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Huang Y, Zhang B, Zheng J, Ma X, Zhang S, Chen Q. Diagnostic Performance of Magnetic Resonance Angiography for Artery Stenosis After Kidney Transplant: A Systematic Review and Meta-Analysis. Acad Radiol 2023; 30:2021-2030. [PMID: 37076370 DOI: 10.1016/j.acra.2023.02.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 02/27/2023] [Accepted: 02/27/2023] [Indexed: 04/21/2023]
Abstract
RATIONALE AND OBJECTIVES Magnetic resonance angiography (MRA) is used to diagnose artery stenosis after kidney transplant. However, there is a lack of applicable consensus guidelines, and the diagnostic value of this technique is unclear. Therefore, the aim of the present study was to evaluate the diagnostic performance of MRA for the detection of artery stenosis after kidney transplant. MATERIALS AND METHODS We searched PubMed, Web of Science, Cochrane Library, and Embase from database inception to September 1, 2022. Two independent reviewers assessed the methodological quality of eligible studies using the quality assessment of diagnostic accuracy studies-2 tool. The diagnostic odds ratio, pooled sensitivity, and specificity values, positive likelihood ratios, and negative likelihood ratios were calculated to synthesize data with a bivariate random-effects model. Meta-regression analysis was performed in cases of high among-study heterogeneity. RESULTS Eleven studies were included in the meta-analysis. The area under the summary receiver operating characteristic curve was 0.96 (95% confidence interval [CI]: 0.94-0.98). The pooled sensitivity and specificity values for MRA in diagnosing artery stenosis after kidney transplant were 0.96 (95% CI: 0.76-0.99) and 0.93 (95% CI: 0.86-0.96), respectively. CONCLUSION MRA demonstrated high sensitivity and specificity for diagnosing artery stenosis after kidney transplant, suggesting that it may be used reliably in clinical practice. However, further large-scale studies are required to validate the present findings.
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Affiliation(s)
- Yao Huang
- Department of Radiology, The First Affiliated Hospital of Jinan University, No. 613 Huangpu West Road Tianhe District, Guangzhou, Guangdong, 510627 China (Y.H., B.Z., J.Z., X.M., S.Z., Q.C.)
| | - Bin Zhang
- Department of Radiology, The First Affiliated Hospital of Jinan University, No. 613 Huangpu West Road Tianhe District, Guangzhou, Guangdong, 510627 China (Y.H., B.Z., J.Z., X.M., S.Z., Q.C.)
| | - Jieling Zheng
- Department of Radiology, The First Affiliated Hospital of Jinan University, No. 613 Huangpu West Road Tianhe District, Guangzhou, Guangdong, 510627 China (Y.H., B.Z., J.Z., X.M., S.Z., Q.C.)
| | - Xiao Ma
- Department of Radiology, The First Affiliated Hospital of Jinan University, No. 613 Huangpu West Road Tianhe District, Guangzhou, Guangdong, 510627 China (Y.H., B.Z., J.Z., X.M., S.Z., Q.C.)
| | - Shuixing Zhang
- Department of Radiology, The First Affiliated Hospital of Jinan University, No. 613 Huangpu West Road Tianhe District, Guangzhou, Guangdong, 510627 China (Y.H., B.Z., J.Z., X.M., S.Z., Q.C.)
| | - Qiuying Chen
- Department of Radiology, The First Affiliated Hospital of Jinan University, No. 613 Huangpu West Road Tianhe District, Guangzhou, Guangdong, 510627 China (Y.H., B.Z., J.Z., X.M., S.Z., Q.C.).
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Hicks CW, Clark TW, Cooper CJ, de Bhailís ÁM, De Carlo M, Green D, Małyszko J, Miglinas M, Textor SC, Herzog CA, Johansen KL, Reinecke H, Kalra PA. Atherosclerotic Renovascular Disease: A KDIGO (Kidney Disease: Improving Global Outcomes) Controversies Conference. Am J Kidney Dis 2022; 79:289-301. [PMID: 34384806 PMCID: PMC9834909 DOI: 10.1053/j.ajkd.2021.06.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 06/23/2021] [Indexed: 02/03/2023]
Abstract
The diagnosis and management of atherosclerotic renovascular disease (ARVD) is complex and controversial. Despite evidence from the ASTRAL (2009) and CORAL (2013) randomized controlled trials showing that percutaneous renal artery revascularization did not improve major outcomes compared with best medical therapy alone over 3-5 years, several areas of uncertainty remain. Medical therapy, including statin and antihypertensive medications, has evolved in recent years, and the use of renin-angiotensin-aldosterone system blockers is now considered the primary means to treat hypertension in the setting of ARVD. However, the criteria to identify kidneys with renal artery stenosis that have potentially salvageable function are evolving. There are also data suggesting that certain high-risk populations with specific clinical manifestations may benefit from revascularization. Here, we provide an overview of the epidemiology, diagnosis, and treatment of ARVD based on consensus recommendations from a panel of physician experts who attended the recent KDIGO (Kidney Disease: Improving Global Outcomes) Controversies Conference on central and peripheral arterial diseases in chronic kidney disease. Most focus is provided for contentious issues, and we also outline aspects of investigation and management of ARVD that require further research.
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Sharma S, Henkin S, Young MN. Renovascular Disease and Mesenteric Vascular Disease. Cardiol Clin 2021; 39:527-537. [PMID: 34686265 DOI: 10.1016/j.ccl.2021.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Renal artery stenosis is caused by atherosclerosis and fibromuscular dysplasia and is associated with ischemic nephropathy, renovascular hypertension, and accelerated cardiovascular disease. Routine screening for renal artery stenosis is not recommended but is reasonable in patients who have rapid onset of hypertension, resistant hypertension, progressive renal insufficiency, recurrent pulmonary edema, or repeat admissions for heart failure. Acute mesenteric ischemia is caused by arterial embolism or thrombosis, mesenteric venous thrombosis, or nonocclusive mesenteric ischemia, whereas chronic mesenteric ischemia is most often caused by arterial obstruction. This article reviews the epidemiology, pathophysiology, diagnosis, and management of these two conditions.
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Affiliation(s)
- Swapna Sharma
- The Elliot Hospital, 1 Elliot Way, Manchester, NH 03103, USA
| | - Stanislav Henkin
- Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH 03756, USA
| | - Michael N Young
- Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH 03756, USA.
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Shirish S, Wajanat J, Hosam M, Sheila R, David D. Abdominal arterial lesions associated with antiphospholipid antibodies: A comparative cross sectional magnetic resonance angiography study. Rheumatology (Oxford) 2021; 61:658-666. [PMID: 33956948 DOI: 10.1093/rheumatology/keab400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 04/27/2021] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Case reports and small case series suggest that stenotic lesions of the renal, coeliac and mesenteric arteries may occur in the antiphospholipid syndrome (APS) resulting in clinical consequences such as hypertension and abdominal angina. OBJECTIVE To determine the prevalence of stenotic lesions in arteries arising from the middle aorta in patients with antiphospholipid antibodies (aPL) compared with healthy, hypertensive and atherosclerotic controls. PATIENTS AND METHODS In a cross-sectional comparative radiological study using magnetic resonance angiography (MRA) we assessed 5 groups of subjects for the prevalence of stenotic lesions in arteries arising from the middle aorta: APS/aPL positive, healthy renal donors, patients with hypertension, patients with atherosclerosis defined radiologically and patients with systemic lupus erythematosus and vasculitis who were negative for aPL. All subjects underwent MRA in suspended respiration and images were assessed by 2 senior radiologists blinded to the clinical details. RESULTS In the atherosclerosis group, vascular stenotic lesions were more prevalent (71%) than in any other group (p≤ 0.000002). The prevalence of all stenotic lesions in aPL positive patients (33%) was significantly higher than in the renal donors (18%) and hypertensive patients (19%) (p≤ 0.009). Renal artery stenosis was significantly more prevalent in aPL positive patients than in renal donors (p≤ 0.0006) but similar to the prevalence in hypertensive patients. Coeliac and/or mesenteric lesions were significantly more common in aPL positive patients vs hypertensive patients (p≤ 0.001). Stenoses did not correlate with traditional risk factors. CONCLUSION Arterial stenotic lesions in arteries arising from the middle aorta were highly prevalent in atherosclerotic subjects and were more common in aPL positive patients than hypertensive patients and healthy renal donors.
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Affiliation(s)
- Sangle Shirish
- Louise Coote Lupus Unit, 1st Floor, Counting House, Guy's Hospital, London, . SE1 9RT, UK
| | - Jan Wajanat
- Radiology Department, St Thomas' Hospital, London, SE1 7EH
| | - Matar Hosam
- Louise Coote Lupus Unit, 1st Floor, Counting House, Guy's Hospital, London, . SE1 9RT, UK
| | - Rankin Sheila
- Radiology Department, St Thomas' Hospital, London, SE1 7EH
| | - D'Cruz David
- Louise Coote Lupus Unit, 1st Floor, Counting House, Guy's Hospital, London, . SE1 9RT, UK
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Wang L, Zhu L, Li G, Zhang Y, Jiang Y, Shui B, Zhang X. Gadolinium-enhanced magnetic resonance versus computed tomography angiography for renal artery stenosis: A systematic review and meta-analysis. J Formos Med Assoc 2021; 120:1171-1178. [PMID: 33583703 DOI: 10.1016/j.jfma.2021.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 08/24/2020] [Accepted: 01/06/2021] [Indexed: 10/22/2022] Open
Abstract
Gadolinium-enhanced magnetic resonance angiography (MRA) and computed tomography angiography (CTA) are commonly used for diagnosing renal arterial stenosis (RAS); however, the diagnostic value is yet controversial. The aim of the study was to evaluate the diagnostic values of both methods. Electronic databases, including PubMed, Embase, and the Cochrane Library, were searched for studies, since inception until October 2017. A total of four articles involving 486 subjects were included in the analysis. The summary of sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and area under the receiver operating characteristic (ROC) (AUC) were 0.70, 0.82, 14.54, 0.29, 63.80, and 0.81 for MRA-based diagnosis of RAS, respectively. The pooled sensitivity, specificity, PLR, NLR, DOR, and AUC for CTA detecting RAS were 0.73, 0.96, 13.04, 0.29, 71.99, and 0.93, respectively. Gadolinium-enhanced MRA and CTA provide a satisfactory diagnostic accuracy, thereby playing a critical role in the diagnosis of RAS.
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Affiliation(s)
- Lisha Wang
- Radiology Department, Xiangyang NO.1 Hospital, The Affiliated Hospital of Hubei University of Medicine, Xiangyang, 441000, China
| | - Lei Zhu
- Cardiovascular Medicine Department, Xiangyang NO.1 Hospital, The Affiliated Hospital of Hubei University of Medicine, Xiangyang, 441000, China.
| | - Guang Li
- Xiangyang Ping an Healthcare Medical Imaging Co, Ltd, Xiangyang, 441000, China
| | - Yue Zhang
- Radiology Department, Xiangyang NO.1 Hospital, The Affiliated Hospital of Hubei University of Medicine, Xiangyang, 441000, China
| | - Yunyun Jiang
- Radiology Department, Xiangyang NO.1 Hospital, The Affiliated Hospital of Hubei University of Medicine, Xiangyang, 441000, China
| | - Bo Shui
- Radiology Department, Xiangyang NO.1 Hospital, The Affiliated Hospital of Hubei University of Medicine, Xiangyang, 441000, China
| | - Xian Zhang
- Radiology Department, Xiangyang NO.1 Hospital, The Affiliated Hospital of Hubei University of Medicine, Xiangyang, 441000, China
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Augustin AM, Welsch S, Bley TA, Lopau K, Kickuth R. Color-coded summation images in the evaluation of renal artery stenosis before and after percutaneous transluminal angioplasty. BMC Med Imaging 2021; 21:21. [PMID: 33568089 PMCID: PMC7874657 DOI: 10.1186/s12880-020-00540-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 12/20/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Endovascular therapy is the gold standard in patients with hemodynamic relevant renal artery stenosis (RAS) resistant to medical therapy. The severity grading of the stenosis as well as the result assessment after endovascular approach is predominantly based on visible estimations of the anatomic appearance. We aim to investigate the application of color-coded DSA parameters to gain hemodynamic information during endovascular renal artery interventions and for the assessment of the procedures´ technical success. METHODS We retrospectively evaluated 32 patients who underwent endovascular renal artery revascularization and applied color-coded summation imaging on selected monochromatic DSA images. The differences in time to peak (dTTP) of contrast enhancement in predefined anatomical measuring points were analyzed. Furthermore, differences in systolic blood pressure values (SBP) and serum creatinine were obtained. The value of underlying diabetes mellitus as a predictor for clinical outcome was assessed. Correlation analysis between the patients´ gender as well as the presence of diabetes mellitus and dTTP was performed. RESULTS Endovascular revascularization resulted in statistically significant improvement in 4/7 regions of interest. Highly significant improvement of perfusion in terms of shortened TTP values could be found at the segmental artery level and in the intrastenotical segment (p < 0.001), significant improvement prestenotical and in the apical renal parenchyma (p < 0.05). In the other anatomic regions, differences revealed not to be significant. Differences between SBP and serum creatinine levels before and after the procedure were significant (p = 0.004 and 0.0004). Patients´ gender as well as the presence of diabetes mellitus did not reveal to be predictors for the clinical success of the procedure. Furthermore, diabetes and gender did not show relevant correlation with dTTP in the parenchymal measuring points. CONCLUSIONS The supplementary use of color-coding DSA and the data gained from parametric images may provide helpful information in the evaluation of the procedures´ technical success. The segmental artery might be a particularly suitable vascular territory for analyzing differences in blood flow characteristics. Further studies with larger cohorts are needed to further confirm the diagnostic value of this technique.
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Affiliation(s)
- Anne Marie Augustin
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Würzburg, Germany.
| | - Stefan Welsch
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Würzburg, Germany
| | - Thorsten Alexander Bley
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Würzburg, Germany
| | - Kai Lopau
- Department of Internal Medicine, Division of Nephrology, University Hospital Würzburg, Würzburg, Germany
| | - Ralph Kickuth
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Würzburg, Germany
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Noncontrast Magnetic Resonance Angiography in the Era of Nephrogenic Systemic Fibrosis and Gadolinium Deposition. J Comput Assist Tomogr 2021; 45:37-51. [PMID: 32976265 DOI: 10.1097/rct.0000000000001074] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
ABSTRACT Gadolinium-based contrast agents for clinical magnetic resonance imaging are overall safe. However, the discovery of nephrogenic systemic fibrosis in patients with severe renal impairment and gadolinium deposition in patients receiving contrast have generated developments in contrast-free imaging of the vasculature, that is, noncontrast magnetic resonance angiography. This article presents an update on noncontrast magnetic resonance angiography techniques, with comparison to other imaging alternatives. Potential benefits and challenges to implementation, and evidence to date for various clinical applications are discussed.
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Prince M, Tafur JD, White CJ. When and How Should We Revascularize Patients With Atherosclerotic Renal Artery Stenosis? JACC Cardiovasc Interv 2020; 12:505-517. [PMID: 30898248 DOI: 10.1016/j.jcin.2018.10.023] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 09/19/2018] [Accepted: 10/01/2018] [Indexed: 01/21/2023]
Abstract
Atherosclerotic renal artery stenosis is the leading cause of secondary hypertension and may lead to resistant (refractory) hypertension, progressive decline in renal function, and cardiac destabilization syndromes (pulmonary edema, recurrent heart failure, or acute coronary syndromes) despite guideline-directed medical therapy. Although randomized controlled trials comparing medical therapy with medical therapy and renal artery stenting have failed to show a benefit for renal artery stenting, according to comparative effectiveness reviews by the Agency for Healthcare Research and Quality, the trials may not have enrolled patients with the most severe atherosclerotic renal artery stenosis, who would be more likely to benefit from renal stenting. Because of limitations of conventional angiography, it is critical that the hemodynamic severity of moderately severe (50% to 70%) atherosclerotic renal artery stenosis lesions be confirmed on hemodynamic measurement. The authors review techniques to optimize patient selection, to minimize procedural complications, and to facilitate durable patency of renal stenting. The authors also review the current American College of Cardiology and American Heart Association guidelines and the Society for Cardiovascular Angiography and Interventions appropriate use criteria as they relate to renal stenting.
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Affiliation(s)
- Marloe Prince
- Department of Cardiology at Ochsner Clinic Foundation, New Orleans, Louisiana.
| | - Jose D Tafur
- Department of Cardiology at Ochsner Clinic Foundation, New Orleans, Louisiana
| | - Christopher J White
- Department of Cardiology at Ochsner Clinic Foundation, New Orleans, Louisiana
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Villegas L, Cahill AM, Meyers K. Pediatric Renovascular Hypertension: Manifestations and Management. Indian Pediatr 2020. [DOI: 10.1007/s13312-020-1820-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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10
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Abstract
Atherosclerotic renal artery stenosis is the most common cause of secondary hypertension and may cause progressive renal disease and cardiac destabilization syndromes. Guideline-directed medical therapy is advised in all patients. Patients with refractory symptoms and hemodynamically significant stenoses are more likely to benefit from renal artery stent placement. Chronic mesenteric ischemia (CMI) is an infrequent and difficult to diagnose illness. Due to robust collateralization, clinical symptoms from mesenteric artery stenosis or occlusion is uncommon. Atherosclerosis is the most common etiology of CMI. Current evidence suggests that, compared with open surgical repair, endovascular therapy is the most cost-effective choice for CMI.
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Affiliation(s)
- Tamunoinemi Bob-Manuel
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Center, Ochsner Medical Center, The Ochsner Clinical School, University of Queensland, 1514 Jefferson Highway, New Orleans, LA 70121, USA
| | - Christopher J White
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Center, Ochsner Medical Center, The Ochsner Clinical School, University of Queensland, 1514 Jefferson Highway, New Orleans, LA 70121, USA; Department of Cardiology, Ochsner Medical Center, 3rd Floor, 1514 Jefferson Highway, New Orleans, LA 70121, USA.
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Abstract
ZusammenfassungErhöhter Blutdruck bleibt eine Hauptursache von kardiovaskulären Erkrankungen, Behinderung und frühzeitiger Sterblichkeit in Österreich, wobei die Raten an Diagnose, Behandlung und Kontrolle auch in rezenten Studien suboptimal sind. Das Management von Bluthochdruck ist eine häufige Herausforderung für Ärztinnen und Ärzte vieler Fachrichtungen. In einem Versuch, diagnostische und therapeutische Strategien zu standardisieren und letztendlich die Rate an gut kontrollierten Hypertoniker/innen zu erhöhen und dadurch kardiovaskuläre Erkrankungen zu verhindern, haben 13 österreichische medizinische Fachgesellschaften die vorhandene Evidenz zur Prävention, Diagnose, Abklärung, Therapie und Konsequenzen erhöhten Blutdrucks gesichtet. Das hier vorgestellte Ergebnis ist der erste Österreichische Blutdruckkonsens. Die Autoren und die beteiligten Fachgesellschaften sind davon überzeugt, daß es einer gemeinsamen nationalen Anstrengung bedarf, die Blutdruck-assoziierte Morbidität und Mortalität in unserem Land zu verringern.
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Aboyans V, Ricco JB, Bartelink MLEL, Björck M, Brodmann M, Cohnert T, Collet JP, Czerny M, De Carlo M, Debus S, Espinola-Klein C, Kahan T, Kownator S, Mazzolai L, Naylor AR, Roffi M, Röther J, Sprynger M, Tendera M, Tepe G, Venermo M, Vlachopoulos C, Desormais I. 2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS): Document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteriesEndorsed by: the European Stroke Organization (ESO)The Task Force for the Diagnosis and Treatment of Peripheral Arterial Diseases of the European Society of Cardiology (ESC) and of the European Society for Vascular Surgery (ESVS). Eur Heart J 2019; 39:763-816. [PMID: 28886620 DOI: 10.1093/eurheartj/ehx095] [Citation(s) in RCA: 1877] [Impact Index Per Article: 375.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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Louis R, Levy-Erez D, Cahill AM, Meyers KE. Imaging studies in pediatric fibromuscular dysplasia (FMD): a single-center experience. Pediatr Nephrol 2018; 33:1593-1599. [PMID: 29869115 PMCID: PMC6082421 DOI: 10.1007/s00467-018-3983-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 05/08/2018] [Accepted: 05/09/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND Fibromuscular dysplasia (FMD) is a non-inflammatory vascular disease that in children unlike in adults shows no sex predilection. FMD is often underdiagnosed, and its pathophysiology is unclear. Delayed diagnosis may lead to refractory hypertension and decreases the chance of successful treatment. Doppler ultrasound (US), magnetic resonance angiography (MRA), computed tomography angiography (CTA), and catheter-based angiography (angiography) are currently used to help make a clinicoradiological diagnosis of FMD. The main aim of the study was to compare the efficacy of imaging modalities which can allow for earlier and improved detection. Furthermore, an anatomical mapping of the location of lesions can help determine the best treatment modalities. METHODS All patients with non-syndromic non-inflammatory renovascular hypertension were recruited from the Nephrology Department at the Children's Hospital of Philadelphia (CHOP) and enrolled in the U.S. FMD Registry maintained at the University of Michigan. Clinical presentation and imaging findings on US, CT, and MRI of children diagnosed with FMD were evaluated. RESULTS Mean age at diagnosis was 7 ± 4.9 years (4 months-17 years). Family history of hypertension (HTN) (52%), FMD (8.7%), Caucasian (60%), headache (48%), and HTN (80%) were the most prevalent symptom and sign at presentation. Bruits were 100% specific for renal artery stenosis (RAS) diagnosis but were heard in the minority of patients (3 patients, 12%). FMD was mainly unifocal within a single site (68%) or multiple sites (28%) and involved the main or first order renal branch in about 68% of children. Isolated distal lesions beyond the second order branches were found in about 25% of children. US imaging was significantly less sensitive than angiography (28%, p = 0.003). MRA had a better sensitivity (62.5%, p = 0.3) than US. Overall, CTA had the best sensitivity (84.2%, p = 0.4) compared to angiography; however, only angiography showed distal vessel disease. CONCLUSIONS Limitations of the study include the sample size and biases-only patients diagnosed with FMD were included in this study and most patients were referred to a pediatric nephrologist for unexplained hypertension. Angiography should be performed as part of the initial work-up of any child suspected of having renovascular FMD, regardless of the findings seen on US, MRA, or CTA.
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Affiliation(s)
- Robert Louis
- Division of Nephrology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- University of Pennsylvania, Philadelphia, PA, USA
| | - Daniella Levy-Erez
- Division of Nephrology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
- University of Pennsylvania, Philadelphia, PA, USA.
| | - Anne Marie Cahill
- University of Pennsylvania, Philadelphia, PA, USA
- Interventional Radiology, Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Kevin E Meyers
- Division of Nephrology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- University of Pennsylvania, Philadelphia, PA, USA
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Taydas O, Kantarci M, Bayraktutan U, Ogul H. Supradiaphragmatic origin of the renal artery; frequency on contrast-enhanced MR imaging. Clin Imaging 2018; 52:152-156. [PMID: 30064025 DOI: 10.1016/j.clinimag.2018.07.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 07/05/2018] [Accepted: 07/23/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE The purpose of this study was to evaluate extremely rare cases of supradiaphragmatic origin of the renal artery, with magnetic resonance (MR) imaging findings. METHODS The study included 9 patients diagnosed with supra-diaphragmatic originating renal artery between 2010 and 2017. The patients were 7 females and 2 males with a mean age of 58.25 years (range, 41-71 years). MR imaging was applied to all patients. RESULTS In 2 patients, lumen loss was of a moderate degree, and mild in 3 patients. Renal artery stenosis was not observed in the remaining 4 patients. None of the patients had advanced luminal stenosis. The distance of the renal arteries to the diaphragmatic crus was 24 mm at the longest and 8 mm at the shortest. Congenital anomaly was found in 6 patients. Of the 9 patients, 7 had concomitant hypertension, and 2 had no history of hypertension. CONCLUSIONS The anomaly of supradiaphragmatic origin of the renal artery is rare but may be associated with renal artery stenosis, which may then result in hypertension. The clinician should investigate renal artery origin anomalies and renal artery compression syndrome in hypertensive cases where the cause cannot be explained.
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Affiliation(s)
- Onur Taydas
- Department of Radiology, Erzincan University Mengücek Gazi Training and Research Hospital, Erzincan, Turkey
| | - Mecit Kantarci
- Department of Radiology, Medical Faculty, Ataturk University, Erzurum, Turkey
| | | | - Hayri Ogul
- Department of Radiology, Medical Faculty, Ataturk University, Erzurum, Turkey.
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Vlachopoulos C, Georgakopoulos C, Koutagiar I, Tousoulis D. Diagnostic modalities in peripheral artery disease. Curr Opin Pharmacol 2018; 39:68-76. [PMID: 29549715 DOI: 10.1016/j.coph.2018.02.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 01/31/2018] [Accepted: 02/22/2018] [Indexed: 01/27/2023]
Abstract
Peripheral artery disease (PAD) affects approximately one in five persons older than 70 years of age and it is often present in patients with concomitant vascular disease in different body territories (e.g. coronary artery disease). Diagnosis at an early stage is important in order to achieve improvement in patient's symptoms and prognosis. Remarkable improvements in the field of noninvasive and invasive imaging techniques have led to an advanced level the management of patients with PAD. Throughout this review article, the clinically available diagnostic modalities in PAD are presented. Strong and weaker points are stressed out in a manner that elucidates that no perfect diagnostic method exists. Based on the patient's individual profile, as well as on certain aspects of the disease (e.g. morphology of carotid plaque lesions) the attending physician will ultimately decide which diagnostic path will lead to a prompt and correct diagnosis of PAD with the minimum amount of exams and risk for the patient.
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Affiliation(s)
- Charalambos Vlachopoulos
- Hypertension and Cardiometabolic Syndrome Unit, 1st Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece.
| | - Christos Georgakopoulos
- Hypertension and Cardiometabolic Syndrome Unit, 1st Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Iosif Koutagiar
- Hypertension and Cardiometabolic Syndrome Unit, 1st Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Dimitrios Tousoulis
- Hypertension and Cardiometabolic Syndrome Unit, 1st Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
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ACR Appropriateness Criteria® Renovascular Hypertension. J Am Coll Radiol 2017; 14:S540-S549. [DOI: 10.1016/j.jacr.2017.08.040] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 08/14/2017] [Indexed: 11/24/2022]
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Xu X, Lin X, Huang J, Pan Z, Zhu X, Chen K, Zee CS, Yan F. The capability of inflow inversion recovery magnetic resonance compared to contrast-enhanced magnetic resonance in renal artery angiography. Abdom Radiol (NY) 2017; 42:2479-2487. [PMID: 28470403 DOI: 10.1007/s00261-017-1161-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE To assess the capability of inflow inversion recovery (IFIR) magnetic resonance angiography (MRA), compared with contrast-enhanced MRA (CE-MRA) as reference standard, in evaluating renal artery stenosis (RAS). METHODS Seventy-two subjects were examined by IFIR MRA with respiratory-gated, prior to CE-MRA with a 1.5-T scanner. Two readers evaluated the quality of IFIR MRA images and renal artery depiction on artery-by-artery basis. The agreement of two methods to assess RAS was analyzed using the Kappa test. The relationship between image quality of IFIR MRA and respiratory rate was analyzed by ANOVA test. RESULTS The visibility of renal artery branch vessels was significantly higher using IFIR MRA than CE-MRA (p < 0.05). A good agreement of two methods in evaluating stenosis grade, and a near-perfect inter-observer agreement for IFIR MRA (Kappa value 0.98) and CE-MRA (Kappa value 0.93), were demonstrated. As RAS ≥50%, the sensitivity and specificity of IFIR MRA were 92 and 98% in reader 1, 93 and 98% in reader 2, respectively. The image quality was significantly better in patients with stable respiration (p < 0.01). CONCLUSIONS IFIR MRA in patients with stable respiration has higher visibility of renal artery branch vessels than CE-MRA, and a good agreement with CE-MRA in evaluating stenosis grade. It could be used to evaluate RAS for screening, and monitoring treatment.
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Editor's Choice - 2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg 2017; 55:305-368. [PMID: 28851596 DOI: 10.1016/j.ejvs.2017.07.018] [Citation(s) in RCA: 645] [Impact Index Per Article: 92.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Trautmann A, Roebuck DJ, McLaren CA, Brennan E, Marks SD, Tullus K. Non-invasive imaging cannot replace formal angiography in the diagnosis of renovascular hypertension. Pediatr Nephrol 2017; 32:495-502. [PMID: 27747454 DOI: 10.1007/s00467-016-3501-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 08/24/2016] [Accepted: 08/25/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Renovascular disease (RVD) is found in about 10 % of secondary childhood hypertension. Digital subtraction angiography (DSA) is the gold standard to diagnose RVD. Non-invasive imaging methods like Doppler ultrasound (US), magnetic resonance angiography (MRA), and computed tomography angiography (CTA) are increasingly used. Our aim was to evaluate the role and accuracy of US, MRA, and CTA compared to DSA in diagnosing RVD in children. PATIENTS AND METHODS A retrospective review of 127 children with suspected renovascular hypertension was performed in children referred to Great Ormond Street Hospital between 2006 and 2014 due to clinical suspicion of renovascular hypertension and/or findings on US and/or MRA or CTA. RESULTS Ninety-nine of 127 children (78 %) were diagnosed with renovascular disease and 80 were treated with percutaneous transluminal angioplasty during the same procedure. The median age at presentation was 5.6 (range, 2.5-10.6) years. Thirty-six children had unilateral renal artery stenosis in major extraparenchymal vessels, 47 bilateral stenosis and 16 intrarenal small vessel disease. US had a sensitivity of 63 % and specificity of 95 %. MRA and CTA were performed in 39 and 34 children, respectively. CTA sensitivity was slightly higher than that of MRA, 88 vs. 80 %, and specificity 81 vs. 63 %. CONCLUSIONS The sensitivity of MRA and CTA is still too low to reliably rule out renovascular disease in children with a strong suspicion of this diagnosis. DSA remains the gold standard to diagnose renovascular hypertension and is recommended when clinical and laboratory criteria are highly suggestive of renovascular disease even with normal radiological investigations from non-invasive methods.
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Affiliation(s)
- Agnes Trautmann
- Department of Pediatric Nephrology, Great Ormond Street Hospital for Children NHS Trust, London, UK
- Department of Pediatric Nephrology, University Center for Pediatrics and Adolescent Medicine, Heidelberg, Germany
| | - Derek J Roebuck
- Department of Radiology, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - Clare A McLaren
- Department of Radiology, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - Eileen Brennan
- Department of Pediatric Nephrology, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - Stephen D Marks
- Department of Pediatric Nephrology, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - Kjell Tullus
- Department of Pediatric Nephrology, Great Ormond Street Hospital for Children NHS Trust, London, UK.
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Abstract
Atherosclerotic renal artery stenosis is the leading cause of secondary hypertension; it can also cause progressive renal insufficiency and cardiovascular complications such as refractory heart failure and flash pulmonary edema. Medical therapy including risk factor modification, renin-angiotensin-aldosterone system antagonists, lipid lowering agents, and antiplatelet therapy is the first line of treatment in all patients. Patients with uncontrolled renovascular hypertension despite optimal medical therapy, ischemic nephropathy, and cardiac destabilization syndromes who have severe renal artery stenosis are likely to benefit from renal artery revascularization. Screening for renal artery stenosis can be done with Doppler ultrasonography, computed tomographic angiography and magnetic resonance angiography. Invasive physiologic measurements are useful to confirm the severity of renal hypoperfusion and therefore improve the selection patients likely to respond to renal artery revascularization. Primary patency exceeds 80% at 5 years and surveillance for in-stent restenosis can be done with periodic clinical, laboratory, and imaging follow-up.
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Accuracy of unenhanced magnetic resonance angiography for the assessment of renal artery stenosis. Eur J Radiol Open 2016; 3:200-6. [PMID: 27536710 PMCID: PMC4975703 DOI: 10.1016/j.ejro.2016.07.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 07/06/2016] [Accepted: 07/11/2016] [Indexed: 11/27/2022] Open
Abstract
Purpose To evaluate the accuracy of unenhanced magnetic resonance angiography (U-MRA) using balanced steady-state free precession (SSFP) sequences with inversion recovery (IR) pulses for the evaluation of renal artery stenosis. Materials and methods U-MRA was performed in 24 patients with suspected main renal artery stenosis. Two radiologists evaluated the quality of the imaging studies and the ability of U-MRA to identify hemodynamically significant main renal artery stenosis (RAS) defined as a stenosis ≥50% when compared to gold standard tests: contrast-enhanced magnetic resonance angiography (CE-MRA) (18 patients) or digital subtraction arteriography (DSA) (6 patients). Results A total of 44 main renal arteries were evaluated. Of them, 32 renal arteries could be assessed with U-MRA. When CE-MRA or DSA was used as the reference standard, nine renal arteries had hemodynamically significant RAS. U-MRA correctly identified eight out of nine arteries as having ≥50% RAS, and correctly identified 22 out of 23 arteries as not having significant RAS, with a sensitivity of 88.8%, a specificity of 95.65%, positive and negative predictive value of 88.8% and 95.65%, respectively, and an accuracy of 93.75%. Renal artery fibromuscular dysplasia (FMD) was observed in the two misclassified arteries. Conclusion U-MRA is a reliable diagnostic method to depict normal and stenotic main renal arteries. U-MRA can be used as an alternative to contrast-enhanced magnetic resonance angiography or computer tomography angiography in patients with renal insufficiency unless FMD is suspected.
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Pediatric Body MR Angiography: Principles, Techniques, and Current Status in Body Imaging. AJR Am J Roentgenol 2015; 205:173-84. [DOI: 10.2214/ajr.14.13795] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Alexanderson-Rosas E, Berríos-Bárcenas E, Meave A, de la Fuente-Mancera JC, Oropeza-Aguilar M, Barrero-Mier A, Monroy-González ADG, Cruz-Mendoza R, Guinto-Nishimura GY. Novel contributions of multimodality imaging in hypertension: A narrative review. World J Hypertens 2015; 5:28-40. [DOI: 10.5494/wjh.v5.i2.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 12/05/2014] [Accepted: 03/05/2015] [Indexed: 02/06/2023] Open
Abstract
Hypertension is currently one of the most prevalent illnesses worldwide, and is the second most common cause of heart failure, only behind ischemic cardiomyopathy. The development of novel multimodality imaging techniques in recent years has broadened the diagnostic methods, risk stratification and monitoring of treatment of cardiovascular diseases available for clinicians. Cardiovascular magnetic resonance (CMR) has a great capacity to evaluate cardiac dimensions and ventricular function, is extremely useful in ruling-out ischemic cardiomyopathy, the evaluation of the vascular system, in making the differential diagnosis for resistant hypertension and risk stratification for hypertensive cardiomyopathy and constitutes today, the method of choice to evaluate left ventricular systolic function. Computed tomography (CT) is the method of choice for the evaluation of vascular anatomy, including coronary arteries, and is also able to provide both functional and structural information. Finally, nuclear cardiology studies have been traditionally used to evaluate myocardial ischemia, along with offering the capacity to evaluate ventricular, endothelial and cardiac innervation function; information that is key in directing the treatment of the patient. In this narrative review, the most recent contributions of multimodality imaging to the patient with hypertension (CMR, CT and nuclear cardiology) will be reviewed.
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Abstract
Atherosclerotic renovascular disease is the most common cause of secondary hypertension. The patients with renovascular disease are at increased risk for adverse cardiac outcomes. Recent trials comparing medical therapy alone to medical therapy with stenting are flawed, but lay to rest any existing debate that unselected revascularization is unwarranted; however, revascularization may be appropriate in high-risk populations. Defining an appropriate population for revascularization is an area of ongoing study. Furthermore, delivery of optimal medical therapy in this population is inadequate. This review describes recent developments in renal artery revascularization.
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Affiliation(s)
- Sharon S Choi
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
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Park SY, Kim CK, Kim E, Park BK. Noncontrast-enhanced magnetic resonance renal angiography using a repetitive artery and venous labelling technique at 3 T: comparison with contrast-enhanced magnetic resonance angiography in subjects with normal renal function. Eur Radiol 2014; 25:533-40. [DOI: 10.1007/s00330-014-3416-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Revised: 07/16/2014] [Accepted: 08/26/2014] [Indexed: 11/29/2022]
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Amarteifio E, Essig M, Böckler D, Attigah N, Schuster L, Demirel S. Comparison of gadofosveset (Vasovist(®)) with gadobenate dimeglumine (Multihance(®))-enhanced MR angiography for high-grade carotid artery stenosis. J Neuroradiol 2014; 42:236-44. [PMID: 24996569 DOI: 10.1016/j.neurad.2014.03.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Revised: 03/16/2014] [Accepted: 03/19/2014] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To prove superiority of blood pool contrast agent gadofosveset over conventional contrast agent gadobenate dimeglumine for assessment of stenotic internal carotid artery (ICA). METHODS Eleven patients with high-grade ICA stenosis (≥75%), confirmed by duplex sonography, underwent MR angiography (MRA) with gadofosveset and gadobenate dimeglumine. RESULTS Agreement in stenosis grade was reached in 7 of 10 stenotic ICAs. In two ICAs, gadobenate dimeglumine led to underestimation of stenosis grade. There was a significant difference in signal intensity (pre-/post-stenotic segments), showing higher values for gadofosveset (P<0.01; P<0.05). Impression of contrast intensity with gadofosveset was better in 8 ICAs and only in 1 ICA with gadobenate dimeglumine (P<0.05). CONCLUSION Gadofosveset-enhanced MR angiography may be superior for assessment of high-grade ICA stenosis compared with gadobenate dimeglumine MR angiography.
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Affiliation(s)
- E Amarteifio
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany; Department of Radiology, German Cancer Research Center (dkfz), Heidelberg, Germany
| | - M Essig
- Department of Radiology, University of Manitoba, GA216-820 Sherbrook Street, MB R3T 2N2 Manitoba, Winnipeg, Canada
| | - D Böckler
- Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, INF 110, 69120 Heidelberg, Germany
| | - N Attigah
- Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, INF 110, 69120 Heidelberg, Germany
| | - L Schuster
- Department of Radiology, German Cancer Research Center (dkfz), Heidelberg, Germany
| | - S Demirel
- Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, INF 110, 69120 Heidelberg, Germany.
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Abstract
Renal artery stenosis (RAS) is a frequently encountered problem in clinical practice. The disease encompasses a broad spectrum of pathophysiologies and is associated with three major clinical syndromes: ischemic nephropathy, hypertension, and destabilizing cardiac syndromes. The two most common etiologies are fibromuscular dysplasia and atherosclerotic renal artery disease with atherosclerotic disease accounting for the vast majority of cases. Atherosclerotic renovascular disease has considerable overlap with atherosclerotic disease elsewhere and is associated with a poor prognosis. A wide range of diagnostic modalities and treatment approaches for RAS are available to clinicians, and with the advent of endovascular interventions, selecting the best course for a given patient has only grown more challenging. Several clinical trials have demonstrated some benefit with revascularization but not to the extent that many had hoped for or expected. Furthermore, much of the existing data is only marginally useful given significant flaws in study design and inherent bias. There remains a need for further identification of subgroups and appropriate indications in hopes of maximizing outcomes and avoiding unnecessary procedures in patients who would not benefit from treatment. In recent decades, the study of RAS has expanded and evolved rapidly. In this review, we will attempt to summarize the amassed body of literature with a focus on the epidemiology of RAS including prevalence, overlap with other atherosclerotic disease, and prognosis. We will also outline existing diagnostic and treatment approaches available to clinicians as well as summarize the findings of several major clinical trials. Finally, we will offer our perspective on future directions in the field.
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Marshall RH, Schiffman MH, Winokur RS, Talenfeld AD, Siegel DN. Interventional Radiologic Techniques for Screening, Diagnosis and Treatment of Patients with Renal Artery Stenosis. Curr Urol Rep 2014; 15:414. [DOI: 10.1007/s11934-014-0414-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Tafur-Soto J, White CJ. Selecting patients likely to benefit from renal artery stenting. Interv Cardiol 2014. [DOI: 10.2217/ica.14.6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
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Turgutalp K, Kiykim A, Özhan O, Helvaci I, Ozcan T, Yildiz A. Comparison of diagnostic accuracy of Doppler USG and contrast-enhanced magnetic resonance angiography and selective renal arteriography in patients with atherosclerotic renal artery stenosis. Med Sci Monit 2013; 19:475-82. [PMID: 23778330 PMCID: PMC3692376 DOI: 10.12659/msm.889035] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background There 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/Methods We 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. Results Seventy-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. Conclusions CE-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.
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Affiliation(s)
- Kenan Turgutalp
- Department of Internal Medicine, Division of Nephrology, School of Medicine, Mersin University, Mersin, Turkey.
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Tanemoto M. Diagnosis and therapy of atheromatous renal artery stenosis. Clin Exp Nephrol 2013; 17:765-70. [PMID: 23529543 DOI: 10.1007/s10157-013-0792-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Accepted: 02/28/2013] [Indexed: 11/28/2022]
Abstract
Atheromatous renal artery stenosis (ARAS), a lesion of systemic atherosclerotic disease, is the leading cause of stenotic lesions in the renal artery, followed by fibromuscular dysplasia, a primary abnormality of the renal artery. As a result of several clinical trails, which failed to show an additional benefit of renal revascularization to medical therapy in ARAS, the treatment of ARAS has shifted, and renal revascularization is less commonly performed for ARAS. However, it is recognized that renal revascularization benefits some patients with ARAS. Advances in imaging modalities would allow more frequent detection of ARAS in a society with a growing elderly population, a group with an increased prevalence of systemic atherosclerotic disease. Therefore, it is imperative to identify the patients with ARAS who could benefit from renal revascularization. This review presents a strategy for the treatment of ARAS based on the results of our analysis.
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Affiliation(s)
- Masayuki Tanemoto
- Division of Nephrology, Department of Internal Medicine, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8605, Japan,
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Saw J, Ricci D, Starovoytov A, Fox R, Buller CE. Spontaneous Coronary Artery Dissection. JACC Cardiovasc Interv 2013; 6:44-52. [PMID: 23266235 DOI: 10.1016/j.jcin.2012.08.017] [Citation(s) in RCA: 288] [Impact Index Per Article: 26.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Revised: 08/20/2012] [Accepted: 08/22/2012] [Indexed: 01/25/2023]
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Johansson L, Kirchin MA, Ahlström H. Gadobenate dimeglumine (MultiHance) in MR angiography: an in-vitro phantom comparison with gadopentetate dimeglumine (Magnevist) at different concentrations. Acta Radiol 2012; 53:1112-7. [PMID: 23081961 DOI: 10.1258/ar.2012.120181] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Numerous clinical studies suggest that gadobenate dimeglumine is diagnostically superior to other gadolinium chelates for MR imaging applications, including contrast-enhanced MR angiography (CE-MRA). However, confirmatory in-vitro phantom studies have thus far been lacking. PURPOSE To evaluate the difference in signal intensity achieved with the high-relaxivity MR contrast agent gadobenate dimeglumine (MultiHance) relative to that achieved with the standard-relaxivity non-specific agent gadopentetate dimeglumine (Magnevist) at different concentrations using an in-vitro phantom study design. MATERIAL AND METHODS Test tubes with whole human blood were prepared with concentrations of gadobenate dimeglumine or gadopentetate dimeglumine ranging from 0 to 12 mM. A three-dimensional (3D) T1-weighted gradient echo sequence normally used for CE-MRA of the renal arteries was performed at flip angles of 25° and 35°. The signal-to-noise ratio (SNR) was calculated for all concentrations of both contrast agents. Furthermore a Look-Locker sequence was used and quantitative T1 mapping was performed for all the test tubes. The contrast agent concentration in the aorta was simulated using previously published data on T1 in the aorta during the first pass of a contrast agent. The differences between gadobenate dimeglumine and gadopentetate dimeglumine were compared at the simulated concentrations. RESULTS The SNR achieved with gadobenate dimeglumine was consistently greater than that achieved with gadopentetate dimeglumine at all concentrations. An improvement of 15-25% in SNR was obtained when increasing the flip angle from 25° to 35°. The relative improvement in SNR with gadobenate dimeglumine relative to gadopentetate dimeglumine ranged from 25-72% and was markedly greater at lower concentrations with a flip angle of 35°. CONCLUSION Our findings suggest that the relative benefit of gadobenate dimeglumine over gadopentetate dimeglumine for CE-MRA applications is greater at lower concentrations.
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Affiliation(s)
- Lars Johansson
- Department of Radiology, Uppsala University Hospital, Uppsala, Sweden
| | - Miles A Kirchin
- Worldwide Medical & Regulatory Affairs, Bracco Imaging SpA, Milan, Italy
| | - Håkan Ahlström
- Department of Radiology, Uppsala University Hospital, Uppsala, Sweden
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Update on Imaging for Suspected Renovascular Hypertension in Children and Adolescents. Curr Hypertens Rep 2012; 14:591-5. [DOI: 10.1007/s11906-012-0308-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Maceira AM, Mohiaddin RH. Cardiovascular magnetic resonance in systemic hypertension. J Cardiovasc Magn Reson 2012; 14:28. [PMID: 22559053 PMCID: PMC3372443 DOI: 10.1186/1532-429x-14-28] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2011] [Accepted: 05/06/2012] [Indexed: 12/28/2022] Open
Abstract
Systemic hypertension is a highly prevalent potentially modifiable cardiovascular risk factor. Imaging plays an important role in the diagnosis of underlying causes for hypertension, in assessing cardiovascular complications of hypertension, and in understanding the pathophysiology of the disease process. Cardiovascular magnetic resonance (CMR) provides accurate and reproducible measures of ventricular volumes, mass, function and haemodynamics as well as uniquely allowing tissue characterization of diffuse and focal fibrosis. In addition, CMR is well suited for exclusion of common secondary causes for hypertension. We review the current and emerging clinical and research applications of CMR in hypertension.
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Affiliation(s)
- Alicia M Maceira
- Cardiac Imaging Unit, ERESA Clinic, C/ Marqués de San Juan, 6, 46015, Valencia, Spain
| | - Raad H Mohiaddin
- Royal Brompton and Harefield NHS Foundation Trust, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
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Tola M, Yurdakul M, Ozbulbul NI. B-flow imaging for the measurement of residual lumen diameter of renal artery stenosis. JOURNAL OF CLINICAL ULTRASOUND : JCU 2012; 40:85-90. [PMID: 22065555 DOI: 10.1002/jcu.20892] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2011] [Accepted: 09/19/2011] [Indexed: 05/31/2023]
Abstract
BACKGROUND The aim of this study was to assess the accuracy and efficacy of B-flow imaging (BFI) in the diagnosis and measurement of renal artery stenosis (RAS) compared with color duplex ultrasonography (CDU) and digital subtraction angiography (DSA). METHODS Fifty-one consecutive patients with RAS diagnosed and measured with DSA were subsequently and independently examined with BFI for the measurement of residual lumen diameter, and with CDU for the measurement of peak systolic velocity and renal-aortic velocity ratio. The diagnostic performances of BFI and CDU in determining 60-99% RAS were compared by receiver operating characteristic curve analysis. The agreement between DSA and BFI stenosis measurements was evaluated with Bland-Altman method. RESULTS The area under curve was 0.983 for BFI and 0.959 for CDU, without a significant difference in diagnostic performances (p = 0.26). BFI yielded an 88% sensitivity and 94% specificity in the diagnosis of RAS with a 3% underestimation of RAS compared to DSA (95% confidence interval 1.4%, 4.6%). CONCLUSIONS BFI is an accurate method that minimally underestimates RAS. It might provide an additional benefit to CDU in patients with RAS.
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Affiliation(s)
- Muharrem Tola
- Turkiye Yuksek Ihtisas Hospital, Kizilay Sokak No. 4, 06100 Sihhiye, Ankara, Turkey
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Bley TA, Johnson KM, François CJ, Reeder SB, Schiebler ML, R Landgraf B, Consigny D, Grist TM, Wieben O. Noninvasive assessment of transstenotic pressure gradients in porcine renal artery stenoses by using vastly undersampled phase-contrast MR angiography. Radiology 2011; 261:266-73. [PMID: 21813739 DOI: 10.1148/radiol.11101175] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To compare noninvasive transstenotic pressure gradient (TSPG) measurements derived from high-spatial- and temporal-resolution four-dimensional magnetic resonance (MR) flow measurements with invasive measurements obtained from endovascular pressure wires with digital subtraction angiographic guidance. MATERIALS AND METHODS After Animal Care and Use Committee approval, bilateral renal artery stenosis (RAS) was created surgically in 12 swine. Respiratory-gated phase-contrast vastly undersampled isotropic projection (VIPR) MR angiography of the renal arteries was performed with a 1.5-T clinical MR system (repetition time, 11.4 msec; echo time [first echo], 3.7 msec; 18,000 projection angles; imaging volume, 260 × 260 × 200 mm; acquired isotropic spatial resolution, 1.0 × 1.0 × 1.0 mm; velocity encoding, 150 cm/sec). Velocities measured with phase-contrast VIPR were used to calculate TSPGs by using Navier-Stokes equations. These were compared with endovascular pressure measurements (mean and peak) performed by using fluoroscopic guidance with regression analysis. RESULTS In 19 renal arteries with an average stenosis of 62% (range, 0%-87%), there was excellent correlation between the noninvasive TSPG measurement with phase-contrast VIPR and invasive TSPG measurement for mean TSPG (R² = 95.4%) and strong correlation between noninvasive TSPG and invasive TSPG for the peak TSPG measures (R² = 82.6%). The phase-contrast VIPR-derived TSPG measures were slightly lower than the endovascular measurements. In four arteries with severe stenoses and one occlusion (mean, 86%; range, 75%-100%), the residual lumen within the stenosis was too small to determine TSPG with phase-contrast VIPR. CONCLUSION The unenhanced MR angiographic technique with phase-contrast VIPR allows for accurate noninvasive assessment of hemodynamic significance in a porcine model of RAS with highly accurate TSPG measurements.
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Affiliation(s)
- Thorsten A Bley
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53705-2275, USA
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Tapping CR, Thackeray AT, Bartlett RJV, Rowland-Hill C, Maliakal P. Evaluation of spinal dural arteriovenous fistulae with gadofosveset trisodium at 3 T (TRICKS and LAVA). Clin Radiol 2011; 66:865-8. [PMID: 21546012 DOI: 10.1016/j.crad.2011.02.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2010] [Revised: 02/04/2011] [Accepted: 02/15/2011] [Indexed: 11/16/2022]
Affiliation(s)
- C R Tapping
- Department of Radiology, Hull Royal Infirmary, Hull, UK
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Khoo MMY, Deeab D, Gedroyc WMW, Duncan N, Taube D, Dick EA. Renal artery stenosis: comparative assessment by unenhanced renal artery mra versus contrast-enhanced MRA. Eur Radiol 2011; 21:1470-6. [DOI: 10.1007/s00330-011-2086-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2010] [Revised: 12/01/2010] [Accepted: 01/03/2011] [Indexed: 11/30/2022]
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Abstract
Renovascular diseases are common conditions with important implications on cardiovascular morbidity and mortality. Renal artery stenosis (RAS) is present in 1-5% of patients with hypertension (HTN) in the US with the vast majority of caused by atherosclerosis. Atherosclerotic RAS is related not only to uncontrolled HTN, but also to renal dysfunction. Atherosclerotic RAS in the USA has been reported to account for approximately 14-16% of new patients requiring dialysis each year. Hence a concerted effort was made in the last decade to treat renovascular stenosis using newly developed endovascular therapies to improve cardiovascular morbidity and renal function. A review on new advances in the endovascular management of renal artery stenosis with low profile stents, embolic protection devices, and drug eluting stents is presented.
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McMahon CJ, Hennessy M, Boyle G, Feely J, Meaney JFM. Prevalence of renal artery stenosis in flash pulmonary oedema: determination using gadolinium-enhanced MRA. Eur J Intern Med 2010; 21:424-8. [PMID: 20816598 DOI: 10.1016/j.ejim.2010.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2009] [Revised: 03/08/2010] [Accepted: 04/12/2010] [Indexed: 10/19/2022]
Abstract
PURPOSE The primary purpose was to determine the prevalence of renal artery stenosis (RAS) in patients presenting with acute ("flash") pulmonary oedema (FPE), without identifiable cause using contrast-enhanced magnetic resonance angiography (CE-MRA) of renal arteries. A secondary goal was to correlate clinical parameters at presentation with the presence or absence of RAS. MATERIALS AND METHODS Patients presenting with acute pulmonary oedema without identifiable cause prospectively underwent CE-MRA. >50% renal artery stenosis was considered significant. Clinical parameters (blood pressure, serum creatinine, history of hypertension/hyperlipidaemia) were compared in patients with and without RAS using an unpaired t-test. Results expressed; mean (+/-SD). RESULTS 20 patients (4 male, 16 female, age 78.5+/-11 years) underwent CE-MRA. 9 patients (45%) had significant RAS (6 (30%) bilateral, 3 (15%) unilateral). Systolic BP was higher in patients with RAS (192+/-38 mm Hg) than those without (134+/-30 mm Hg) (p<.005). Diastolic BP was higher in patients with RAS (102+/-23 mm Hg) than those without (76+/-17 mm Hg) (p<.01). All patients with RAS and 6/11(55%) patients without RAS had a history of hypertension. No significant difference in creatinine or hyperlipidaemia history was observed. CONCLUSION The prevalence of RAS in patients presenting with FPE is 45%. The diagnosis should be considered in patients presenting with unexplained acute pulmonary oedema, particularly if hypertensive at presentation.
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Affiliation(s)
- Colm J McMahon
- Department of Diagnostic Imaging, St. James Hospital, Dublin 8, Ireland.
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Slanina M, Žižka J, Klzo L, Lojík M. Contrast-enhanced MR angiography utilizing parallel acquisition techniques in renal artery stenosis detection. Eur J Radiol 2010; 75:e46-50. [DOI: 10.1016/j.ejrad.2009.07.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2009] [Revised: 07/08/2009] [Accepted: 07/14/2009] [Indexed: 12/30/2022]
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Tullus K, Roebuck DJ, McLaren CA, Marks SD. Imaging in the evaluation of renovascular disease. Pediatr Nephrol 2010; 25:1049-56. [PMID: 19856000 PMCID: PMC2855432 DOI: 10.1007/s00467-009-1320-9] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2009] [Revised: 08/23/2009] [Accepted: 08/24/2009] [Indexed: 10/26/2022]
Abstract
Renovascular disease (RVD) is an important cause of hypertension in children, as it often is amenable to potentially curative treatment. Imaging aimed at finding RVD therefore needs to have high sensitivity so as not to miss important findings. Digital subtraction angiography is the gold standard investigation. Doppler ultrasonography, computed tomography (CT) angiography and magnetic resonance (MR) angiography can all be helpful, but none has, at present, high enough sensitivity to rule out RVD in a child with a suggestion of that diagnosis.
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Affiliation(s)
- Kjell Tullus
- Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London, WC1N 3JH, UK.
| | - Derek J. Roebuck
- Department of Radiology, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - Clare A. McLaren
- Department of Radiology, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - Stephen D. Marks
- Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London, WC1N 3JH UK
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Mantha M, Kumar SK, MacGinley R, Mount P, Roberts M, Mangos G. The CARI guidelines. Screening tests for diagnosis of renal artery stenosis. Nephrology (Carlton) 2010; 15 Suppl 1:S218-26. [PMID: 20591035 DOI: 10.1111/j.1440-1797.2009.01244.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Diagnosis and management of atherosclerotic renal artery stenosis: improving patient selection and outcomes. Nat Rev Cardiol 2009; 6:176-90. [PMID: 19234498 DOI: 10.1038/ncpcardio1448] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2008] [Accepted: 12/04/2008] [Indexed: 01/02/2023]
Abstract
Renal artery stenosis (RAS) is common among patients with atherosclerosis, and is found in 20-30% of individuals who undergo diagnostic cardiac catheterization. Renal artery duplex ultrasonography is the diagnostic procedure of choice for screening outpatients for RAS. Percutaneous renal artery stent placement is the preferred method of revascularization for hemodynamically significant RAS, and is favored over balloon angioplasty alone. Stent placement carries a class I recommendation for atherosclerotic RAS according to ACC and AHA guidelines. Discordance exists between the very high (>95%) procedural success rate and the moderate (60-70%) clinical response rate after renal stent placement, which is likely to be a result of poor selection of patients, inadequate angiographic assessment of lesion severity, and the presence of renal parencyhmal disease. Physiologic lesion assessment using translesional pressure gradients, and measurements of biomarkers (e.g. brain natriuretic peptide), or both, could enhance the selection of patients and improve clinical response rates. Long-term patency rates for renal stenting are excellent, with 5-year secondary patency rates greater than 90%. This Review will outline the clinical problem of atherosclerotic RAS and its diagnosis, and will critically assess treatment options and strategies to improve patients' outcomes.
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Free-Breathing Accelerated Gadolinium-Enhanced MR Angiography in the Diagnosis of Renovascular Disease. AJR Am J Roentgenol 2009; 192:1531-7. [DOI: 10.2214/ajr.08.1559] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Potthast S, Maki JH. Non–Contrast-Enhanced MR Imaging of the Renal Arteries. Magn Reson Imaging Clin N Am 2008; 16:573-84, vii. [DOI: 10.1016/j.mric.2008.07.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Gadofosveset (Vasovist®, Bayer Schering Pharma AG, Berlin/Germany) is the first intravascular contrast agent approved for use with magnetic resonance angiography in the European Union, Switzerland, Turkey, Canada, and Australia. Gadofosveset reversibly binds to albumin providing extended intravascular enhancement compared wth existing extracellular magnetic resonance contrast agents. Prior to approval, gadofosveset underwent extensive testing to evaluate the safety and efficacy of the drug; the clinical trials show that gadofosveset-enhanced magnetic resonance angiography (MRA) is safe and well tolerated in patients with vascular disease and effective for the detection of vascular stenosis and aneurysms gadofosveset has the potential to open new horizons in diagnostic MRA by increasing the spatial resolution and the robustness of MRA examinations and facilitating the examination of multiple vascular beds.
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Affiliation(s)
- Mathias Goyen
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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