scholarly journals How to diagnose renal artery stenosis correctly using ultrasound? Evaluation of results of renal arteries duplex ultrasonography examinations

2018 ◽  
Vol 20 (3) ◽  
pp. 298 ◽  
Author(s):  
Rong Zhu ◽  
Zhonghui Xu ◽  
Zhenhong QI ◽  
We YE ◽  
Jian Wang ◽  
...  
Keyword(s):  
Renal Artery ◽  
Renal Artery Stenosis ◽  
Peak Systolic Velocity ◽  
Renal Arteries ◽  
Artery Stenosis ◽  
Common Reason ◽  
Duplex Ultrasonography ◽  
Non Invasive ◽  
Ultrasound Evaluation ◽  
Discordant Diagnosis

Aim: Renal artery duplex ultrasonography (RDU) is an effective and non-invasive screening test in diagnosing renal artery stenosis. The discordance of results in multiple RDU is common. We aim to evaluate the discordance and the reasons for discordance between diagnoses and measurements from multiple RDU examinations.Material and method: A retrospective study was performed in 64 examinations of renal arteries from 32 patients that were referred for two or more RDU examinations and renal artery digital subtraction angiography (DSA) within six months, between August 2013 and January 2016. Using DSA as gold standard, we divided the renal arteries into three groups: discordant (one diagnosis of RDU was correct and one was wrong), misdiagnosed (neither RDU diagnosis was correct) and correct (both RDU diagnoses were correct) groups.We evaluated the discordance and reasons for discordance of diagnoses and measurements from multiple RDU examinations. Results: Among 64 renal arteries included in this study, 37 renal arteries had two correct diagnoses, 19 renal arteries had two discordant diagnoses, and eight renal arteries were misdiagnosed twice by RDU. The discordance of peak systolic velocity (PSV), the ratio between PSV in the renal artery with stenosis and PSV in the aorta (RAR), and tardus-parvus waveform measurements were clearly higher in the discordant diagnoses group than in the correctly diagnosed group. The most common reason for a discordant diagnosis was failure in obtaining correct tardus-parvus waveforms of the interlobar artery (26.31%). Themost common reason for misdiagnosis was the presence of an extremely severe stenosis with an atrophic kidney (31.25%). Overall, 87.50% of patients underwent RDU examinations had correct diagnoses of stenosis or occlusion at least once (including location and degree), as confirmed by DSA.Conclusions: Our study indicates that standard operating procedures and improvements in examination technique by ultrasound doctors could reduce the discordance between multiple tests. 

Nierenarterienstenose: Möglichkeiten der Kernspintomographie

1989 ◽  
Vol 28 (06) ◽  
pp. 226-233 ◽  
Author(s):  
G. P. Krestin ◽  
P. Theissen ◽  
G. Friedmann ◽  
H. Schicha ◽  
A. Linden
Keyword(s):  
Renal Artery ◽  
Renal Artery Stenosis ◽  
Vascular Diseases ◽  
Renal Perfusion ◽  
Renal Arteries ◽  
Artery Stenosis ◽  
Gradient Echo ◽  
Gadolinium Dtpa ◽  
Non Invasive ◽  
Dynamic Studies

Non-invasive detection of stenotic lesions of the renal arteries remains an important clinical problem. Recent advances in magnetic resonance angiography represent a significant progress towards achieving non-invasive diagnosis of vascular diseases. The purpose of this study was to evaluate the possibilities of assessment of renal artery stenosis with commonly available hard-and software equipment. Imaging of renal arteries was performed with a ECG-gated fast multiphase gradient echo sequence which allows production of a series of images in different heart phases. Examinations were performed in 15 healthy volunteers and in 12 patients with angiographically verified renal artery stenosis. In 10 patients additional dynamic studies with fast imaging during short breath-holding periods after administration of gadolinium-DTPA served for the assessment of renal perfusion. A superconducting system operating at 1.5 T was used to produce gradient echo sequences with small flip angles and dephasing gradients of constant amplitude. To find the optimal imaging method for depiction of the renal arteries the following parameters were systematically varied: respiratory gating, resolution, number of excitations, slice thickness, phase encoding direction, rephasing gradients, Flip angle and echo time. A good visualization of the vessels was always possible and using the best parameter combination even the narrowed lumen could be assessed in some cases. With this technique or with gadolinium-enhanced dynamic studies the perfusion of the kidneys can be demonstrated. However, quantitation of the stenosis or quantitation of renal perfusion was not possible; even the depiction of the stenotic lesion was successful only in half of the cases. Thus commonly used MR equipment is not yet able to replace more invasive methods in the diagnosis of renal artery stenosis. In order to make MR angiography a successful technique for the assessment of vascular diseases more sophisticated methods that allow a quantitation of flow or velocity across the vessel, will have to be developed.

scholarly journals Morphologic and Functional Magnetic Resonance Imaging of Renal Artery Stenosis: A Multireader Tricenter Study

2002 ◽  
Vol 13 (1) ◽  
pp. 158-169
Author(s):  
Stefan O. Schoenberg ◽  
Michael V. Knopp ◽  
Frank Londy ◽  
Sumati Krishnan ◽  
Ivan Zuna ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Renal Artery ◽  
Renal Artery Stenosis ◽  
Interobserver Variability ◽  
Renal Arteries ◽  
Artery Stenosis ◽  
Functional Magnetic Resonance ◽  
Cine Phase Contrast ◽  
Contrast Flow ◽  
Phase Contrast Flow

ABSTRACT. The effect of combined morphologic and functional magnetic resonance (MR) imaging on the interobserver and intermodality variability for the grading of renal artery stenosis is assessed. In a randomized, blinded tricenter analysis, seven readers evaluated 43 renal arteries on x-ray digital subtraction angiography (DSA), 3D-Gadolinium MR angiography (3D-Gd-MRA), cine phase-contrast flow measurement (PC-flow), and a combined analysis of the last two. Interobserver variability was assessed for the grading of renal artery stenosis as well as regional vessel visibility. Intermodality variability for stenosis grading was analyzed in cases in which the readers agreed on the degree of stenosis in DSA. DSA had a substantial interobserver variability for the grading of stenosis (mean κ κ 0.64). 3D-Gd-MRA revealed a slightly improved interobserver variability but incorrectly graded 6 of 34 stenoses on a two-point scale (<50%, ≥50%). The combined approach of 3D-Gd-MRA and PC-flow revealed the best (P = 0.0003) interobserver variability (median κ = 0.75) and almost perfect intermodality agreement with DSA (97% of cases). These findings were confirmed in a prospective analysis of 97 renal arteries. The vessel visibility of the renal artery ostium was significantly better in 3D-Gd-MRA than in DSA, whereas the visibility of the hilar and intrarenal vessels was significantly worse (P = 0.0001). A combined morphologic and functional MR examination significantly reduces interobserver variability and offers reliable and reproducible grading of renal artery stenosis based on stenosis morphology and hemodynamic changes. It can be considered a safe and noninvasive alternative for diagnostic DSA in cases that do not require assessment of intrarenal vessels.

scholarly journals Non-invasive investigations of potential renal artery stenosis in renal insufficiency

2010 ◽  
Vol 25 (11) ◽  
pp. 3607-3614 ◽  
Author(s):  
P. Eriksson ◽  
A. A. Mohammed ◽  
J. De Geer ◽  
J. Kihlberg ◽  
A. Persson ◽  
...  
Keyword(s):  
Renal Insufficiency ◽  
Renal Artery ◽  
Renal Artery Stenosis ◽  
Artery Stenosis ◽  
Non Invasive

Does peak systolic velocity correlate with renal artery stenosis in a pediatric renal transplant population?

2006 ◽  
Vol 10 (5) ◽  
pp. 608-612 ◽  
Author(s):  
Anthony Cook ◽  
Antoine Khoury ◽  
Karim Kader ◽  
Diane Hebert ◽  
Oscar Navarro ◽  
...  
Keyword(s):  
Renal Transplant ◽  
Renal Artery ◽  
Renal Artery Stenosis ◽  
Peak Systolic Velocity ◽  
Artery Stenosis ◽  
Pediatric Renal Transplant

Phase-contrast MR angiography for detection of arteriosclerotic renal artery stenosis

1997 ◽  
Vol 38 (2) ◽  
pp. 287-291 ◽  
Author(s):  
S. H. Duda ◽  
F. Schick ◽  
F. Teufl ◽  
M. Müller-Schimpfle ◽  
C. Erley ◽  
...  
Keyword(s):  
Mr Imaging ◽  
Renal Artery ◽  
Renal Artery Stenosis ◽  
Phase Contrast ◽  
Mr Angiography ◽  
False Negative ◽  
False Negative Rate ◽  
Renal Arteries ◽  
Artery Stenosis ◽  
Renal Artery Stenoses

Purpose: to compare the accuracy of 3-D phase-contrast (PC) MR imaging with a 2-D time-of-flight (TOF) technique in the detection of arteriosclerotic renal artery stenosis. Material and Methods: Twenty-two patients with 28 angiographically proven renal artery stenoses were examined in a prospective blinded fashion by using 2-D TOF MR angiography (MRA) with venous saturation (FLASH) and 3-D PC MRA. the renal arteries were subdivided into 3 segments and graded for the presence of stenoses on a scale of 0–4 by 3 radiologists in blind. Results: the accuracy of TOF and PC imaging in detecting renal artery stenoses was 65% and 77% respectively. Both 2-D TOF and 3-D PC MRA depicted 84% of the stenoses of the proximal renal artery greater than 50% in diameter. Renal artery stenoses greater than 50% and more than 15 mm in distance from the aorta were detected in 40% of cases with the 2-D TOF sequence and in 76% with the 3-D PC technique (p<0.05). the rate of false-negative results was 32%. Conclusion: PC MRA is better at visualizing stenoses in the middle segment of the renal arteries and supplements conventional TOF techniques with additional information. However, even when the two techniques are combined, the false-negative rate in the MR imaging of stenoses of the renal arteries still needs to be reduced.

Non-Invasive Assessment of Renal Artery Stenosis: Current Concepts and Future Directions in Magnetic Resonance Angiography

1999 ◽  
Vol 23 ◽  
pp. S111-S117 ◽  
Author(s):  
Michael V. Knopp ◽  
Frank Floemer ◽  
Stephan O. Schoenberg ◽  
Hendrik von Tengg-Kobligk ◽  
Michael Bock ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Magnetic Resonance Angiography ◽  
Renal Artery ◽  
Renal Artery Stenosis ◽  
Artery Stenosis ◽  
Future Directions ◽  
Non Invasive
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