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Year :2016
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Month :
July-August
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Volume :
5
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Issue :
3
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Page :
-
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Diagnostic Performance of the Modern Imaging Modalities in Renovascular Disease: An Evaluation
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Correspondence Address :
Surg Cdr Brijesh K Soni, Surg Cdr SN Singh,
Surg Cdr (Dr) Brijesh K Soni,
Cl Specialist (Radiodiagnosis), Department of Radiology,
Command Hospital Air Force, Bangalore- 560007, India.
E-mail: taureandoc@gmail.com
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Introduction: Introduction: Renal artery stenosis is a very important cause of Renovascular disease. Atherosclerosis has been identified as a most common etiology for renal artery stenosis. Long standing renal artery stenosis can cause irreversible changes in kidney hence, it is imperative to identify the disease at early stage and treat.
Aim: To evaluate the diagnostic accuracy of Color Doppler US, CT Angiography(CTA), and GD-enhanced MR Angiography (MRA) compared with digital subtraction angiography(DSA) for the detection of renal artery stenosis in patients with clinically suspected renovascular hypertension and to select the most appropriate noninvasive modality as alternate diagnostic tool compared with the invasive intra-arterial digital subtraction angiography.
Materials and Methods: Fifty patients were prospectively recruited from the internal medicine outpatient clinics over the period of two years. All the hypertensive patients between 20 and 80 years of age with an arterial systolic blood pressure over 140 mmHg and diastolic over 90 mmHg were screened for predefined clinical clues indicating renal artery stenosis. Patients who exhibited at least 1 clinical clue were included in the study. All the recruited patient further underwent Color Doppler US, CTA and GD-enhanced MRA followed by DSA. DSA was considered gold standard.
Results: Sensitivity, specificity, positive and negative predictive value for diagnosis of renal artery stenosis were 75%,90%, 60% and 95%, respectively, for color Doppler US; 90%, 93%,75%, and 97.9%, respectively, for CTA; and 90%,95%, 82%, and 98%, respectively, for GD-enhanced MRA.
Conclusion: Diagnostic accuracy of CTA and GD enhanced MRA is almost similar to exclude the renal artery stenosis. Color Doppler US can be used as screening modality and CTA or MRA to further confirm the findings or as primary investigating modality where color Doppler US findings were equivocal. DSA is considered gold standard hence it can be utilized for the case with disagreement or case where therapeutic interventions are indicated.
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