Impact of Levovist ultrasonographic contrast agent on the diagnosis and management of hypertensive patients with suspected renal artery stenosis: a Canadian multicentre pilot study.
OBJECTIVE
To compare the diagnoses obtained with unenhanced ultrasonography (US), contrast-enhanced US and captopril-enhanced renal scintigraphy and to determine whether use of a contrast agent improves ability to assess the renal arteries with duplex Doppler US.


METHODS
The study was an open-label controlled trial involving 78 patients with hypertension suspected to have a renovascular cause. The patients underwent captopril-enhanced scintigraphy or routine unenhanced US (the usual diagnostic methods at the centres where the study was conducted) and contrast-enhanced US (with Levovist, Berlex Canada, Lachine, Que.). The patients were followed for 3 months after the diagnostic tests were performed.


RESULTS
Enhanced US yielded a diagnosis for a significantly greater proportion of patients than did unenhanced US (77 [99%] v. 64 [82%] of 78 patients; p = 0.002) or captopril-enhanced scintigraphy (71 [99%] v. 58 [81%] of 72 patients; p = 0.002). Diagnosis was possible with both enhanced and unenhanced duplex Doppler US in only 64 (82%) of the 78 patients, and the diagnosis was the same with both methods for 63 (98%) of these 64 patients. In contrast, diagnosis was possible for only 58 (81%) of the 72 patients who underwent both enhanced US and captopril-enhanced scintigraphy; the same diagnosis was reported in 53 (91%) of these 58 cases. During follow-up, 11 patients (21 kidneys) underwent angiography. Significant stenosis was detected in 6 (55%) of the patients (8 [38%] of the kidneys). Both the enhanced and unenhanced US results agreed more often with angiography than did captopril-enhanced scintigraphy (9 [82%] v. 8 [73%] of the 11 patients). The proportion of patients in whom the left and right renal artery could be assessed by duplex Doppler US increased significantly (by 58% and 43%, respectively) with use of the contrast agent.


CONCLUSIONS
Enhanced US had a higher rate of successful diagnosis than unenhanced US and captopril-enhanced renal scintigraphy. Enhanced US might therefore be suitable as a screening method for hypertensive patients with suspected renal artery stenosis.
Lacourcière
Yves
Y
Centre hospitalier de l'Université du Québec. Yves.Lacourciere@crchul.ulaval.ca
Lévesque
Jacques
J
Onrot
John M
JM
Wilson
Stephanie R
SR
Szaky
Esther
E
Thibodeau
Micheline
M
Vasilevsky
Murray L
ML
Dashefsky
Sidney M
SM
Allan
Donald R
DR
Lafortune
Michel
M
Vendeville
Benoît
B
Zaleski
Witold M
WM
Pagé
Denis E
DE
D'Onofrio
Franco
F
D000328:Adult; D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors; D002170:Canada; D002216:Captopril; D003287:Contrast Media / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D006978:Hypertension, Renovascular / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011134:Polysaccharides / Q000008:administration & dosage*; D011877:Radionuclide Imaging; D012078:Renal Artery Obstruction / Q000150:complications / Q000000981:diagnostic imaging*; D018616:Ultrasonography, Doppler, Duplex
D000806:Angiotensin-Converting Enzyme Inhibitors; D003287:Contrast Media; D011134:Polysaccharides; C059891:SHU 508; D002216:Captopril