文献翻译：肾脏声像图综述（节选）
Ultrasonography of the Kidney：A Pictorial Review
文献翻译：肾脏声像图综述（节选）
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。
3. Findings in the Normal Kidney
Normal adult kidney. Measurement of kidney length on the US image is illustrated by ‘+’ and a dashed line.
* Column of Bertin; ** pyramid;*** cortex;**** sinus.
正常成人肾脏结构（下图）
“+”表示肾脏的测量
* 肾柱；** 肾锥；*** 肾皮质；**** 肾窦。
Normal pediatric kidney.
* Column of Bertin;** pyramid; *** cortex;**** sinus.
正常小儿肾脏结构（下图）
* 肾柱；** 肾锥；*** 肾皮质；**** 肾窦。
Cortical thickness should be estimated from the base of the pyramid and is generally 7–10 mm.
If the pyramids are difficult to differentiate, the parenchymal thickness can be measured instead and should be 15–20 mm.
测量皮质厚度的时候，应从肾锥的基部开始测，通常为7-10毫米。
如果肾锥边界不清，可以改为测量肾实质厚度，通常为15-20毫米。
Measures of the kidney.
L = length.
P = parenchymal thickness.
C = cortical thickness.
肾脏测量（下图）
L = 长径.
P = 肾实质厚度.
C = 肾皮质厚度.
Cystic Renal Masses
Masses are seen as a distortion of the normal renal architecture. Most renal masses are simple cortical cysts with a round appearance and a smooth thin capsule encompassing anechoic fluid. The simple cyst is a benign lesion, which does not require further evaluation.
肾囊肿（下图）
单纯囊肿形态较圆，并有薄膜包绕，随年龄增长发生率也增高，一般为良性，不需要进一步评估。
Complex cysts can have membranes dividing the fluid-filled center with internal echoes, calcifications or irregular thickened walls. The complex cyst can be further evaluated with Doppler US, and for Bosniak classification and follow-up of complex cysts, either contrast-enhanced ultrasound (CEUS) or contrast-enhanced computed tomography (CT) are used (Figure 6) [14,15]. The Bosniak classification is divided into four groups going from I, corresponding to a simple cyst, to IV, corresponding to a cyst with solid parts and an 85%–100% risk of malignancy [13,16].
复杂囊肿（下图）常有分隔、钙化或不规则增厚的囊壁，应行超声造影或增强CT进一步评估。Bosniak分型：单纯囊肿为I型，而实质回声的囊肿则为IV型（恶性肿瘤的风险为85％-100％）。
In polycystic kidney disease, multiple cysts of varying size in close contact with each other are seen filling virtually the entire renal region. In advanced stages of this disease, the kidneys are enlarged with a lack of corticomedullary differentiation.
多囊肾（下图），整个肾都被大小不等、相互密切接触的多发性囊肿填充。疾病晚期，肾脏增大，肾皮髓质分界不清。
Solid Renal Masses
A solid renal mass appears in the US exam with internal echoes, without the well-defined, smooth walls seen in cysts, often with Doppler signal, and is frequently malignant or has a high malignant potential [4]. The most common malignant renal parenchymal tumor is renal cell carcinoma (RCC), which accounts for 86% of the malignancies in the kidney [2]. RCCs are typically isoechoic and peripherally located in the parenchyma, but can be both hypo- and hyper-echoic and are found centrally in medulla or sinus.
肾实性肿块（下图）
一般边界不清，无包膜，有血流信号，常为恶性或潜在恶性。最高发的是肾细胞癌（占肾恶性肿瘤的86％），常为肾实质内的等回声团，也有低/高回声团，也可发生于肾髓质或肾窦部内的。
The lesions can be multifocal and have cystic elements due to necrosis, calcifications and be multifocal. RCC is associated with von Hippel–Lindau disease, and with tuberous sclerosis, and US has been recommended as a tool for assessment and follow-up of renal masses in these patients.
肾实性肿块（下图）病变可以是多灶性伴囊性坏死、多灶性伴钙化。 RCC与von Hippel–Lindau病、结节性硬化症相关，建议这些患者积极参与超声随访。
Angiomyofibroma are often found in patients with tuberous sclerosis. They are composed of fat, smooth muscle tissue and vascular elements. The echogenicity is governed by the composition of these elements, but the lesion is often hyperechoic.
血管纤维瘤（下图）往往在结节性硬化症患者中发现。由脂肪、平滑肌组织和血管组成。声像为以上组织的混合，常表现为高回声。
Patient with tuberous sclerosis and multiple angiomyolipomas in the kidney.
结节性硬化症患者肾内的多发性血管纤维瘤（下图）。
Hydronephrosis
One of the primary indications for referral to US evaluation of the kidneys is evaluation of the urinary collecting system. Enlargement of the urinary collecting system is usually related to urinary obstruction and can include the pelvis, the calyces and the ureter. Hydronephrosis is seen as an anechoic fluid-filled interconnected space with enhancement within the renal sinus, and normally, the dilated pelvis can be differentiated from the dilated calyces.
肾积水
肾脏超声其中一个主要用途是评估肾集合系统。集合系统扩张常见于尿路梗阻（包括肾盂、肾盏和输尿管）。积水为相连的无回声，可见扩张的肾盂和扩张的肾盏。
下图患儿为肾盂输尿管连接部梗阻。
Under normal conditions, the ureter is not seen with US. However, in, e.g., urinary obstruction and vesicoureteric reflux with dilation of the ureter, the proximal part in continuation with the renal pelvis, as well as the distal part near the ostium can be evaluated.
正常情况下，超声是看不到输尿管的。而在尿路梗阻或膀胱输尿管回流时，可以评估输尿管与肾盂相连处，以及扩张的输尿管口。
下图患儿为膀胱输尿管反流导致双侧输尿管扩张。
The hydronephrosis is typically graded visually and can be divided into five categories going from a slight expansion of the renal pelvis to end-stage hydronephrosis with cortical thinning. The evaluation of hydronephrosis can also include measures of calyces at the level of the neck in the longitudinal scan plane, of the dilated renal pelvis in the transverse scan plane and the cortical thickness, as explained previously.
从肾盂的轻度扩张到皮质变薄的声像改变，可将肾积水分为五级。评估积水还可以测量纵切面的颈部、横切面扩张的肾盂、皮质厚度。
下图为皮质变薄型肾积水，测量肾盂分离。
Hydronephrosis with dilated anechoic pelvis and calyces, along with cortical atrophy. The width of a calyx is measured on the US image in the longitudinal scan plane, and illustrated by ‘+’ and a dashed line.
下图肾盂肾盏扩张，伴有皮质萎缩，纵切面上测量肾盏扩张。
Same patient as in Figure 16 with measurement of the pelvis dilation in the transverse scan plane illustrated on the US image with ‘+’ and a dashed line.
同一个患者，横切面上测量肾盂扩张（下图）。
If the fluid in the dilated collecting system has echoes, pyonephrosis should be excluded by clinical exam, blood analysis and, in special cases, puncture or drainage. Hydronephrosis can also be caused by non-obstructive conditions, such as brisk diuresis in patients treated with diuretics, in pregnant women and in children with vesicoureteral reflux
如果在集合系统的积液中发现异常回声，应取样化验、抽血检验，必要时予以穿刺或引流排出积脓。
非梗阻性积水，比如膀胱输尿管反流的孕妇、小儿，可以使用利尿剂治疗。
（本文来源于“超声”公众号，英语、图片为文献原文，中文为黄文宇翻译、发布）
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