目的：

基于常规超声联合超声造影（contrast-enhanced ultrasound，CEUS）评估肾动脉的超声参数探究副肾动脉（accessory renal artery，ARA）发生的独立预测因素，构建超声无创评估ARA发生的预测模型，为临床工作中高效、准确评估ARA提供可量化的参考依据。

方法：

本研究为单中心研究，回顾分析2020年1月至2024年12月于北京医院超声医学科因可疑肾性高血压进行肾动脉CEUS检查的患者，将常规超声联合CEUS检查诊断伴有ARA的148例患者，共计296个肾脏纳入研究中。收集所有入选患者的临床资料及超声参数资料。根据常规超声联合CEUS检查的诊断结果，将肾脏分为伴有ARA组和不伴有ARA组。先对两组中的各个变量进行单因素差异性分析，将单因素分析结果中差异具有统计学意义的变量进行多重共线性检验，随后纳入多因素Logistic回归分析中，最终筛选出ARA发生的独立预测因素，构建ARA发生的列线图预测模型，采用受试者工作特征曲线（receiver operating characteristic，ROC）和Hosmer-Lemeshow检验评估预测模型的预测效能和拟合能力。

结果：

单因素差异性分析表明，不伴有ARA组的主肾动脉（main renal artery，MRA）内径、研究侧与对侧主肾动脉内径比值（target-opposite renal artery diameter ratio，T-Or）、研究侧与对侧肾脏宽径比值均大于伴有ARA组，差异具有统计学意义（P<0.05）；左侧肾脏较右侧肾脏ARA发生率更高，差异有统计学意义（P<0.05）。多因素Logistic回归分析表明，T-Or、左右两侧肾脏是ARA发生的独立预测因素。基于T-Or、左右两侧肾脏构建的ARA发生的列线图预测模型经ROC曲线分析显示曲线下面积（area under the curve，AUC) 为0.806（95%CI：0.756-0.856），经Hosmer-Lemeshow拟合优度检验结果P>0.05,说明该模型具有较好的预测效能和拟合能力。

结论：

基于T-Or、左右两侧肾脏构建的ARA发生的预测模型具有良好的预测效能，是超声评估ARA的可靠辅助工具。当T-Or小于0.8时，ARA发生的可能性大于70%，提示超声医师应进行更加全面系统的扫查以提高超声对ARA的检出率。 

Objective: 

To investigate independent predictive factors for the occurrence of the accessory renal artery (ARA) by evaluating renal artery ultrasound parameters through conventional ultrasonography combined with contrast-enhanced ultrasound (CEUS), and to construct a noninvasive ultrasound-based predictive model for the ARA occurrence, providing quantifiable references for efficient and accurate clinical assessment of the ARA.

Methods: 

This single-center study retrospectively analyzed 296 kidneys from 148 patients (suspected renal hypertension) who underwent renal artery CEUS at Beijing Hospital between January 2020 and December 2024. Based on the CEUS and conventional ultrasound findings, kidneys were categorized into the ARA-positive and the ARA-negative groups. Clinical and ultrasound parameters were collected for all participants. Variables showing statistically significant differences in univariate analysis (P<0.05) underwent multicollinearity diagnosis and subsequent multivariate logistic regression to identify independent predictors. A nomogram prediction model was developed and evaluated using receiver operating characteristic (ROC) curve analysis and Hosmer-Lemeshow goodness-of-fit test.

Results: 

Univariate analysis revealed that the ARA-negative group exhibited larger main renal artery diameter, higher ratios of observed-to-contralateral main renal artery diameter, and observed-to-contralateral renal width (P<0.05). Left kidneys demonstrated a higher the ARA incidence than right kidneys (P<0.05). Multivariate analysis identified the target-opposite renal artery diameter ratio and bilateral kidneys as independent predictors. The nomogram model, incorporating these factors, achieved an area under the curve (AUC) of 0.806 (95% CI: 0.756–0.856)，Hosmer-Lemeshow test confirmed good model fit (P>0.05).

Conclusion:

The prediction model for the ARA occurrence constructed based on T-Or and bilateral renal parameters demonstrates favorable predictive performance, serving as a reliable auxiliary tool for ultrasound assessment of the ARA. When T-Or is less than 0.8, the probability of the ARA occurrence exceeds 70%, suggesting that sonographers should perform more comprehensive and systematic scanning to enhance the ultrasound detection rate of the ARA.