Distal vessel atherosclerosis as a cause for false-positive renal scintigraphy.
While captopril-enhanced renal scintigraphy is acknowledged to be a useful screening technique to detect clinically silent obstructive lesions of the main renal arteries, the presence of significant atherosclerosis of distal, smaller renal vessels as a cause of positive scintigraphy scans has not been reported extensively. In a retrospective 2-year analysis of 31 consecutive captopril-enhanced renal scintigrams, we found a total of 13 studies in 11 patients that were classified as "positive" for renal artery stenosis. Of these 11 patients with positive scintigraphic studies, 4 patients underwent 5 renal arteriography procedures; only 1 of these renal arteriograms showed significant stenosis of the main renal artery. In the other 4 cases, an angiographic pattern of diffuse intrarenal distal arterial disease correlated with scintigram lateralization. Angiography was also performed in 4 patients with negative captopril renal scintiscans. In each of these cases the arteriogram was also negative for significant renal artery stenosis, and only 1 patient had diffuse bilateral intrarenal arterial disease. We conclude that distal renal arterial narrowing should be considered in the differential diagnosis of lateralized renal scintigrams. A negative renal scintigraphic study may be more reliable for excluding significant main renal artery obstructive disease.
Cristol
L
L
Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, USA.
Walker
B
B
Henrich
W L
WL
D000328:Adult; D001161:Arteriosclerosis / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology; D002216:Captopril / Q000008:administration & dosage; D003937:Diagnosis, Differential; D005189:False Positive Reactions; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D011877:Radionuclide Imaging; D012077:Renal Artery / Q000000981:diagnostic imaging / Q000473:pathology; D012078:Renal Artery Obstruction / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
D002216:Captopril