Comparison of diagnostic accuracy of Doppler USG and contrast-enhanced magnetic resonance angiography and selective renal arteriography in patients with atherosclerotic renal artery stenosis

Abstract

BackgroundThere are many systemic complications of conventional selective renal arteriography (SRA), such as contrast-mediated nephropathy. Contrast-enhanced magnetic resonance angiography (CE-MRA) and renal artery Doppler ultrasonography (DUSG) have been used increasingly for renal artery stenosis (RAS). The aim of this study was to evaluate the accuracy of CE-MRA and DUSG as used for diagnosis of RAS.Material/MethodsWe divided 130 consecutive patients investigated for resistant hypertension into 2 groups based on age: group 1 was patients <60 years old and group 2 was patients >60 year. DUSG, CE-MRA, and SRA were performed in group 1 and group 2 patients.ResultsSeventy-two patients (24 males [M], 48 females [F]) in group 1, and 58 patients (26 M, 32 F) in group 2 were included in the study. In the evaluation of clinically significant renal artery stenosis with DUSG, in group 1 the overall sensitivity was 83.33% and overall specificity was 81.82%, and in group 2 they were 69.23% and 0%, respectively, when compared with SRA. In the evaluation of clinically significant renal artery stenosis with CE-MRA, the overall sensitivity and specificity were 92.31% and 36.36%, respectively, in group 1 and 100.00% and 73.33%, respectively in group 2, when compared with SRA.ConclusionsCE-MRA is an accurate, non-invasive method for the diagnosis of RAS in patients above 60 years of age and DUSG may be the choice of diagnostic method for RAS in patients under 60 years of age.

Accuracy of Duplex Ultrasound for Detecting Renal Artery Stenosis: A Systematic Review

“…Twelve of 25 studies reported accuracy as a main outcome. 12,14,[24][25][26][27][28][29][30][31]32,33 Six of those 12 studies reported high agreement with CVA, 14,30,33 SRA, 25,29 and MRA 24 (range: 81-98%). The remaining 6 of 12 studies reported either moderate, 28 low, 31 or a combination of the degree of agreement depending on the DUS parameter.…”

“…For each statistic, heuristic thresholds of > 80%, 60% to 80%, and < 60% were considered high, moderate, and low agreement, respectively. 12 As outlined above, only studies post-2005 (≥ 2006) were included.…”

“…The remaining 6 of 12 studies reported either moderate, 28 low, 31 or a combination of the degree of agreement depending on the DUS parameter. 12,27,32 These studies were generally conducted using similar criterion measures (eg, MRA, SRA, and CVA). Most studies reported sensitivity (n = 24/25) 3,5,12,14,[24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43] and specificity (n = 24/25).…”

Endovascular Management of Atherosclerotic Renal Artery Stenosis: Post-Cardiovascular Outcomes in Renal Atherosclerotic Lesions Era Winner or False Alarm?

“…The gold standard for ARAS diagnosis is conventional renal angiography [ 22 ]. However, the measurements of the stenosis degree can be performed with less invasive techniques including DUS (sensitivity 84%, specificity 97%) [ 23 ], magnetic resonance angiography (MRA, sensitivity 92%–97%, specificity 73%–93%) [ 24 ] and/or computed tomographic angiography (sensitivity 59%–96%, specificity 82%–99%) [ 25 ]. DUS also allows monitoring of stent patency in cases with stent deployment.…”

Color-coded summation images in the evaluation of renal artery stenosis before and after percutaneous transluminal angioplasty

“…Nevertheless, duplex US is highly dependent on the examiner skills and can be impeded by patients´ body habitus. Alternatively, cross-sectional imaging like computed tomography angiography (CTA) or magnetic resonance angiography (MRA) revealed high sensitivity and specificity rates in the assessment of RAS [ 3 – 5 ]. Performance of non-invasive diagnostic assessment prior to invasive management might be useful in providing information regarding anatomical variants and characteristics of the stenosis.…”