Non-invasive renal artery duplex ultrasound and computerized nuclear renography to screen for and follow progress in renal artery stenosis

Hawkins, Peter G.; McKnoulty, Leanne M.; Gordon, Richard D.; Klemm, Shelley A.; Tunny, Terry J.

doi:10.1097/00004872-198900076-00088

Cited by 17 publications

(5 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…An RAR of > 3.5 indicates an over 60 % RAS with a sensitivity of 84–91 % and a specificity of 95–97 % [ 16 , 17 , 22 , 47 ]. Recent studies were unable to confirm this accuracy, working instead with sensitivities of 73–84 %, specificities of 72–81 % and accuracies of 76–78 % [ 1 , 42 ].…”

Section: Significance Of Color-coded Duplex Sonography In the Detectimentioning

confidence: 99%

Ultrasound diagnostics of renal artery stenosis

et al. 2015

View full text Add to dashboard Cite

Background and purposeAs a non-invasive, side effect-free and cost-effective method, ultrasonography represents the method of choice for the diagnosis of renal artery stenosis. Four different criteria in total, including two direct criteria in peak systolic velocity (PSV) and renal aortic ratio (RAR) and two indirect criteria in resistance index (RI) and acceleration time (AT) for the measurement of relevant renal artery stenosis are described, each demonstrating highly variable accuracy in studies. Furthermore, there is controversy over the degree beyond which stenosis becomes therapeutically relevant and which ultrasound PSV is diagnostically relevant in terms of stenosis grading.Material and methodsThis article gives a critical review based on a selective literature search on measurement methodology and the validity of ultrasound in renal artery stenosis. A critical evaluation of methods and a presentation of measurement principles to establish the most precise measurement method possible compared with the gold standard angiography, as well as an evaluation of the importance of computed tomography angiography (CTA) and magnetic resonance angiography (MRA).Results and conclusionsThe PSV provides high sensitivity and specificity as a direct measurement method in stenosis detection and grading. Most studies found sensitivities and specificities of 85–90 % for > 50 % stenosis at a PSV > 180–200 cm/s in ROC curve analysis. Other methods, such as the ratio of the PSV in the aorta to the PSV in the renal artery (RAR) or indirect criteria, such as side to side differences in RI (dRI) or AT can be additionally used to improve accuracy. Contrast-enhanced ultrasound improves accuracy by means of echo contrast enhancement. Although in the past only high-grade stenosis was considered relevant for treatment, a drop in pressure of > 20 mmHg in > 50 % stenosis (PSV 180 cm/s) is classified as relevant for increased renin secretion. Stenosis in fibromuscular dysplasia can be reliably graded according to the continuity equation. Although the available studies on the grading of in-stent restenosis are the subject of controversy, there is a tendency to assume higher cut-off values for PSV and RAR. Whilst MRA and CTA demonstrate an accuracy of > 90 %, this is at the cost of possible side effects for patients, particularly in the case of pre-existing renal parenchymal damage.Additional online materialThis article includes two additional video sequences on visualizing renal artery stenosis. This supplemental material can be found under: dx.doi.org/10.1007/s00772-015-0060-3

show abstract

Section: Significance Of Color-coded Duplex Sonography In the Detectimentioning

confidence: 99%

Ultrasound diagnostics of renal artery stenosis

et al. 2015

View full text Add to dashboard Cite

show abstract

“…For screening, DU is a safe, inexpensive, and widely available imaging technique, characterized by relatively high sensitivity (85-94%) and specificity (81-92%) for RAS diagnosis. [35][36][37][38] Among patients with a RAR below 3.5, significant RAS is highly unlikely. A RAR above 3.5 strongly correlates with above 60% RAS on invasive angiography.…”

Section: Discussionmentioning

confidence: 99%

A new threshold for kidney asymmetry improves association with abnormal renal-aortic ratio for diagnosis of renal artery stenosis

et al. 2022

View full text Add to dashboard Cite

Background: Renal artery stenosis (RAS) reflects more widespread atherosclerosis deposition and is associated with high morbidity and mortality. According to the guidelines, a discrepancy in the size of the kidneys of over 15 mm found in an ultrasound should initiate the RAS diagnostic algorithm. This study aims to find the optimal threshold for renal asymmetry that better reflects the frequency of a significantly abnormal renal-aortic ratio (RAR), justifying further RAS diagnostic workup, than the currently used cut-off of 15 mm difference in renal diameters. Methods: The analysis included 1175 patients (mean age: 52 years, IQR: 38–66, men/women: 597/578) who underwent Doppler ultrasonography screening of renal arteries with recorded kidney size and RAR calculation. Ultrasound features of RAS were defined as a RAR greater than 3.5 or signs of renal artery occlusion. Receiver operating characteristic (ROC) curves were created and analyzed for absolute differences in kidney size and abnormal RAR. We calculated the area under the curve (AUC) and optimal cut-off values for sensitivity and specificity analysis. Results: The final analysis included 169 patients with a significant difference in renal dimension. RAS features were met in 61 patients. According to ROC curve analysis, the optimal index of renal asymmetry was 12 mm. The sensitivity and specificity for this method were 82.0% and 83.3%, respectively, and AUC was 86.3%. Conclusion: Changing the definition of a significant difference in kidney size from 15 mm to 12 mm increases sensitivity and specificity for abnormal RAR and this finding may accelerate the diagnosis of RAS.

show abstract

“…Several Doppler parameters have been proposed for the diagnosis of Ͼ60% RAS. Initially, several authorities used the PSV of the renal artery 15,17,34 or RAR, [5][6][7]17 or both, and presently, these parameters are the most frequently used. Others, such as pulsatility index 35 or renal resistive index, have been proposed as alternatives.…”

Section: Discussionmentioning

confidence: 99%

“…Since its early introduction in detecting RAS, [4][5][6] several published studies have reported differing results of RDU imaging in detecting significant RAS using different Doppler parameters. [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] One of the most reliable Doppler parameters is based on the renal-to-aortic systolic ratio (RAR). An RAR Ͼ3.5 predicts Ն60% RAS with a sensitivity of 84% to 91% and a specificity of 95% to 97%.…”

mentioning

confidence: 99%

“…An RAR Ͼ3.5 predicts Ն60% RAS with a sensitivity of 84% to 91% and a specificity of 95% to 97%. [5][6][7][8] Meanwhile, several others reported the value of renal peak systolic velocities (PSVs) ranging from 100 to 200 cm/s with different accuracies. 8,[14][15][16] Presently, there is no consensus on specific RDU criteria for the diagnosis of significant RAS.…”

mentioning

confidence: 99%

See 1 more Smart Citation