Accuracy of computed tomographic angiography and magnetic resonance angiography for diagnosing renal artery stenosis.
BACKGROUND
Timely, accurate detection of renal artery stenosis is important because this disorder may be a potentially curable cause of hypertension and renal impairment.


OBJECTIVE
To determine the validity of computed tomographic angiography (CTA) and magnetic resonance angiography (MRA) compared with digital subtraction angiography (DSA) for detection of renal artery stenosis.


METHODS
Prospective multicenter comparative study conducted from 1998 to 2001. Two panels of 3 observers judged CTA and MRA image data and were blinded to all other results. Digital subtraction angiography images were evaluated by consensus.


METHODS
3 large teaching hospitals and 3 university hospitals in the Netherlands.


METHODS
402 hypertensive patients with suspected renal artery stenosis were included. A group of 356 patients who underwent all 3 diagnostic tests was used for analysis.


METHODS
Reproducibility was assessed by calculating interobserver agreement. Diagnostic performance was evaluated in terms of sensitivity, specificity, and other diagnostic variables. Atherosclerotic stenoses of 50% or greater and fibromuscular dysplasia were considered clinically relevant.


RESULTS
Twenty percent of patients who underwent all 3 tests had clinically relevant renal artery stenosis. Moderate interobserver agreement was found, with kappa values ranging from 0.59 to 0.64 for CTA and 0.40 to 0.51 for MRA. The combined sensitivity and specificity were 64% (95% CI, 55% to 73%) and 92% (CI, 90% to 95%) for CTA and 62% (CI, 54% to 71%) and 84% (CI, 81% to 87%) for MRA.


CONCLUSIONS
Eighteen percent of the patients were included nonconsecutively. Digital subtraction angiography may be an imperfect reference test.


CONCLUSIONS
Computed tomographic angiography and MRA are not reproducible or sensitive enough to rule out renal artery stenosis in hypertensive patients. Therefore, DSA remains the diagnostic method of choice. *For a list of the other investigators and research coordinators who participated in RADISH, see the Appendix.
Vasbinder
G Boudewijn C
GB
Cardiovascular Research Institute Maastricht (CARIM), Department of Radiology, Maastricht University Hospital, Maastricht, The Netherlands. vasbinder@rad.unimaas.nl
Nelemans
Patricia J
PJ
Kessels
Alfons G H
AG
Kroon
Abraham A
AA
Maki
Jeffrey H
JH
Leiner
Tim
T
Beek
Frederik J A
FJ
Korst
Michael B J M
MB
Flobbe
Karin
K
de Haan
Michiel W
MW
van Zwam
Willem H
WH
Postma
Cornelis T
CT
Hunink
M G Myriam
MG
de Leeuw
Peter W
PW
van Engelshoven
Jos M A
JM
D000328:Adult; D000368:Aged; D000792:Angiography / Q000379:methods*; D015901:Angiography, Digital Subtraction; D005260:Female; D006801:Humans; D006978:Hypertension, Renovascular / Q000209:etiology; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011446:Prospective Studies; D012015:Reference Standards; D012078:Renal Artery Obstruction / Q000150:complications / Q000175:diagnosis*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed