Evaluation of renal artery stenosis by magnetic resonance angiography.
BACKGROUND
Accurate identification of patients with surgically correctable renovascular hypertension has been difficult by noninvasive means. Advances in the technique of magnetic resonance angiography (MRA) have begun to provide detailed, accurate imaging of the vascular system. This study reports our recent experience in the evaluation of the renal arteries by this technique.


METHODS
MRA and contrast arteriography were performed in 32 arteries (16 adult patients) for evaluation of hypertension, abdominal aortic aneurysm, mesenteric vascular disease, and aorto-iliac occlusive disease. Luminal diameter reduction (%) was determined from two-dimensional time-of-flight (TOF) axial images. Contrast arteriography served as the gold standard for comparison.


RESULTS
Contrast arteriography revealed a 50% or greater stenosis in 11 of 32 vessels studied (34%). As a screening test for detection of greater than 50% diameter reduction, MRA had a sensitivity of 91%, a negative predictive value of 94%, and an overall accuracy of 81%. Linear regression analysis demonstrated significant correlation between MRA and arteriographic measurements (r = 0.8; P < 0.001).


CONCLUSIONS
This study demonstrates the ability of MRA to accurately assess the main renal arteries for the presence of critical stenosis. This noninvasive evaluation compares well with conventional angiography and may have increasing application in the screening of patients with suspected renovascular disease.
Hertz
S M
SM
Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia.
Holland
G A
GA
Baum
R A
RA
Haskal
Z J
ZJ
Carpenter
J P
JP
D000328:Adult; D001014:Aortic Aneurysm / Q000175:diagnosis*; D001157:Arterial Occlusive Diseases / Q000175:diagnosis*; D003287:Contrast Media; D005188:False Negative Reactions; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D006978:Hypertension, Renovascular / Q000175:diagnosis* / Q000209:etiology; D007083:Iliac Artery / Q000473:pathology*; D008279:Magnetic Resonance Imaging; D008297:Male; D008641:Mesenteric Vascular Occlusion / Q000175:diagnosis*; D008875:Middle Aged; D015588:Observer Variation; D011237:Predictive Value of Tests; D012044:Regression Analysis; D012077:Renal Artery / Q000473:pathology*; D012078:Renal Artery Obstruction / Q000175:diagnosis*; D015203:Reproducibility of Results
D003287:Contrast Media