[Evaluation of spiral computed tomography of the renal arteries alone or combined with Doppler ultrasonography in the detection of renal artery stenosis. Prospective study of 114 renal arteries].

A renovascular etiology occurs in 0.2 to 2% of hypertensive patients. Recently, spiral computed tomography (CT) has evolved as a new minimally invasive tool for the diagnosis of vascular pathologic conditions. The purpose of this study was to compare both spiral CT and color Doppler ultrasonography (US) with intraarterial digital subtraction angiography (DA) in the detection of renal artery stenosis (RAS) in hypertensive patients. Between December 1993 and April 1994, 44 hypertensives (men 22, mean age 52 years) suspected secondary hypertension were prospectively studied with spiral CT (Somatom Plus S, Siemens) US (Acuson, 3.5 MHz probe) and DA (double-blind evaluation). DA visualized 11 significant (> 50%) stenoses (11/114 renal arteries, including 27 accessory). On spiral CT, 9/11 were detected and 2 additional stenoses considered false positive. On US 5 stenoses were detected whereas 11 were demonstrated by DA; 2 patients had false positive US results. [table: see text] We conclude that combined spiral CT and color Doppler ultrasonography is an effective and relatively non invasive alternative to intraarterial digital angiography for the detection of renal artery stenosis in a hypertensive population screened for renovascular hypertension.