Noninvasive assessment of renal artery stenosis: current imaging protocols and future directions in ultrasonography.
Doppler ultrasound is one of many modalities that have been evaluated for the detection of renal artery stenosis. The lack of standardization in examination protocols and diagnostic criteria, as well as the wide differences in reported accuracy among different laboratories have, however, prevented universal acceptance of this technique as a reliable screening test for renal artery stenosis. The recent introduction of ultrasound contrast agents has substantially expanded the potential of color Doppler ultrasound. The use of microbubble echoenhancers in combination with harmonic Doppler imaging has been shown to improve diagnostic confidence by improving the operator's ability to visualize the renal arteries, and to significantly reduce the number of equivocal examinations. Moreover, contrast-enhanced Doppler ultrasound can provide functional information through analysis of renal time-intensity wash in/wash out curves. State-of-the-art contrast-enhanced Doppler ultrasound seems to have the potential to become a useful screening test for patients at risk from renovascular hypertension.
Lencioni
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Division of Diagnostic and Interventional Radiology, University of Pisa, Italy. Lencioni@do.med.unipi.it
Pinto
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Napoli
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Bartolozzi
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D001783:Blood Flow Velocity; D003287:Contrast Media / Q000008:administration & dosage; D003937:Diagnosis, Differential; D005544:Forecasting; D006801:Humans; D006978:Hypertension, Renovascular / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology; D007275:Injections, Intravenous; D017410:Practice Guidelines as Topic; D012077:Renal Artery / Q000000981:diagnostic imaging*; D012078:Renal Artery Obstruction / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology; D015203:Reproducibility of Results; D018615:Ultrasonography, Doppler, Color / Q000379:methods* / Q000592:standards
D003287:Contrast Media