Qanadli S D, Soulez G, Therasse E, Nicolet V, Turpin S, Froment D, Courteau M, Guertin M C, Oliva V L
Department of Radiology, CHUM, Hôpital Notre-Dame, 1560 Sherbrooke St. E., Montréal, Quebec H2L 4M1, Canada.
AJR Am J Roentgenol. 2001 Nov;177(5):1123-9. doi: 10.2214/ajr.177.5.1771123.
The objective of our study was to compare the value of captopril-enhanced Doppler sonography, captopril-enhanced renal scintigraphy, and gadolinium-enhanced MR angiography for detecting renal artery stenosis.
Forty-one patients with suspected renovascular hypertension were prospectively examined with captopril-enhanced Doppler sonography, captopril-enhanced renal scintigraphy, gadolinium-enhanced MR angiography, and catheter angiography. The sensitivity and specificity of each technique for detecting renal artery stenosis measuring 50% or greater and 70% or greater were compared using the McNemar test. Positive and negative predictive values were estimated for populations with 5% and 30% prevalence of renal artery stenosis. Kappa values for interobserver agreement were assessed for both gadolinium-enhanced MR angiography and catheter angiography.
For detecting renal artery stenosis measuring 50% or greater, the sensitivity of gadolinium-enhanced MR angiography (96.6%) was greater than that of captopril-enhanced Doppler sonography (69%, p = 0.005) and captopril-enhanced renal scintigraphy (41.4%, p = 0.001). No significant difference in specificity was observed among modalities. For renal artery stenosis measuring 50% or greater, positive and negative predictive values were respectively 62% and 86% for captopril-enhanced Doppler sonography, 49% and 76% for captopril-enhanced renal scintigraphy, and 53% and 98% for gadolinium-enhanced MR angiography. Interobserver agreement was high for both gadolinium-enhanced MR angiography (kappa = 0.829) and catheter angiography (kappa = 0.729).
Gadolinium-enhanced MR angiography is the most accurate noninvasive modality for detecting renal artery stenosis greater than or equal to 50%. The use of captopril-enhanced Doppler sonography in combination with gadolinium-enhanced MR angiography for identifying renal artery stenosis needs to be evaluated with a cost-effectiveness analysis.
本研究的目的是比较卡托普利增强多普勒超声、卡托普利增强肾闪烁扫描和钆增强磁共振血管造影在检测肾动脉狭窄方面的价值。
对41例疑似肾血管性高血压患者进行前瞻性检查，采用卡托普利增强多普勒超声、卡托普利增强肾闪烁扫描、钆增强磁共振血管造影和导管血管造影。使用McNemar检验比较每种技术检测肾动脉狭窄程度为50%及以上和70%及以上的敏感性和特异性。对肾动脉狭窄患病率为5%和30%的人群评估阳性和阴性预测值。对钆增强磁共振血管造影和导管血管造影评估观察者间一致性的kappa值。
对于检测肾动脉狭窄程度为50%及以上，钆增强磁共振血管造影的敏感性（96.6%）高于卡托普利增强多普勒超声（69%，p = 0.005）和卡托普利增强肾闪烁扫描（41.4%，p = 0.001）。各检查方式在特异性方面未观察到显著差异。对于肾动脉狭窄程度为50%及以上，卡托普利增强多普勒超声的阳性和阴性预测值分别为62%和86%，卡托普利增强肾闪烁扫描为49%和76%，钆增强磁共振血管造影为53%和98%。钆增强磁共振血管造影（kappa = 0.829）和导管血管造影（kappa = 0.729）的观察者间一致性均较高。
钆增强磁共振血管造影是检测大于或等于50%肾动脉狭窄最准确的非侵入性检查方式。卡托普利增强多普勒超声联合钆增强磁共振血管造影用于识别肾动脉狭窄的应用需要通过成本效益分析进行评估。
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