. 2A. 30-year-old man with acute left flank pain. Sonogram shows unobstructed right kidney and corresponding normal resistive index.

 


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Fig. 2B. 30-year-old man with acute left flank pain. Sonogram shows obstructed left kidney. Note mild collecting system dilatation, elevated left RI, and marked difference in RIs (0.12) between kidneys. (Reprinted with permission from [58])

 


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Fig. 3. Diagram of ex vivo pulsatile perfusion system. Perfusion pressures (systole and diastole) are adjusted by changing heights of reservoirs, and pulse rate is controlled by function generator. Flow (F) and pressure (P) are measured instantaneously upstream from renal artery using in-line probes. Doppler spectra are simultaneously obtained from perfused kidney using commercially available ultrasound platform. Temp = temperature. (Reprinted with permission from [94])

 


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Fig. 4. Diagram shows how ureteral pressure affects mean, systolic, and diastolic cross-sectional areas of renal arterioles. Area of compliant vessels is determined by transmural pressure (intraarterial pressure – interstitial pressure). Interstitial pressure is almost zero in absence of ureteral pressure (left half of diagram). During diastole, cross-sectional area of vessel is relatively large (B), and some additional distention occurs during systole (A). High ureteral pressures increase interstitial pressure (right half of diagram). In this setting, arteriole is almost occluded during diastole because transmural pressure is so low (D), but significant distention still occurs during systole (C). Although mean cross-sectional area is markedly smaller with high ureteral pressures (mean conductance of C and D, A and B), relative distention that occurs during systole is greater (conductance of A > B, but C >>D). These cyclic changes in cross-sectional area are underlying cause for parallel changes in total renal conductance (flow / pressure). (Reprinted with permission from [94])

 


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Fig. 5. Diagram shows how ureteral pressure affects systolic and diastolic blood flow in larger renal arteries typically insonated during clinical renal Doppler studies. Each section of figure shows Doppler gate in conduit (segmental or arcuate) artery, which branches into smaller compliant vessels downstream. Length of arrow in Doppler gate represents velocity of blood flow. As shown in Figure 4, changes in ureteral pressure (0 mm Hg in A and B; 60 mm Hg in C and D) significantly affect arteriolar cross-sectional areas and thus total blood flow volume. In less compliant, larger conduit arteries, these changes in blood flow are manifested as cyclic changes in blood velocity. Thus, relative increase in velocity that occurs at systole (measured using resistive index) is greater when ureteral pressure is elevated (velocity in A > B, but C >> D). (Reprinted with permission from [94])

 

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