Hemodynamic significance of renal artery stenosis: digital subtraction angiography versus systolically gated three-dimensional phase-contrast MR angiography.
OBJECTIVE
To compare digital subtraction angiography with three-dimensional phase-contrast magnetic resonance (MR) angiography in detection of significant renal artery stenosis.


METHODS
Sixteen patients underwent digital subtraction angiography and systolically gated three-dimensional phase-contrast MR angiography within 1 week. Scoring of stenosis on MR angiograms was based on presence and length of a flow void and quality of flow signal intensity in the distal part of the artery. Intraarterial pressure measurement was the reference standard for hemodynamically significant renal artery stenosis.


RESULTS
MR angiography depicted two of five patent accessory arteries. Comparison of digital subtraction angiography and MR angiography with intraarterial pressure measurements was possible in 25 main renal arteries. In 13 arteries, a pressure gradient of more than 15 mm Hg was found. Digital subtraction angiography depicted 10 of these stenoses (sensitivity, 77%; specificity, 92%). A flow void was present at MR angiography in eight stenoses (sensitivity, 62%; specificity, 83%). In 12 of the stenosed vessels, distal flow signal intensity was impaired at MR angiography (sensitivity, 92%; specificity, 75%). There was no difference between the two modalities (P > .05) in grading hemodynamic significance of renal artery stenosis.


CONCLUSIONS
Systolically gated MR angiography and digital subtraction angiography are equally effective in depicting hemodynamically significant stenoses in the main renal arteries. MR angiography, however, is not adequate in depiction of accessory renal arteries.
Wasser
M N
MN
Department of Diagnostic Radiology and Nuclear Medicine, Leiden University Hospital, The Netherlands.
Westenberg
J
J
van der Hulst
V P
VP
van Baalen
J
J
van Bockel
J H
JH
van Erkel
A R
AR
Pattynama
P M
PM
D000328:Adult; D000368:Aged; D015901:Angiography, Digital Subtraction; D001794:Blood Pressure; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D012077:Renal Artery / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D012078:Renal Artery Obstruction / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000503:physiopathology; D012680:Sensitivity and Specificity