The diagnostic performance of three-dimensional contrast-enhanced magnetic resonance angiography in demonstrating renal vasculature in patients with suspected renovascular hypertension

Yıl 2019, Cilt: 11 Sayı: 2, 174 - 180, 01.06.2019

Meltem Özdemir , Tahsin Rendan Edgüer Halil Öztürk , Emine Öztürk Alper Dilli , Baki Hekimoğlu

https://doi.org/10.21601/ortadogutipdergisi.424843

Öz

Aim: The aim of our study was to evaluate the diagnostic
value of three-dimensional contrast-enhanced magnetic resonance angiography (3D
CE-MRA) in detecting renal artery stenosis (RAS), and in demonstrating segmental
and accessory renal arteries in patients with suspected renovascular hypertension,
taking digital subtraction angiography (DSA) as the reference method.

Material and Method: Twenty five patients underwent 3D CE-MRA
and DSA. Sensitivity, specificity, positive predictive value, and negative predictive
value of CE-MRA in depicting RAS, and sensitivity of the technique in demonstrating
segmental and accessory arteries were calculated.

Results: For detecting RAS, the sensitivity, specificity,
positive predictive value, and negative predictive value of 3D CE-MRA were; 100%,
97.8%, 87.5%, and 100%, respectively. The sencitivity of the technique in demonstrating
segmental and accessory arteries were 58% and 91.7%,
respectively.

Conclusion: We found that 3D CE-MRA is a reliable technique
in not only detecting RAS, but in demonstrating accessory arteries as well. However,
according to our results, the value of the method in visualising segmental arteries
is limited.

Anahtar Kelimeler

Renal MRA, magnetic resonance angiography, contrast-enhanced MRA

Renovasküler hipertansiyon şüphesi olan hastalarda renal arterlerin görüntülenmesinde üç boyutlu kontrastlı manyetik rezonans anjiyografinin tanı değeri

Öz

Amaç: Çalışmamızın amacı, digital subtraction angiography
(DSA) tekniğini referans metod alarak, üç boyutlu kontrastlı manyetik rezonans anjiyografi
(3D CE-MRA) tekniğinin, renal arter stenozu (RAS) tanısındaki ve segmental ve aksesuar
renal arter görüntülemesindeki değerini saptamak idi.

Gereç ve Yöntem: Yirmi beş hastaya 3D CE-MRA ve DSA tetkikleri
uygulandı. CE-MRA tekniğinin RAS tanısındaki sensitivite, spesifisite ve pozitif
ve negatif kestirim değerleri ile tekniğin segmental ve aksesuar renal arter görüntülemedeki
sensitivite değerleri hesaplandı.

Bulgular: RAS tanısında CE-MRA tekniğinin sensitivite,
spesifisite, pozitif ve negatif kestirim değerleri, aynı sıra ile; %100, %97,8,
%87,5, ve %100 olarak hesaplandı. Tekniğin segmental ve aksesuar renal arter görüntülemedeki
sensitivite değerlerinin, aynı sıra ile; %58 ve %91,7 olduğu saptandı.

Sonuç: 3D CE-MRA tekniğinin, sadece renal arter stenozu
tanısında değil, aksesuar arterlerin görüntülemesinde de güvenilir olduğu saptandı.
Ancak çalışmamızın sonuçlarına göre, tekniğin segmental arter görüntülemesindeki
değeri sınırlıdır.

Anahtar Kelimeler

Renal MRA, manyetik rezonans anjiyografi, kontrastlı MRA

Kaynakça

• Samadian F, Dalili N, Jamalian A. New insights into pathophysiology, diagnosis, and treatment of renovascular hypertension. Iranian J Kidney Dis 2017; 11: 79-89.
• Vasbinder GB, Nelemans PJ, Kessels AG, et al. Diagnostic tests for renal artery stenosis in patients suspected of having renovascular hypertension: a meta-analysis. Ann Intern Med 2001; 135: 401-11.
• Granata A, Fiorini F, Andrulli S, et al. Doppler ultrasound and renal artery stenosis: An overview. J Ultrasound 2009; 12: 133-43.
• Turgutalp K, Kiykim A, Özhan O, Helvaci I, Ozcan T, Yıldız A. Comparison of diagnostic accuracy of Doppler USG and contrast-enhanced magnetic resonance angiography and selective renal arteriography in patients with atherosclerotic renal artery stenosis. Med Sci Monit 2013; 19: 475-82.
• Lenz T, Schulte KL. Current management of renal artery stenosis. Panminerva Med 2016; 58: 94-101.
• Tuna IS, Tatlı S. Contrast-enhanced CT and MR imaging of renal vessels. Abdom Imaging 2014; 39: 875-91.
• Miyazaki M, Isoda H. Non-contrast-enhanced MR angiography of the abdomen. Eur J Radiol 2011; 80: 9-23.
• Radermacher J, Chavan A, Bleck J, et al. Use of Doppler ultrasonography to predict the outcome of therapy for renal artery stenosis. N Eng J Med 2001; 344: 410-7.
• Olbricht CJ, Paul K, Prokop M, et al. Minimally invasive diagnosis of renal artery stenosis by spiral computed tomography angiography. Kidney Int 1995; 48: 1332-7.
• Grovic VD, Achaumer MA, Kittner T, et al. Gadodiamide-enhanced MR angiography to intraarterial digital subtraction angiography for evaluation of renal artery stenosis: results of a phase III multicenter trial. J Magn Reson Imaging 2010; 31: 390-7.
• Miyazaki M, Akahane M. Non-contrast enhanced MR angiography: Established techniques. J Magn Reson Imaging 2012; 35: 1-19.
• Prince MR, Arnoldus C, Frisoli JK. Nephrotoxicity of high-dose gadolinium compared with iodinated contrast. J Magn Reson Imaging 1996; 6: 162-6.
• Rofsky NM, Weinreb JC, Bosniak MA, Libes RB, Birnbaum BA. Renal lesion characterization with gadolinium-enhanced MR imaging: efficacy and safety in patients with renal insuficiency. Radiology 1991; 180: 85-9.
• Murphy KJ, Brunberg JA, Cohan RH. Adverse reactions to gadolinium contrast media: a review of 36 cases. AJR Am J Roentgenol 1996: 167: 847-49.
• Prince MR, Zhang HL, Prowda JC, et al. Nephrogenic systemic fibrosis and its impact on abdominal imaging. Radiographics 2009:29:1565-74.
• Yamuna J, Chandrasekharan A, Rangasami R, Ramalakshmi S, Joseph S. Unenhanced renal magnetic resonance angiography in patients with chronic kidney disease & suspected renovascular hypertension: Can it affect patient management? Indian J Med Res 2017; 146: 22-9.
• Gondalia R, Vernuccio F, Marin D, Bashir MR. The role of MR imaging in the assessment of renal allograft vasculature. Abdom Radiol (NY) 2018 Apr 26. (doi: 10.1007/s00261-018-1611-3).
• Laader A, Beiderwellen K, Kraff O, Maderwald S, Ladd ME, Forsting M, Umutlu L. Non-enhanced versus low-dose contrast-enhanced renal magnetic resonance angiography at 7 T: a feasibility study. Acta Radiol. 2018 Mar; 59(3): 296-304.
• Liang KW, Chen JW, Huang HH, Su CH, Tyan YS, Tsao TF. The Performance of Noncontrast Magnetic Resonance Angiography in Detecting Renal Artery Stenosis as Compared With Contrast Enhanced Magnetic Resonance Angiography Using Conventional Angiography as a Reference. J Comput Assist Tomogr. 2017 Jul/Aug; 41(4): 619-627.
• ESUR Guidlines on Contrast Media v 10.0. (last updated: 09:33 Mon 26 Mar 2018). Available from: http://www.esur.org/esur-guidelines/