
renal ultrasonography

renal ultrasonography (renal yuu. aiss.) medical ultrasound kaa upayog karke ack yaa donon gurdon kii jaanch haye.
gurde seey sambandhit rogon key nidan aur prabandhan mein gurde kii ultrasonography aavashyak haye. gurdon kii aasaani seey jaanch kii jaati haye, aur gurdon mein adhikansh rogjanak parivartan ultrasound key saath alag kiye jaa sakate hain. yuu. aiss. gurde key lakshnon vaale rogiyon mein nirnay lene aur gurde key hastakshep mein margadarshan key liye ack sulabh, bahumukhi sastee aur twarit sahaayata haye.
renal ultrasound (yuu. aiss.) ack samanya pariksha haye, joe dashakon seey kii jaa rahee haye. bee-mode imaging kaa upayog karke, gurde kii shareer rachana kaa mulyankan aasaani seey kiya jaataa haye, aur hamein aksar gurde key hastakshep key liye chhavi margadarshan key roop mein upayog kiya jaataa haye. isake alawa, renal yuu. aiss. mein nae anuprayogon koo contrast-enhanced ultrasound (see. ee. yuu. aiss.), elastography aur fusion imaging key saath pesh kiya gayaa haye. haalaanki, gurde kii kuchh seemaaen hain, aur anya taur-tareeke, jaise kii ct aur mri, koo hamesha gurde kii bimari key mulyankan mein poorak imaging taur-tarikon key roop mein maanaa jaanaa chaahiye.
takneek.
ultrasonic renal pariksha mein rogi kii kissy bhee taiyari kii aavashyakta naheen hoti haye aur aamtaur parr rogi key saath sust sthiti mein kiya jaataa haye. gurdon kii jaanch anudairdhya aur anuprasth scan vimaanon mein kii jaati haye, jisamen anupravaahika koo buggle mein rakhaa jaataa haye. jaba gurde kaa soojan aanton kii havaa seey aspasht hoe jaataa haye, tou supeen scan sthiti koo paarshv dqbitus sthiti key saath jodaa jaataa haye aur transducer dorsali sthanantarit hoe jaataa haye. adhimaantah, pariksha anudairdhya scan tala mein shuru kii jaati haye, joe gurde key lambe vyaas key samanantar hoti haye, kyonki gurde mein antar karna aasaan hotaa haye.
vayask rogi mein, 3-6 megahertz kii kendra aavrittiyon key saath ack ghumaavdaar sarani transducer kaa upayog kiya jaataa haye, jabaki baal roga rogi kii uchch kendra aavrittiyon key saath ack raikhik sarani transducer key saath jaanch kii jaani chaahiye. sabse nichali pasaliyon kii kalaakritiyaan hamesha gurde key oopari dhruvon parr chhaaya karati hain. haalaanki, poore gurde kii jaanch yaa tou samanya shwasan yaa saans pakadane key dauran kii jaa sakati haye, kyonki gurda diaphram kaa paalan karega aur tadnusar sthiti badal dega.
samanya gurde mein nishkarsh.
anudairdhya scan tala mein, gurde mein vishisht andakar bean-aakar hotaa haye. dahini gurda aksar adhik kaudali paaee jaati haye aur baain gurde kii tulanaa mein patali hoti haye, jisamen pliha kii nikatata key kaaran ack tathaakathit dromedary koobad hoe sakata haye. gurda ack capsule seey ghiraa hotaa haye joe gurde koo ecogenic perirenal vasaa seey alag kartaa haye, jise ack patali raikhik sanrachana key roop mein dekhaa jaataa haye.
gurde koo perenkima aur renal sinus mein vibhajit kiya jaataa haye. gurde kaa sinus hyprecoic hotaa haye aur yeh callis, gurde key shroni, vasaa aur pramukh antahpravaah vaahikaon seey banaa hotaa haye. samanya gurde mein, gurde key sinus mein mootra sangrah pranali dikhaai naheen detee haye, lekin yeh antarveshtit vasaa aur vaahikaon key saath ack visham roop paida karati haye. perenkaima adhik hypocoic aur sajaatiya hotaa haye aur sabse baahari prantstha aur sabse ander aur thodaa cumm ecogenic medulary pyramid mein vibhajit hotaa haye. pyramids key beach cortical infoldings hotey hain, jinhen bertin key collum (chitra 1) kahaa jaataa haye. baal roga rogi mein, hypocoic medular pyramid koo parenchyma rima mein cortex key adhik ecogenic paridhiya kshetra key saath-saath bertin key stambhon (chitra 2) seey alag karna aasaan haye.
vayask gurde kii lambai aam taur parr 10-12 semi hoti haye, aur daaen gurde kii lambai aksar baaen gurde kii tulanaa mein thodi adhik hoti haye. shareer kii oonchaai aur umr key saath sahsambandh key kaaran vayask gurde kaa aakar parivartansheel haye; haalaanki, baal gurde key aakar key liye maanak upalabdh hain.
cortical motai kaa anuman pyramid key aadhar seey lagaaya jaanaa chaahiye aur aam taur parr 7-10 mimi haye. yadi pyramids koo alag karna mushkil haye, tou perenkaimal kii motai koo maapa jaa sakata haye aur 15-20 mimi (chitra 3) honah chaahiye. prantstha kii ecogenesity umr key saath cumm hoe jaati haye aur chhah maheene seey adhik umr key vyaktiyon mein samaan gaharaai parr yakrit aur pliha kii tulanaa mein cumm ecogenic yaa usake barabar hoti haye. navjat shishuon aur chhah maheene kii umr taka key bachchon mein, samaan gaharaai kii tulanaa mein yakrit aur pliha kii tulanaa mein prantstha adhik ecogenic hoti haye.
gurde kii doppler ultrasonography kaa vyaapak roop seey upayog kiya jaataa haye, aur perfusion kaa mulyankan karane key liye vaahikaon koo aasaani seey rung doppler takneek dwara chitrit kiya jaataa haye. gurde kii dhamani aur chayanit antahkoshiya dhamniyon, shikhar systolic wegg, pratirodhi soochkaank aur twaran vakron parr varnakramiya doppler lagaane kaa anuman lagaaya jaa sakata haye (chitra 4) (ee.jee.180 semi/seey seey oopar kii gurde kii dhamani kaa charam systolic wegg 60 pratishat seey adhik key gurde kii dhamani stenosis kaa ack bhavishyavakta haye, aur ack pratirodhi soochkaank, joe kii 0.7 seey oopar key charam systolic aur anta systolic wegg seey ganana kii jaati haye, asamanya navinikaran pratirodh kaa sanket haye).
cystic renal dravyamaan.
dravyamaan koo samanya gurde kii vastukala key viroopan key roop mein dekhaa jaataa haye. adhikansh gurde key dravyamaan goal dikhane vaale saral cortical gurde key sist hotey hain aur ack chikani patali capsule hoti haye joe anicoic taral padaarth koo gherati haye. umr key saath ghatana badhati haye, kyonki 50 varsh seey adhik ayu key cumm seey cumm 50 pratishat logon mein ack gurde mein ack sadharan sist hotaa haye. sist taral padaarth (chitra 5) key bheetar ultrasound key cumm ksheenan key parinamswarup sist pashch vriddhi kaa kaaran banate hain. sadharan sist ack saumya ghaav haye, jisake liye aage key mulyankan kii aavashyakta naheen hoti haye.
jatil sist mein jhilli hoe sakati haye joe taral padaarth seey bharey kendra koo aantarik pratidhvani, calcification yaa aniyamit motee divaaron key saath vibhajit karati haye. jatil sist kaa aage doppler key saath mulyankan kiya jaa sakata haye, aur jatil sist key bosniac vargeekaran aur anuvarti kaarravaai key liye, yaa tou contrast-enhanced ultrasound (see. ee. yuu. aiss.) yaa contrast ct kaa upayog kiya jaataa haye (chitra 6). bosniac vargeekaran koo chaar samoohon mein vibhajit kiya gayaa haye joe i seey, ack sadharan sist key anuroop, IV taka, thhos bhaagon key saath ack sist key anuroop aur ack 85-100% durbhavana key jokhim key anuroop haye.
polycystic gurde kii bimari mein, ack dusare key nikat sampark mein aaney parr alag-alag aakar key kaee sist lagbhag poore gurde key kshetra koo bharate hue dekhe jaate hain. iss bimari key unnat charanon mein, gurde corticomedular vibhedan kii kamee key saath badey hoe jaate hain (chitra 7).
thhos gurde dravyamaan.
ack thhos gurde kaa dravyamaan yuu. aiss. pariksha mein aantarik pratidhvaniyon key saath dikhaai detaa haye, joe sist mein achchi tarah seey paribhaashit, chikani divaaron key binaa dikhaai detaa haye, aksar doppler sanket key saath, aur aksar ghaatak hotaa haye yaa isamen uchch ghaatak kshamata hoti haye. sabse aam ghaatak renal perenkaimal tumour renal cell carcinoma (aar. see. see.) haye, joe gurde mein 86 pratishat ghaataktaa key liye jimmedaar haye. aar. see. see. aamtaur parr isocoic hotey hain aur paridhiya roop seey perenkaima mein sthit hotey hain, lekin hypo-aur hyper-ecoic donon hoe sakate hain aur medula yaa sinus mein kendriya roop seey paae jaate hain. ghaav bahu-fokal hoe sakate hain aur necrosis, calcification key kaaran cystic tatva hoe sakate hain aur bahu-fokal hoe sakate hain (chitra 8 aur chitra 9). aar. see. see. wonn hippel-lindaau roga aur tuberus sclerosis seey judaa huaa haye, aur inn rogiyon mein gurde key dravyamaan key mulyankan aur anuvarti kaarravaai key liye ack upkaran key roop mein hamari sifarish kii gaee haye.
haalaanki, gurde mein thhos tumour key mulyankan key liye humm praathamik tarika naheen hain, aur ct pahali pasand kaa tarika haye. phir bhee, raktasravi sist ct parr rcc key samaan hoe sakate hain, lekin way aasaani seey doppler ultrasonography key saath alag kiye jaate hain. aar. see. see. mein, doppler hamein aksar neovascularization aur dhamani shunt key kaaran uchch wegg vaali vaahikaon koo dikhaata haye. kuchh aar. see. see. hypovascular hotey hain aur doppler key saath bhed karane yogya naheen hotey hain. isaliye, binaa doppler sanket key gurde key tumour, joe humm parr spasht roop seey saral sist naheen hain aur ct, kii see. ee. yuu. aiss. key saath aage jaanch kii jaani chaahiye, kyonki see. ee. yuu. aiss. aur ct donon kii tulanaa mein adhik samvedansheel haye.
gurde mein anya ghaatak tumour sankraman koshika carcinoma aur squamous cell carcinoma hain, joe eurothelium seey utpann hotey hain aur gurde key sinus key saath-saath adenocarcinoma, lymphoma aur metastasis paae jaate hain, joe gurde mein kaheen bhee paae jaa sakate hain (chitra 10).
gurde key saumya thhos tumour oncocytoma aur angiomyophybroma hain. oncocytoma kii alag-alag ultrasonic upasthiti hoti haye, lekin ack kendriya nishan yaa calcification ack pehchaan key roop mein hoe sakata haye. angiomyophybroma aksar tuberus sclerosis key rogiyon mein paaya jaataa haye. way vasaa, chikani maanspeshiyon key ootak aur samvahani tatvon seey baney hotey hain. ecogenesity inn tatvon kii sanrachana dwara niyantrit hoti haye, lekin ghaav aksar hyperecoic hotaa haye (aakriti 11 aur aakriti 12).
saumya tumour koo ghaatak tumour seey alag karna mushkil haye. iss prakaar, humm parr paae jaane vaale thhos gurde key dravyamaan koo vargeekrit karna mushkil haye aur ct key saath aage mulyankan kiya jaanaa chaahiye. cystic yaa thhos gurde key dravyamaan key vishesh mamalon mein, shalya chikitsa parr nirnay lene seey pahale hystologic tumour key prakaar kii pehchaan karane key liye atirikt yuu. aiss. nirdeshit biopsy yaa jall nikasi kii jaati haye.
hydronephrosis.
gurde key mulyankan key liye hamein sandarbhit karane key praathamik sanketon mein seey ack mootra sangrah pranali kaa mulyankan haye. mootra sangrah pranali kaa vistaar aamtaur parr mootra kii baadha seey sambandhit hotaa haye aur isamen shroni, callis aur mootramaarg shamil hoe sakate hain. hydronephrosis koo gurde key sinus key bheetar vriddhi key saath ack anicoic drav seey bharey paraspar judey sthaan key roop mein dekhaa jaataa haye, aur aam taur parr, faila huaa shroni koo failaaye gaye callis seey alag kiya jaa sakata haye.
kaee sthitiyon key parinamswarup mootra mein baadha aaa sakati haye. vayaskon aur bachchon donon mein, phode aur tumour jaise dravyamaan mootramaarg koo sankuchit curr sakate hain. bachchon mein, hydronephrosis mutramaargak junction baadha, ectopic antahsth mootramaarg, praathamik brihad mootramaarg aur pashch mootramaarg valve (chitra 13) key kaaran hoe sakata haye. baad mein, donon gurde prabhaavit honge. vayaskon mein, hydronephrosis mootra pathri key kaaran hoe sakata haye, joe gurde key shroni yaa mootramaarg key nikas mein baadha daaltaa haye, aur mootramaarg key sampeedan seey hoe sakata haye.jee.garbhavastha aur retroperitoneal fibrosis. vayask rogi mein eurolithiasis hydronephrosis kaa sabse aam kaaran haye aur iska prasaar 10%-15% haye.
samanya paristhitiyon mein, mootramaarg hamaare saath naheen dikhaai detaa haye. haalaanki, ee.jee.mootramaarg key failaav key saath mootra sambandhi baadha aur vesicorateric reflux, gurde key shroni key saath nirantarta mein sameepavarti bhaag, saath hii saath ostium key paas door key bhaag kaa mulyankan kiya jaa sakata haye (chitra 14).
hydronephrosis koo aam taur parr drishtigat roop seey vargeekrit kiya jaataa haye aur ise paanch shreniyon mein vibhajit kiya jaa sakata haye joe gurde key shroni key mamuli vistaar seey laker courtical thinning (chitra 15) key saath antim charan hydronephrosis taka jaataa haye. hydronephrosis key mulyankan mein anudairdhya scan tala mein gardan key star parr callis key upaay, anuprasth scan tala mein faile hue gurde key shroni aur courtical motai shamil hoe sakate hain, jaisa kii pahale bataaya gayaa haye (chitra 16 aur chitra 17).
yadi faila huaa sangrah pranali mein taral padaarth mein pratidhvani haye, tou naidaanik pariksha, rakt vishleshan aur vishesh mamalon mein, puncher yaa jall nikasi dwara pionephrosis koo baahar rakhaa jaanaa chaahiye. hydronephrosis gair-avarodhak sthitiyon key kaaran bhee hoe sakata haye, jaise kii mootravardhak key saath ilaaj kiye gaye rogiyon mein tej mootravardhak, garbhavati mahilaaon mein aur vesicorail reflux vaale bachchon mein.
gurde kii pathri kii bimari.
bhale hii hamaare paas gurde kii pathri (eurolithiasis) kaa pataa lagaane key liye ct kii tulanaa mein cumm samvedansheelta aur vishishtata haye, aggar upalabdh hoe, tou gurde kii brihadantra aur sandigdh eurolithiasis key rogiyon mein praarambhik imaging modality key roop mein anushansit haye. hamein vikiran kaa koee khatra naheen haye, yeh prajanan yogya aur sastaa haye, aur praarambhik ct pariksha seey gujarane vaale rogiyon kii tulanaa mein praarambhik eurolithiasis seey peedit sandigdh rogiyon key liye parinam kaafee alag naheen haye.
hamaare saath, gurde key bheetar badee pathri (> 5-7 mimi), i.ee.callis mein, shroni aur pyeloretaric junction koo alag kiya jaa sakata haye, vishesh roop seey hydronephrosis key saath mamalon mein (chitra 18 aur chitra 19). pashch chhayankan key saath hyperocoic patthar dekhe jaate hain. patthar key neeche atirikt jhapakati hui kalakritiyon koo aksar doppler yuu. aiss. kaa upayog karate hue dekhaa jaa sakata haye. poore sangrah pranali koo bharane vaale badey pattharon koo prawal patthar yaa staghorn kailkuli kahaa jaataa haye aur aasaani seey hamaare saath dekhaa jaa sakata haye (chitra 20). mootramaarg mein patthar aamtaur parr hamaare saath havaa seey bharee aanton key kaaran soojan khidki koo aspasht karane key kaaran naheen dekhe jaate hain. haalaanki, ostium key paas mootramaarg kii pattharon koo mootrashay key oopar scan sthiti key saath dekhaa jaa sakata haye. mootramaarg key chhidron kii ack pariksha aur mootrashay mein mootra key visarjan koo mootrashay mein mootramaarg key vimaanon kaa rung doppler key saath nireekshan karke kiya jaa sakata haye.
purani gurde kii bimari.
yuu. aiss. deerghakaalik gurde kii bimari mein naidaanik aur purvanuman uddeshyon key liye upayogi haye. chaahe antarnihit rogjanak parivartan glomerular sclerosis, tubeler atrophy, interstitial fibrosis yaa soojan hoe, parinam aksar cortex kii ecogenesity mein vriddhi hoti haye. gurde kii ecogenesity yaa tou yakrit yaa pliha kii ecogenesity seey sambandhit honey chaahiye (chitra 22 aur chitra 23). isake alawa, gurde key aakar mein kamee aur cortical kaa patala honah bhee aksar dekhaa jaataa haye aur vishesh roop seey jaba bimari badhati haye (aankada 24 aur aankada 25). haalaanki, gurde kaa aakar oonchaai seey sambandhit haye, aur chhote vyaktiyon mein chhote gurde hotey hain; iss prakaar, gurde kaa aakar ekmatra mapdand key roop mein vishvasaniya naheen haye.
gurde kii gambhir chot.
gurde mein teevra parivartanon kii aksar hamaare saath pahali pankti key taur parr jaanch kii jaati haye, jahaan ct aur chumbakiya anunaad imaging (mri) kaa upayog anuvarti pareekshaon key liye kiya jaataa haye aur jaba humm asaamaanyataon koo pradarshit karane mein whiffle rahate hain. gurde mein teevra parivartanon key mulyankan mein, gurde kii sanrachanaon kii ecogenesity, gurde kaa chitran, gurde kii samvahaneeta, gurde kaa aakar aur kendra sambandhi asaamaanyataaen dekhi jaati hain (chitra 26 aur chitra 27). see. tii. koo gurde key aghaat mein prathamikta dee jaati haye, lekin yuu. aiss. kaa upayog anuvarti kaarravaai key liye kiya jaataa haye, vishesh roop seey mootranali key gathan key liye sandigdh rogiyon mein (chitra 28).
humm-nirdeshit hastakshep.
sonography gurde mein hastakshep karate samay margadarshan key liye pasand kaa tarika haye, chaahe vaha gurde kii biopsy hoe, percutaneous nephrostomy hoe yaa phode kii nikasi hoe. aitihaasik roop seey, gurde key tumour kaa thermal ablation ct margadarshan key tahat kiya jaataa haye, kyonki yuu. aiss.-nirdeshit prakriya key dauran padosi aanton koo ghayal karane kaa jokhim chalati aantr kii kharaab pehchaan key kaaran bahut adhik maanaa jaataa thaa. haalaanki, renal interventional key liye haal key dishaanirdeshon mein radiofrequency, microwave aur cryoablation shamil hain joe hamaare saath aadarsh imaging guide key roop mein hain.
percutaneous nephrostomy aur phode kii nikasi key liye, yaa tou ack-charan yaa seldinger takneek kaa upayog kiya jaataa haye. seldinger takneek kaa upayog karate hue, guha koo ack tej khokhali suee seey puncher kiya jaataa haye, jise troker kahaa jaataa haye. ack goal-tipped guidewire koo troker key lumen key madhyam seey aage badhaaya jaataa haye, aur troker koo vaapas lene key baad, sahee sthaan sunishchit karane key liye guidewire parr ack catheter yaa nephrostomy daala jaa sakata haye. ack-charaniya takneek taba hoti haye jaba ack guidewire kii sahaayata key binaa naali yaa nephrostomy kaa sammilan kiya jaataa haye. hastakshep sthaaniya sangyaaharan key tahat aur ack sterile setup mein kiye jaate hain. vareeyata, anubhav aur vyavastha (chitra 29) key anusaar suee margadarshan key saath yaa usake binaa prakriyaaen kii jaa sakati hain.
see. ee. yuu. aiss., chhavi sanlayan aur elastography.
contrast-enhanced ultrasound (see. ee. yuu. aiss.) microvasculature kaa mulyankan curr sakata haye, jiska rung doppler hamein pataa lagaane mein asamarth haye. renal us pariksha mein, see. ee. yuu. aiss. kaa upayog tumour aur sudotumer koo alag karane key liye kiya jaa sakata haye, jaise kii bertin key pramukh stambh. chhadm tumour nikatvarti gurde key ootak key roop mein badhate hain. vishesh mamalon mein cystic aur hypovascularised thhos ghaavon key beach antar karane key liye, jatil sist, phode, dardanaak ghaavon aur ischemic ghaavon koo chihnit karane key liye see. ee. yuu. aiss. key upayog kii sifarish kii jaati haye.
gurde mein thhos ghaatak tumour kuchh yakrit ghaavon jaise vishisht vriddhi pattern pradarshit naheen karate hain, aur saumya aur ghaatak gurde key ghaavon key beach koee vaidh vriddhi mandand prastaavit naheen kiya gayaa haye. haalaanki, see. ee. yuu. aiss. kaa upayog kuchh rogiyon mein gurde kii koshika carcinoma key kshay key baad upchaarit kshetra mein vipareet grahan kaa mulyankan karane key liye kiya jaataa haye (chitra 30).
see. tii. yaa anya taur-tarikon key pahale darj kiye gaye dataset key saath ultrasound kaa chhavi sanlayan shayed hii kabhi gurde mein upayog kiya jaataa haye. see. ee. yuu. aiss. yaa yuu. aiss. key saath see. tii. yaa aim. aar. aaee. key saath milkar renal ghaavon kii jaanch mein aur kathin yuu. aiss.-nirdeshit renal hastakshepon mein chhavi sanlayan parr report prakaashit kii gaee haye (chitra 31). haalaanki, abhee taka koee sifaarishen prakaashit naheen kii gaee hain.
elastography ootak kii loach koo dekhane key liye ack yuu. aiss. vidhi haye. cortical fibrosis kaa mulyankan karane key liye pratyaaropit gurdon parr upayog kii jaane vaali us elastography parr praarambhik report ashajanak parinam (chitra 32) dikhaate hue prakaashit kii gaee hain.