A prospective study of carbon dioxide-digital subtraction vs standard contrast arteriography in the evaluation of the renal arteries.
OBJECTIVE
To compare carbon dioxide-digital subtraction arteriographic (CO2-DSA) images of renal artery anatomy with standard iodinated contrast arteriographic (ICA) images.


METHODS
One hundred patients with vascular disease who required abdominal aortography were evaluated by both CO2-DSA and ICA modalities. Two blinded readers interpreted arteriograms for the degree of renal artery stenosis, and a third reader was employed to resolve differences in reader interpretations.


METHODS
University medical center.


METHODS
The sensitivity, specificity, negative predictive value, positive predictive value, and accuracy were calculated for the ability of CO2-DSA to demonstrate a 60% or greater stenosis of the main renal artery; kappa values for CO2-DSA and ICA were calculated to assess intraobserver variability.


RESULTS
Of the 200 main renal arteries imaged, 17 (9 by means of CO2-DSA), 8 means of ICA) were eliminated because of inadequate visualization of the renal artery. In identifying a renal artery stenosis of 60% or greater, CO2-DSA had a sensitivity of 0.83, specificity of 0.99, positive predictive value of 0.94, and negative predictive value of 0.98. The overall accuracy was 0.97. The kappa was 0.75 for CO2-DSA and 0.70 for ICA, hence, the variation in the interpretations of CO2-DSA and ICA were comparable.


CONCLUSIONS
Images by means of CO2-DSA accurately reflect pathologic changes in renal arteries and are thus useful in the diagnosis of clinically occult occlusive renal artery disease in patients at risk of contrast medium-related nephrotoxicity.
Schreier
D Z
DZ
Department of Surgery, University of Southern California School of Medicine, Los Angeles, USA.
Weaver
F A
FA
Frankhouse
J
J
Papanicolaou
G
G
Shore
E
E
Yellin
A E
AE
Harvey
F
F
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D015901:Angiography, Digital Subtraction; D002245:Carbon Dioxide; D003287:Contrast Media; D005260:Female; D006801:Humans; D007457:Iodine Radioisotopes; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012077:Renal Artery / Q000000981:diagnostic imaging*; D012078:Renal Artery Obstruction / Q000000981:diagnostic imaging*
D003287:Contrast Media; D007457:Iodine Radioisotopes; D002245:Carbon Dioxide