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Image Correlation
ES
P PS ESP = Early systolic peak
AT = Acceleration time
AT
Tips
Explain to the patient that this is a lengthy examination and that their cooperation with
breathing instructions will cut down some on the exam time.
This is a technically difficult exam limited by patient body habitus and bowel gas. Inability to
visualize any portion of the main renal artery should be reported to the interpreting
physician.
Scan through the kidney first before storing any images.
In addition to documenting renal size, you are also evaluating cortical echogenicity and
thickness.
Any pathology seen, such as masses or hydronephrosis, should be documented.
If renal artery stenosis is suspected, document that segment of the vessel in gray scale and
color Doppler. Then obtain spectral waveforms at the site of stenosis as well as just distal to
it.
If a renal artery stent is present, document the stent in gray scale and color Doppler.
Spectral waveforms should be obtained (if possible) proximal to, within, and just distal to the
stent. Velocities will be increased throughout the stent.
Spectral Doppler
Have patient hold their breath when obtaining spectral waveforms to decrease
movement
Must use angle correct, and the angle must be less than 60 degrees. Less than 20 degrees is
optimal for intrarenal waveforms.
Gate (SV length) must be in center of vessel and an appropriate width for size of
vessel
Adjust your PRF (scale) to display a large waveform so that you can obtain
appropriate measurements
Increase your sweep speed to display between 2 to 3 cycles for the renal artery
waveforms
Normal aortic PSV proximal to and at the level of the renal arteries ranges from 60-
100 cm/s
Normal proximal renal artery PSV ranges from 90-120 cm/s
Renal artery velocities will decrease as you move distally and into the kidney
Acceleration time, peak systolic and end diastolic velocities, and resistive index should be
obtained from all renal artery waveforms
Acceleration time is calculated by measuring the time from the onset of systole to the
ESP.
o Normal AT for renal arteries is < 0.07 seconds
RI is calculated by the machine using the PSV and EDV. If the machine does not
automatically calculate it for you, you will need to manually select the RI measurement after
obtaining your PSV and EDV.
o 0.6 is considered a normal RI for renal arteries
o RIs in young children may be slightly higher
Dampened waveform with loss of ESP (tardus-parvus) in distal main and segmental renal
arteries indicates proximal renal artery stenosis exceeding 80%
< 60% no > 180 < 3.5 absent > 0.07 < 0.7
cm/sec second
> 60% yes > 180 > 3.5 present > 0.1 > 0.7
cm/sec second
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