Yıl 2019, Cilt 11 , Sayı 2, Sayfalar 174 - 180 2019-06-01

Renovasküler hipertansiyon şüphesi olan hastalarda renal arterlerin görüntülenmesinde üç boyutlu kontrastlı manyetik rezonans anjiyografinin tanı değeri
The diagnostic performance of three-dimensional contrast-enhanced magnetic resonance angiography in demonstrating renal vasculature in patients with suspected renovascular hypertension

Meltem ÖZDEMİR [1] , Tahsin Rendan EDGÜER [2] , Halil ÖZTÜRK [3] , Emine ÖZTÜRK [4] , Alper DİLLİ [5] , Baki HEKİMOĞLU [6]


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.

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.

  • 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/
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Orcid: 0000-0002-7388-2871
Yazar: Meltem ÖZDEMİR (Sorumlu Yazar)
Kurum: University oh Health Science, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Department of Radiology, Ankara, Turkey
Ülke: Turkey


Yazar: Tahsin Rendan EDGÜER
Kurum: University oh Health Science, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Department of Radiology, Ankara, Turkey
Ülke: Turkey


Yazar: Halil ÖZTÜRK
Kurum: University oh Health Science, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Department of Radiology, Ankara, Turkey
Ülke: Turkey


Yazar: Emine ÖZTÜRK
Kurum: University oh Health Science, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Department of Radiology, Ankara, Turkey
Ülke: Turkey


Orcid: 0000-0002-8057-9109
Yazar: Alper DİLLİ
Kurum: University oh Health Science, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Department of Radiology, Ankara, Turkey
Ülke: Turkey


Yazar: Baki HEKİMOĞLU
Kurum: University oh Health Science, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Department of Radiology, Ankara, Turkey
Ülke: Turkey


Tarihler

Yayımlanma Tarihi : 1 Haziran 2019

Vancouver Özdemir M , Edgüer T , Öztürk H , Öztürk E , Dilli A , Hekimoğlu B . The diagnostic performance of three-dimensional contrast-enhanced magnetic resonance angiography in demonstrating renal vasculature in patients with suspected renovascular hypertension. Ortadoğu Tıp Dergisi. 2019; 11(2): 174-180.