Value of contrast-enhanced ultrasound for diagnosis and follow-up of renal artery stenosis in patients with chronic kidney disease

Effectiveness of contrast‐enhanced duplex ultrasound for detecting renal artery stenosis: A systematic review

“…The included studies had an average sample size of 41 ± 25 participants (range: 15-78; 447 unique), 17 ± 13 females (193 unique or 43%), age of 56 ± 9 years (average range: 36-64 years). Common disease conditions included hypertension, [23][24][25][26] coronary artery disease, 23,27 peripheral artery disease, 23,27 diabetes mellitus, 23,27 and recent renal transplant. 28,29 Most studies defined stenosis as of at least 60% occlusion (4/11), but it was also defined as 50% (n = 3/11) or 70% (n = 2/11), and on a scale (i.e., mild: 30%-50%, moderate: 50%- ).…”

“…Only 3/11 studies reported using trained sonographers. 23,27,28 All included study characteristics are presented in Table 1.…”

“…Five of eleven studies investigated the agreement of CEUS using SonoVue contrast agent versus angiography. 14,[27][28][29][30] Three of five studies reported accuracy as a metric of agreement. 27,28,30 The average accuracy was 91.3% ± 2.1% and they were all high agreement (all, >80%) in correctly determining stenosis relative to the criterion measures of DSA, 27,30 and CTA.…”

AIUM Practice Parameter for the Performance of Duplex Sonography of Native Renal Vessels

“…It may be necessary to document more than one spectral Doppler waveform in a specific region to ensure optimal interpretation. This is especially true in children in whom motion artifact can significantly degrade spectral and color Doppler image quality. Contrast‐enhanced ultrasound ( CEUS )The use of microbubble ultrasound contrast agents may be helpful in identification of the main renal arteries, in detection of duplicated or accessory renal arteries, in assessment of renal perfusion, and in more accurately depicting and localizing renal artery stenosis 37 . Note: This would be an off‐label use of CEUS based upon current FDA approval status.…”

“…The use of microbubble ultrasound contrast agents may be helpful in identification of the main renal arteries, in detection of duplicated or accessory renal arteries, in assessment of renal perfusion, and in more accurately depicting and localizing renal artery stenosis 37 . Note: This would be an off‐label use of CEUS based upon current FDA approval status.…”