Estimation of the Ratio of Renal Artery Stenosis with Magnetic Resonance Angiography Using Parallel Imaging Technique in Suspected Renovascular Hypertension

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Abstract

Background: Renovascular hypertension, which may lead to end-stage renal failure, necessitates prompt diagnosis and medication. Although various diagnostic tools exist for evaluation of renal arteries, magnetic resonance angiography (MRA), with the improvement of hardware and software systems, has become a very promising technique in screening patients with suspected renal hypertension. In this study, we aimed to assess renal artery stenosis on MRA in patients with suspected renovascular disease using a parallel imaging technique which allows faster scanning with higher resolution. Methods: Eighty-four patients with hypertension underwent MRA and digital angiography. Results: MRA detected renal artery stenosis with a sensitivity rate ranging from 69.3 to 100% and specificity rate ranging from 85.7 to 96%. Conclusion: Contrast-enhanced MRA of renal arteries is very effective in the demonstration of renal artery stenoses and assessment of stenosis ratio. Furthermore, parallel imaging technology has improved this procedure by reducing the scan time. Renal MRA, as a diagnostic tool, can accurately direct patients with renovascular disease to intravascular treatment.

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The effect of balloon angioplasty on hypertension in atherosclerotic renal-artery stenosis. Dutch Renal Artery Stenosis Intervention Cooperative Study Group.

H Pieterman, Tineke C. T. M. van der Pouw Kraan, Maite Huis in ‘t Veld … (2000)

Patients with hypertension and renal-artery stenosis are often treated with percutaneous transluminal renal angioplasty. However, the long-term effects of this procedure on blood pressure are not well understood. We randomly assigned 106 patients with hypertension who had atherosclerotic renal-artery stenosis (defined as a decrease in luminal diameter of 50 percent or more) and a serum creatinine concentration of 2.3 mg per deciliter (200 micromol per liter) or less to undergo percutaneous transluminal renal angioplasty or to receive drug therapy. To be included, patients also had to have a diastolic blood pressure of 95 mm Hg or higher despite treatment with two antihypertensive drugs or an increase of at least 0.2 mg per deciliter (20 micromol per liter) in the serum creatinine concentration during treatment with an angiotensin-converting-enzyme inhibitor. Blood pressure, doses of antihypertensive drugs, and renal function were assessed at 3 and 12 months, and patency of the renal artery was assessed at 12 months. At base line, the mean (+/-SD) systolic and diastolic blood pressures were 179+/-25 and 104+/-10 mm Hg, respectively, in the angioplasty group and 180+/-23 and 103+/-8 mm Hg, respectively, in the drug-therapy group. At three months, the blood pressures were similar in the two groups (169+/-28 and 99+/-12 mm Hg, respectively, in the 56 patients in the angioplasty group and 176+/-31 and 101+/-14 mm Hg, respectively, in the 50 patients in the drug-therapy group; P=0.25 for the comparison of systolic pressure and P=0.36 for the comparison of diastolic pressure between the two groups); at the time, patients in the angioplasty group were taking 2.1+/-1.3 defined daily doses of medication and those in the drug-therapy group were taking 3.2+/-1.5 daily doses (P<0.001). In the drug-therapy group, 22 patients underwent balloon angioplasty after three months because of persistent hypertension despite treatment with three or more drugs or because of a deterioration in renal function. According to intention-to-treat analysis, at 12 months, there were no significant differences between the angioplasty and drug-therapy groups in systolic and diastolic blood pressures, daily drug doses, or renal function. In the treatment of patients with hypertension and renal-artery stenosis, angioplasty has little advantage over antihypertensive-drug therapy.

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Aortoiliac and renal arteries: prospective intraindividual comparison of contrast-enhanced three-dimensional MR angiography and multi-detector row CT angiography.

Thomas Pfammatter, Juergen K Willmann, Simon Wildermuth … (2003)

To compare contrast material-enhanced three-dimensional (3D) magnetic resonance (MR) angiography and multi-detector row computed tomographic (CT) angiography in the same patients for assessment of the aortoiliac and renal arteries, with digital subtraction angiography (DSA) as the standard of reference. DSA, 3D MR angiography, and multi-detector row CT angiography were performed in 46 consecutive patients. A total of 769 arterial segments were analyzed for arterial stenosis by using a four-point grading system. Aneurysmal changes were noted. The time required for performing 3D reconstructions and image analysis of both MR and CT data sets was measured. Patient acceptance for each modality was assessed with a visual analogue scale. Statistical analysis of data was performed. Sensitivity of MR angiography for detection of hemodynamically significant arterial stenosis was 92% for reader 1 and 93% for reader 2, and specificity was 100% and 99%, respectively. Sensitivity of CT angiography was 91% for reader 1 and 92% for reader 2, and specificity was 99% and 99%, respectively. Differences between the two modalities were not significant. Interobserver and intermodality agreement was excellent (kappa = 0.88-0.90). The time for performance of 3D reconstruction and image analysis of CT data sets was significantly longer than that for MR data sets (P <.001). Patient acceptance was best for CT angiography (P =.016). There is no statistically significant difference between 3D MR angiography and multi-detector row CT angiography in the detection of hemodynamically significant arterial stenosis of the aortoiliac and renal arteries.

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High-spatial-resolution MR angiography of renal arteries with integrated parallel acquisitions: comparison with digital subtraction angiography and US.

Henrik Michaely, Stefan Schoenberg, Tobias Waggershauser … (2005)

To retrospectively compare three-dimensional gadolinium-enhanced magnetic resonance (MR) angiography, performed with an integrated parallel acquisition technique for high isotropic spatial resolution, with selective digital subtraction angiography (DSA) and intravascular ultrasonography (US) for accuracy of diameter and area measurements in renal artery stenosis. The study was approved by the institutional review board, and consent was obtained from all patients. Forty-five patients (17 women, 28 men; mean age, 62.2 years) were evaluated for suspected renal artery stenosis. Three-dimensional gadolinium-enhanced MR angiograms were acquired with isotropic spatial resolution of 0.8 x 0.8 x 0.9 mm in 23-second breath-hold with an integrated parallel acquisition technique. In-plane diameter of stenosis was measured along vessel axis, and perpendicular diameter and area of stenosis were assessed in cross sections orthogonal to vessel axis, on multiplanar reformations. Interobserver agreement between two radiologists in measurements of in-plane and perpendicular diameters of stenosis and perpendicular area of stenosis was assessed with mean percentage of difference. In a subset of patients, degree of stenosis at MR angiography was compared with that at DSA (n = 20) and intravascular US (n = 11) by using Bland-Altman plots and correlation analyses. Mean percentage of difference in stenosis measurement was reduced from 39.3% +/- 78.4 (standard deviation) with use of in-plane views to 12.6% +/- 9.5 with use of cross-sectional views (P < .05). Interobserver agreement for stenosis grading based on perpendicular area of stenosis was significantly better than that for stenosis grading based on in-plane diameter of stenosis (mean percentage of difference, 15.2% +/- 24.2 vs 54.9% +/- 186.9; P < .001). Measurements of perpendicular area of stenosis on MR angiograms correlated well with those on intravascular US images (r(2) = 0.90). Evaluation of cross-sectional images reconstructed from high-spatial-resolution three-dimensional gadolinium-enhanced MR renal angiographic data increases the accuracy of the technique and decreases interobserver variability. (c) RSNA, 2005.

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Journal

Journal ID (publisher-id): NEC

Journal ID (nlm-ta): Nephron Clin Pract

Journal ID (doi): 10.1159/issn.1660-2110

Title: Nephron Clinical Practice

Publisher: S. Karger AG

ISSN (Electronic): 1660-2110

Publication date Subscription-year: 2006

Publication date (Print): November 2006

Publication date (Electronic): 25 September 2006

Volume: 104

Issue: 4

Pages: c169-c175

Affiliations

Cukurova University Balcali Hospital, Adana, Turkey

Article

Publisher ID: 95852 Other ID: Nephron Clin Pract 2006;104:c169–c175

DOI: 10.1159/000095852

PubMed ID: 17003568

SO-VID: 3e67cfa9-439e-491e-9b7d-1ecf402e62af

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Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

History

Date received : 15 February 2006

Date accepted : 31 May 2006

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Figures: 4, Tables: 4, References: 30, Pages: 1

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Estimation of the Ratio of Renal Artery Stenosis with Magnetic Resonance Angiography Using Parallel Imaging Technique in Suspected Renovascular Hypertension

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Abstract

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Karger: Nephrology

Most cited references 14

The effect of balloon angioplasty on hypertension in atherosclerotic renal-artery stenosis. Dutch Renal Artery Stenosis Intervention Cooperative Study Group.

Aortoiliac and renal arteries: prospective intraindividual comparison of contrast-enhanced three-dimensional MR angiography and multi-detector row CT angiography.

High-spatial-resolution MR angiography of renal arteries with integrated parallel acquisitions: comparison with digital subtraction angiography and US.

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