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A prospective comparison of duplex ultrasonography, Captopril renography, MRA and CTA in assessing renal artery stenosis
Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för onkologi, radiologi och klinisk immunologi, Enheten för radiologi. (Nyman)
Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för onkologi, radiologi och klinisk immunologi, Enheten för radiologi. (Ahlstrom)
Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper.
Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Klinisk fysiologi.
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2006 (Engelska)Ingår i: Acta Radiologica, ISSN 0284-1851, E-ISSN 1600-0455, Vol. 47, nr 8, s. 764-774Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Purpose: To prospectively compare the diagnostic accuracy of duplex ultrasonography, captopril renography, computed tomography angiography (CTA), and 3D Gd magnetic resonance angiography (MRA) in diagnosing hemodynamically significant renal artery stenosis (RAS).

Material and Methods: The standard of reference was measurement of transstenotic pressure gradient. Fifty-eight hypertensive patients with suspicion of RAS were evaluated, when possible, by all five techniques. Sensitivity and specificity to detect RAS were compared for each technique on both a patient and kidney basis. Discrepancies were evaluated separately and classified as borderline, method dependent, or operator dependent.

Results: The prevalence of RAS was 77%. The sensitivity/specificity of ultrasonography, captopril renography, CTA, and MRA in detecting kidneys with RAS was 73/71%, 52/63%, 94/62%, and 93/91%, respectively. Ultrasonography had a significantly lower sensitivity than CTA and MRA (P < 0.001) but higher than captopril renography (P = 0.013). Borderline RAS was the main cause for discrepancies.

Conclusion: MRA and CTA were significantly better than duplex ultrasonography and captopril renography in detecting hemodynamically significant RAS. The ultrasonography criteria for RAS based on the evaluation of renal peak systolic velocity and renal/aortic ratio are questionable. Captopril renography cannot be recommended for assessing RAS.

Ort, förlag, år, upplaga, sidor
2006. Vol. 47, nr 8, s. 764-774
Nyckelord [en]
atherosclerosis, comparative studies, kidney, technology assessment, vascular
Nationell ämneskategori
Medicin och hälsovetenskap
Identifikatorer
URN: urn:nbn:se:uu:diva-93518DOI: 10.1080/02841850600849092ISI: 000242362100004PubMedID: 17050355OAI: oai:DiVA.org:uu-93518DiVA, id: diva2:167015
Tillgänglig från: 2005-09-06 Skapad: 2005-09-06 Senast uppdaterad: 2017-12-14Bibliografiskt granskad
Ingår i avhandling
1. On Renal Artery Stenosis
Öppna denna publikation i ny flik eller fönster >>On Renal Artery Stenosis
2005 (Engelska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
Abstract [en]

Renal artery stenosis (RAS) is a potentially curable cause of hypertension and azotemia. Besides intra-arterial renal angiography there are several non-invasive techniques utilized to diagnose patients with suspicion of renal artery stenosis. Removing the stenosis by revascularization to restore unobstructed blood flow to the kidney is known to improve and even cure hypertension/azotemia, but is associated with a significant complication rate.

To visualize renal arteries with x-ray techniques a contrast medium must be used. In a randomized, prospective study the complications of two types of contrast media (CO2 and ioxaglate) were compared. CO2 was not associated with acute nephropathy, but induced nausea and had lower attenuation differences compared to Ioxaglate. Acute nephropathy was related to the ioxaglate dose and the risk was evident even at very low doses if the patients were azotemic with creatinine clearance <40 ml/min.

Evaluating patients for clinically relevant renal artery stenosis can be done utilizing several non-invasive techniques. MRA was retrospectively evaluated and shown to be accurate in detecting hemodynamically significant RAS. In a prospective study of 58 patients, evaluated with four methods for renal artery stenosis, it was shown that MRA and CTA were significantly better than ultrasonography and captopril renography in detecting hemodynamically significant RAS. The standard of reference was trans-stenotic pressure gradient measurement, defining a stenosis as significant at a gradient of ≥15 mmHg. The discrepancies were mainly found in the presence of borderline stenosis.

The outcome of percutaneous revascularization procedures showed a technical success rate of 95%, clinical benefit in 63% of treated patients, 30-day mortality 1.5% and major complication rate of 13%. The major complication rate for patients with baseline serum creatinine >300µmol/l was 32%. Our results compare favorably with published studies and guidelines.

Ort, förlag, år, upplaga, sidor
Uppsala: Enheten för radiologi, 2005. s. 54
Nyckelord
Radiology, Renal artery obstruction, Comparative studies, Contrast media, adverse events, Revascularization, Radiologisk forskning
Nationell ämneskategori
Radiologi och bildbehandling
Identifikatorer
urn:nbn:se:uu:diva-5945 (URN)91-506-1824-5 (ISBN)
Disputation
2005-09-30, Enghoffsalen, 50, Akademiska sjukhuset, Uppsala, 13:15
Opponent
Handledare
Tillgänglig från: 2005-09-06 Skapad: 2005-09-06Bibliografiskt granskad

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