Eklöf H, Ahlström H, Magnusson A, Andersson L-G, Andrén B, Hägg A, Bergqvist D, Nyman R
Department of Radiology, Uppsala University Hospital, Uppsala, Sweden.
Acta Radiol. 2006 Oct;47(8):764-74. doi: 10.1080/02841850600849092.
To prospectively compare the diagnostic accuracy of duplex ultrasonography, captopril renography, computed tomography angiography (CTA), and 3D Gd magnetic resonance angiography (MRA) in diagnosing hemodynamically significant renal artery stenosis (RAS).
The standard of reference was measurement of transstenotic pressure gradient. Fifty-eight hypertensive patients with suspicion of RAS were evaluated, when possible, by all five techniques. Sensitivity and specificity to detect RAS were compared for each technique on both a patient and kidney basis. Discrepancies were evaluated separately and classified as borderline, method dependent, or operator dependent.
The prevalence of RAS was 77%. The sensitivity/specificity of ultrasonography, captopril renography, CTA, and MRA in detecting kidneys with RAS was 73/71%, 52/63%, 94/62%, and 93/91%, respectively. Ultrasonography had a significantly lower sensitivity than CTA and MRA (P<0.001) but higher than captopril renography (P = 0.013). Borderline RAS was the main cause for discrepancies.
MRA and CTA were significantly better than duplex ultrasonography and captopril renography in detecting hemodynamically significant RAS. The ultrasonography criteria for RAS based on the evaluation of renal peak systolic velocity and renal/aortic ratio are questionable. Captopril renography cannot be recommended for assessing RAS.
前瞻性比较双功超声、卡托普利肾图、计算机断层血管造影（CTA）和三维钆增强磁共振血管造影（MRA）在诊断具有血流动力学意义的肾动脉狭窄（RAS）方面的诊断准确性。
参考标准为跨狭窄压力梯度测量。对58例疑似RAS的高血压患者尽可能采用所有五种技术进行评估。在患者和肾脏层面比较每种技术检测RAS的敏感性和特异性。分别评估差异并分类为临界、方法依赖性或操作者依赖性。
RAS的患病率为77%。超声、卡托普利肾图、CTA和MRA检测存在RAS肾脏的敏感性/特异性分别为73/71%、52/63%、94/62%和93/91%。超声的敏感性显著低于CTA和MRA（P<0.001），但高于卡托普利肾图（P = 0.013）。临界RAS是差异的主要原因。
在检测具有血流动力学意义的RAS方面，MRA和CTA明显优于双功超声和卡托普利肾图。基于肾动脉峰值收缩速度和肾动脉/主动脉比值评估的RAS超声标准存在疑问。不推荐使用卡托普利肾图评估RAS。
