Doppler Ultrasound in the Diagnosis of Renal Artery Stenosis: Re-evaluation of Current Criteria with Single-Center Experience
Öz
Background[SA1.1][rb1.2]: Hypertension is a leading cause of premature mortality worldwide and remains a treatable condition. Approximately 5% of cases are secondary, with renal artery stenosis (RAS) being a major underlying cause. Doppler ultrasonography is the first-line imaging modality for evaluating suspected RAS. The aim of this study is to determine optimal Doppler ultrasonography threshold values for detecting ≥60% RAS using digital subtraction angiography (DSA) as the reference standard.
Materials and Methods: This retrospective study included 51 patients (25 women, 26 men; age range: 25–89 years) who underwent both Doppler ultrasonography and DSA for suspected RAS between September 2011 and May 2015. A total of 101 renal arteries were evaluated. Receiver operating characteristic (ROC) curve analysis was used to determine optimal cutoff values for peak systolic velocity (PSV), end-diastolic velocity (EDV), and reno–aortic ratio (RAR).
Results: Using DSA as the reference standard, the optimal cutoff values for detecting ≥60% RAS were determined as >247 cm/s for PSV (sensitivity 96%, specificity 87%), >60 cm/s for EDV (sensitivity 79%, specificity 81%), and >2.88 for RAR (sensitivity 96%, specificity 83%). Area under the curve analysis showed that PSV had the highest diagnostic accuracy, followed by RAR and EDV.
Conclusion:The application of Doppler ultrasonography with appropriately defined threshold values in the evaluation of RAS may enhance diagnostic confidence and contribute to the reduction of unnecessary invasive procedures.
Anahtar Kelimeler
Renal Artery Stenosis, hypertension, doppler criteria, peak cyctolic velocity, end diastolic velocity, renoaortic ratio, digital subtraction anjiography
Destekleyen Kurum
The authors received no financial support for the research, authorship, and/or publication of this article
Etik Beyan
This study is part of a thesis. Ethical approval was obtained from Ankara Yuksek Ihtisas Hospital on 07/06/2015 (Approval No: 332). Data collection and patient recruitment were performed at Ankara Yuksek Ihtisas Hospital between 2011 and 2015, when the authors were affiliated with that institution. Due to the retrospective nature of the study, the requirement for informed consent was waived.
Teşekkür
There are no acknowledgements
Kaynakça
- NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants. Lancet. 2021;398(10304):957-80. doi: 10.1016/S0140-6736(21)01330-1.
- Cameron NA, Jones DW, Khan SS, Lloyd-Jones DM. Case-Based Applications of the 2025 AHA/ACC/Multispecialty High Blood Pressure Guideline. Hypertension. 2025;82(12):2055-63. doi: 10.1161/HYPERTENSIONAHA.125.25913.
- Bendagiri Matam M, Chand S, Harikrishnan S, Neelakantan Ramaswamy S, Bhatt NK, Agarwal Y, et al. A Literature Review of Renal Arterial Stenosis: Presentation, Diagnosis, and Management Options in Secondary Hypertension. Cureus. 2025;17(9):e92945. doi: 10.7759/cureus.92945.
- Darabont RO. Current insights in the screening of secondary hypertension: a cardiologist's perspective. Acta Endocrinol (Buchar). 2024;20(4):551-4. doi: 10.4183/aeb.2024.551.
- Zeller T, Frank U, Späth M, Roskamm H. [Color duplex ultrasound imaging of renal arteries and detection of hemodynamically relevant renal artery stenoses]. Ultraschall Med. 2001;22(3):116-21. German. doi: 10.1055/s-2001-15287.
- Gunabushanam G, Chaubal R, Scoutt LM. Doppler Ultrasound of the Renal Vasculature. J Ultrasound Med. 2024;43(8):1543-62. doi: 10.1002/jum.16466.
- Vasbinder GBC. Evaluation of CT and MR angiography for the diagnosis of renal artery stenosis [dissertation]. Maastricht (NL): Maastricht University; 2003. doi: 10.26481/dis.20031030gv.
- Radermacher J, Chavan A, Schäffer J, Stoess B, Vitzthum A, Kliem V, et al. Detection of significant renal artery stenosis with color Doppler sonography: combining extrarenal and intrarenal approaches to minimize technical failure. Clin Nephrol. 2000;53(5):333-43.
- Soares GM, Murphy TP, Singha MS, Parada A, Jaff M. Renal artery duplex ultrasonography as a screening and surveillance tool to detect renal artery stenosis: a comparison with current reference standard imaging. J Ultrasound Med. 2006;25(3):293-8. doi: 10.7863/jum.2006.25.3.293.
- Miralles M, Cairols M, Cotillas J, Giménez A, Santiso A. Value of Doppler parameters in the diagnosis of renal artery stenosis. J Vasc Surg. 1996;23(3):428-35. doi: 10.1016/s0741-5214(96)80007-3.