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Yamada T, Masui T, Sasaki M, Katayama M, Iwadate Y, Takei N, Miyoshi M. Time resolved DCE-MRI of the kidneys: Evaluation of the renal vasculatures and tumors using F-DISCO with and without compressed sensing in normal and wide-bore 3T systems. Medicine (Baltimore) 2022; 101:e29971. [PMID: 35945778 PMCID: PMC9351894 DOI: 10.1097/md.0000000000029971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Dynamic contrast-enhanced MR imaging (DCE-MRI) has been widely used for the evaluation of renal arteries. This method is also useful for tumor and renal parenchyma characterization. The very fast MRI may provide stable and precise information regarding vasculature and soft tissues. The purpose of this study was to evaluate the ability of DCE-MRI to assess renal vasculatures and tumor perfusions using Differential subsampling with Cartesian ordering with spectrally selected inversion recovery with adiabatic pulses (F-DISCO) with and without compressed sensing (CS) in normal and wide-bore 3T systems. Fifty-one patients who underwent DCE-MRI using F-DISCO with or without CS for evaluation of renal or adrenal regions were included. Image quality, artifacts, fat saturation, and selective visual recognition of renal vasculatures were assessed by using a 5-point scale. Tumor recognition was verified by using a 5-point scale of confidence level. Signal intensities of each structure were also measured. In all cases, the temporal resolution of each phase for DCE-MRI was 1.9 to 2.0 seconds. Image quality, artifacts, fat saturation, and selective visual recognition of vasculatures were all acceptable (mean score 4.2-4.9). The selective visualization of renal arteries and veins was successfully accomplished (mean score 4.0-4.9). Contrast media perfusion for renal vasculature, renal parenchyma, and tumors was also recognized. DCE-MRI for the evaluation of renal vasculatures and tumors using F-DISCO with or without CS can be performed with high temporal and spatial resolutions in normal and wide-bore 3T systems. This information can be obtained in a stable fashion throughout the dynamic contrast study. CS can additionally provide benefits that the total imaging time may be shorter than without CS.
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Affiliation(s)
- Takahiro Yamada
- Department of Radiology, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan
| | - Takayuki Masui
- Department of Radiology, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan
- *Correspondence: Takayuki Masui, MD, PhD, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Naka-district, Hamamatsu, Shizuoka 430-8558, Japan (e-mail )
| | - Masako Sasaki
- Department of Radiology, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan
| | - Motoyuki Katayama
- Department of Radiology, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan
| | - Yuji Iwadate
- Global MR Applications and Workflow, GE Healthcare Japan, Hino, Tokyo, Japan
| | - Naoyuki Takei
- Global MR Applications and Workflow, GE Healthcare Japan, Hino, Tokyo, Japan
| | - Mitsuharu Miyoshi
- Global MR Applications and Workflow, GE Healthcare Japan, Hino, Tokyo, Japan
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Percutaneous transluminal renal artery stenting using digital subtraction angiography with diluted contrast medium in a patient with severe chronic kidney disease. J Cardiol Cases 2022; 26:317-320. [DOI: 10.1016/j.jccase.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 06/10/2022] [Accepted: 06/20/2022] [Indexed: 11/19/2022] Open
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Trautmann A, Roebuck DJ, McLaren CA, Brennan E, Marks SD, Tullus K. Non-invasive imaging cannot replace formal angiography in the diagnosis of renovascular hypertension. Pediatr Nephrol 2017; 32:495-502. [PMID: 27747454 DOI: 10.1007/s00467-016-3501-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 08/24/2016] [Accepted: 08/25/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Renovascular disease (RVD) is found in about 10 % of secondary childhood hypertension. Digital subtraction angiography (DSA) is the gold standard to diagnose RVD. Non-invasive imaging methods like Doppler ultrasound (US), magnetic resonance angiography (MRA), and computed tomography angiography (CTA) are increasingly used. Our aim was to evaluate the role and accuracy of US, MRA, and CTA compared to DSA in diagnosing RVD in children. PATIENTS AND METHODS A retrospective review of 127 children with suspected renovascular hypertension was performed in children referred to Great Ormond Street Hospital between 2006 and 2014 due to clinical suspicion of renovascular hypertension and/or findings on US and/or MRA or CTA. RESULTS Ninety-nine of 127 children (78 %) were diagnosed with renovascular disease and 80 were treated with percutaneous transluminal angioplasty during the same procedure. The median age at presentation was 5.6 (range, 2.5-10.6) years. Thirty-six children had unilateral renal artery stenosis in major extraparenchymal vessels, 47 bilateral stenosis and 16 intrarenal small vessel disease. US had a sensitivity of 63 % and specificity of 95 %. MRA and CTA were performed in 39 and 34 children, respectively. CTA sensitivity was slightly higher than that of MRA, 88 vs. 80 %, and specificity 81 vs. 63 %. CONCLUSIONS The sensitivity of MRA and CTA is still too low to reliably rule out renovascular disease in children with a strong suspicion of this diagnosis. DSA remains the gold standard to diagnose renovascular hypertension and is recommended when clinical and laboratory criteria are highly suggestive of renovascular disease even with normal radiological investigations from non-invasive methods.
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Affiliation(s)
- Agnes Trautmann
- Department of Pediatric Nephrology, Great Ormond Street Hospital for Children NHS Trust, London, UK
- Department of Pediatric Nephrology, University Center for Pediatrics and Adolescent Medicine, Heidelberg, Germany
| | - Derek J Roebuck
- Department of Radiology, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - Clare A McLaren
- Department of Radiology, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - Eileen Brennan
- Department of Pediatric Nephrology, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - Stephen D Marks
- Department of Pediatric Nephrology, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - Kjell Tullus
- Department of Pediatric Nephrology, Great Ormond Street Hospital for Children NHS Trust, London, UK.
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Affiliation(s)
- Michele Petruzzelli
- From the Clinical Pharmacology Unit (M.P., M.J.B.) and Department of Oncology (M.P.), University of Cambridge, Cambridge, United Kingdom; Clinical Biochemistry (K.P.T.) and Department of Radiology (B.K.), Addenbrooke’s Hospital, Cambridge, United Kingdom; Departments of Clinical Pharmacology and Endocrinology, William Harvey Research Institute, Queen Mary University London, London, United Kingdom (M.J.B.)
| | - Kevin P. Taylor
- From the Clinical Pharmacology Unit (M.P., M.J.B.) and Department of Oncology (M.P.), University of Cambridge, Cambridge, United Kingdom; Clinical Biochemistry (K.P.T.) and Department of Radiology (B.K.), Addenbrooke’s Hospital, Cambridge, United Kingdom; Departments of Clinical Pharmacology and Endocrinology, William Harvey Research Institute, Queen Mary University London, London, United Kingdom (M.J.B.)
| | - Brendan Koo
- From the Clinical Pharmacology Unit (M.P., M.J.B.) and Department of Oncology (M.P.), University of Cambridge, Cambridge, United Kingdom; Clinical Biochemistry (K.P.T.) and Department of Radiology (B.K.), Addenbrooke’s Hospital, Cambridge, United Kingdom; Departments of Clinical Pharmacology and Endocrinology, William Harvey Research Institute, Queen Mary University London, London, United Kingdom (M.J.B.)
| | - Morris J. Brown
- From the Clinical Pharmacology Unit (M.P., M.J.B.) and Department of Oncology (M.P.), University of Cambridge, Cambridge, United Kingdom; Clinical Biochemistry (K.P.T.) and Department of Radiology (B.K.), Addenbrooke’s Hospital, Cambridge, United Kingdom; Departments of Clinical Pharmacology and Endocrinology, William Harvey Research Institute, Queen Mary University London, London, United Kingdom (M.J.B.)
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Brucher N, Vial J, Baunin C, Labarre D, Meyrignac O, Juricic M, Bouali O, Abbo O, Galinier P, Sans N. Non-contrast-enhanced MR angiography using time-spin labelling inversion pulse technique for detecting crossing renal vessels in children with symptomatic ureteropelvic junction obstruction: comparison with surgical findings. Eur Radiol 2015; 26:2697-704. [DOI: 10.1007/s00330-015-4065-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 07/02/2015] [Accepted: 10/09/2015] [Indexed: 11/30/2022]
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Andersson M, Jägervall K, Eriksson P, Persson A, Granerus G, Wang C, Smedby Ö. How to measure renal artery stenosis--a retrospective comparison of morphological measurement approaches in relation to hemodynamic significance. BMC Med Imaging 2015; 15:42. [PMID: 26459634 PMCID: PMC4601150 DOI: 10.1186/s12880-015-0086-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Accepted: 09/23/2015] [Indexed: 11/26/2022] Open
Abstract
Background Although it is well known that renal artery stenosis may cause renovascular hypertension, it is unclear how the degree of stenosis should best be measured in morphological images. The aim of this study was to determine which morphological measures from Computed Tomography Angiography (CTA) and Magnetic Resonance Angiography (MRA) are best in predicting whether a renal artery stenosis is hemodynamically significant or not. Methods Forty-seven patients with hypertension and a clinical suspicion of renovascular hypertension were examined with CTA, MRA, captopril-enhanced renography (CER) and captopril test (Ctest). CTA and MRA images of the renal arteries were analyzed by two readers using interactive vessel segmentation software. The measures included minimum diameter, minimum area, diameter reduction and area reduction. In addition, two radiologists visually judged the diameter reduction without automated segmentation. The results were then compared using limits of agreement and intra-class correlation, and correlated with the results from CER combined with Ctest (which were used as standard of reference) using receiver operating characteristics (ROC) analysis. Results A total of 68 kidneys had all three investigations (CTA, MRA and CER + Ctest), where 11 kidneys (16.2 %) got a positive result on the CER + Ctest. The greatest area under ROC curve (AUROC) was found for the area reduction on MRA, with a value of 0.91 (95 % confidence interval 0.82–0.99), excluding accessory renal arteries. As comparison, the AUROC for the radiologists’ visual assessments on CTA and MRA were 0.90 (0.82–0.98) and 0.91 (0.83–0.99) respectively. None of the differences were statistically significant. Conclusions No significant differences were found between the morphological measures in their ability to predict hemodynamically significant stenosis, but a tendency of MRA having higher AUROC than CTA. There was no significant difference between measurements made by the radiologists and measurements made with fuzzy connectedness segmentation. Further studies are required to definitely identify the optimal measurement approach.
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Affiliation(s)
- Malin Andersson
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden. .,Department of Radiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
| | - Karl Jägervall
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden. .,Department of Radiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
| | - Per Eriksson
- Department of Nephrology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
| | - Anders Persson
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden. .,Department of Radiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
| | - Göran Granerus
- Department of Clinical Physiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
| | - Chunliang Wang
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden. .,Department of Radiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden. .,School of Technology and Health (STH), KTH Royal Institute of Technology, Stockholm, Sweden.
| | - Örjan Smedby
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden. .,Department of Radiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden. .,School of Technology and Health (STH), KTH Royal Institute of Technology, Stockholm, Sweden.
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Remer EM, Papanicolaou N, Casalino DD, Bishoff JT, Blaufox MD, Coursey CA, Dighe M, Eberhardt SC, Goldfarb S, Harvin HJ, Heilbrun ME, Leyendecker JR, Nikolaidis P, Oto A, Preminger GM, Raman SS, Sheth S, Vikram R, Weinfeld RM. ACR Appropriateness Criteria(®) on renal failure. Am J Med 2014; 127:1041-1048.e1. [PMID: 24865874 DOI: 10.1016/j.amjmed.2014.05.014] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Revised: 05/07/2014] [Accepted: 05/07/2014] [Indexed: 10/25/2022]
Abstract
Imaging plays a role in the management of patients with acute kidney injury or chronic kidney disease. However, clinical circumstances strongly impact the appropriateness of imaging use. In patients with newly detected renal dysfunction, ultrasonography can assess for reversible causes, assess renal size and echogenicity, and thus, establish the chronicity of disease. Urinary obstruction can be detected, but imaging is most useful in high-risk groups or in patients in whom there is a strong clinical suspicion for obstruction. Computed tomography, computed tomography or magnetic resonance arteriography, and percutaneous ultrasound-guided renal biopsy are valuable in other clinical situations. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 3 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
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Kurian J, Epelman M, Darge K, Meyers K, Nijs E, Hellinger JC. The role of CT angiography in the evaluation of pediatric renovascular hypertension. Pediatr Radiol 2013. [PMID: 23208533 DOI: 10.1007/s00247-012-2567-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Historically, the evaluation of renovascular hypertension has been accomplished by US, renal scintigraphy and digital subtraction angiography. Based on its high accuracy reported in adults renal CT angiography (CTA) with pediatric-appropriate low radiation dose techniques has become an important tool in the workup of renovascular hypertension in children. Renal CTA has several advantages over more conventional imaging modalities, including rapid and non-invasive acquisition, high resolution and easy reproducibility. Additionally, in our experience high-quality renal CTA can be performed using low-dose radiation exposures and can be acquired without sedation in most instances. This article illustrates by examples the usefulness of renal CTA for diagnosis of childhood renovascular hypertension and provides an overview of renal CTA findings in the most common childhood renovascular diseases.
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Affiliation(s)
- Jessica Kurian
- Department of Radiology, The Children's Hospital of Philadelphia, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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9
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Kim JH, Park SH, Ji AY, Lee JH, Jin M, Song C, Kim I, Kim YJ, Lee MH. Importance of Clinical Evaluations Related to Secondary Hypertension in Patients with Resistant Hypertension. J Lipid Atheroscler 2013. [DOI: 10.12997/jla.2013.2.1.37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Jin Ho Kim
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Sung-Ha Park
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Ah Young Ji
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Jung Hee Lee
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Moonyun Jin
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Changho Song
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Insoo Kim
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Young Ju Kim
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Moon-Hyoung Lee
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
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Salame M, Padulla GA, Muradás RR, Machado G, Braun SK, Santos KRD, Mussio AV, Konopka CL. Nefropatia isquêmica. J Vasc Bras 2012. [DOI: 10.1590/s1677-54492012000400010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
A doença renal isquêmica ou nefropatia isquêmica relacionada à doença renovascular pode evoluir de forma rápida e progressiva para a insuficiência renal crônica. É fundamental a identificação e o tratamento precoces desta condição clínica, prevenindo a ocorrência de doença renal em estágio terminal, com consequente necessidade de terapia de substituição renal. Há uma década, o controle da hipertensão renovascular era o objetivo primário no manejo de pacientes com doença renovascular. Atualmente, a meta está dirigida principalmente para a estabilização e a melhora da função renal, além do controle dos níveis pressóricos.
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Onniboni M, De Filippo M, Averna R, Coco L, Zompatori M, Sverzellati N, Rossi C. Magnetic resonance imaging in the complications of kidney transplantation. Radiol Med 2012; 118:837-50. [PMID: 23090252 DOI: 10.1007/s11547-012-0891-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Accepted: 05/28/2012] [Indexed: 11/28/2022]
Abstract
Kidney transplantation is currently the treatment of choice in most patients with end-stage chronic renal failure owing to the excellent results in terms of both graft and patient survival. However, surgical complications are still very frequent. Although urological (stricture, urinary fistulas, vesico-ureteral reflux) and lymphatic complications (lymphocoele) have a high incidence, they only rarely lead to graft loss. By contrast, vascular complications (stenosis, arterial and venous thrombosis, arterio-venous fistulas, pseudoaneurysms) are relatively rare, but potentially serious and may affect graft survival. Finally, medical complications such as acute tubular necrosis (ATN), rejection and de novo neoplasms may also arise in kidney transplantation. The purpose of this pictorial review is to illustrate the increasingly significant contribution of magnetic resonance angiography (MRA) in the management of complications of kidney transplantation, and emphasise how this method should now be considered a mandatory step in the diagnostic workup of selected cases. Moreover, the application and role in this setting of new magnetic resonance imaging (MRI) techniques, such as diffusion-weighted and blood oxygen level-dependent (BOLD) MRI, are also discussed.
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Affiliation(s)
- M Onniboni
- Scienze Radiologiche, Azienda Ospedaliero-Universitaria di Parma, Via Gramsci 14, Padiglione Barbieri, 43100, Parma, Italy.
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Diagnosis and endovascular treatment of acute thromboembolic renal artery occlusion presenting with abdominal pain. J Thromb Thrombolysis 2012; 34:419-24. [DOI: 10.1007/s11239-012-0729-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Abstract
Renal artery stenosis (RAS) is characterized by a heterogeneous group of pathophysiologic entities, of which fibromuscular dysplasia and atherosclerotic RAS (ARAS) are the most common. Whether and which patients should undergo revascularization for ARAS is controversial. The general consensus is that all patients with ARAS should receive intensive medical treatment. The latest randomized clinical trials have increased confusion regarding recommendations for revascularization for ARAS. Although revascularization is not indicated in all patients with ARAS, experts agree that it should be considered in some patients, especially those with unstable angina, unexplained pulmonary edema, and hemodynamically significant ARAS with either worsening renal function or with difficult to control hypertension. A search of the literature was performed using PubMed and entering the search terms renal artery stenosis, atherosclerotic renal artery stenosis, and renal artery stenosis AND hypertension to retrieve the most recent publications on diagnosis and treatment of ARAS. In this review, we analyze the pathways related to hypertension in ARAS, the optimal invasive and noninvasive modalities for evaluating the renal arteries, and the available therapies for ARAS and assess future tools and algorithms that may prove useful in evaluating patients for renal revascularization therapy.
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Affiliation(s)
- David Lao
- Division of Cardiology, University of California San Francisco, San Francisco, CA 94143-0103, USA
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MD CT Angiography and MR Angiography of Nonatherosclerotic Renal Artery Disease. Cardiovasc Intervent Radiol 2011; 34:1151-64. [DOI: 10.1007/s00270-011-0202-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2011] [Accepted: 05/22/2011] [Indexed: 11/25/2022]
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Ardelean A, Mandry D, Claudon M. [Vascular complications following renal transplantation: diagnostic evaluation]. ACTA ACUST UNITED AC 2011; 92:343-57. [PMID: 21549890 DOI: 10.1016/j.jradio.2011.02.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2011] [Accepted: 02/23/2011] [Indexed: 02/07/2023]
Abstract
Vascular complications after renal transplantation are the most frequent type of complication following urological complications. They may affect the function of the transplant. Early vascular complications include renal artery or vein thrombosis, lesions to the iliac vessels and cortical necrosis. Delayed complications mainly include renal artery stenosis, arteriovenous fistula, and rarely false aneurysm. Doppler sonography, sometimes with the use of intravenous contrast, is the imaging modality of choice in the acute setting or routine follow-up. MRI may be performed for additional morphological and functional evaluation while CT may provide additional evaluation of the arterial supply. Angiography is performed prior to endovascular treatment.
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Affiliation(s)
- A Ardelean
- Inserm U947, service de radiologie, hôpital d'enfants, CHU Nancy-Brabois, rue du Morvan, 54505 Vandœuvre-lès-Nancy, France
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Palmieri BJ, Petroianu A, Silva LC, Andrade LM, Alberti LR. Estudo do padrão arterial de 200 pedículos renais por meio de angiotomografias. Rev Col Bras Cir 2011; 38:116-21. [DOI: 10.1590/s0100-69912011000200009] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2010] [Accepted: 05/07/2010] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Verificar a prevalência e a distribuição das artérias renais e de seus ramos in vivo, relacionando as particularidades encontradas nas artérias renais com o sexo e sua lateralidade. MÉTODO: Duzentos pedículos renais foram estudados por meio de angiotomografias e suas artérias analisadas de acordo com número, posição de origem, calibre, comprimento e trajeto em relação aos segmentos renais. Sua frequência e lateralidade foram pesquisadas quanto ao sexo e idade. RESULTADOS: Foram observadas múltiplas artérias em 61,5% dos pedículos (56% à direita e 67% à esquerda), ocorrendo em 65% dos homens e 58% das mulheres. A origem aórtica para as múltiplas artérias foi mais frequente à direita e, com maior frequência, as artérias renais se originaram entre as vértebras L1 e L2 como divisões pré-hilares da artéria principal. O comprimento médio da artéria principal foi maior em rins direitos com artéria única. Não houve diferença entre o diâmetro da artéria renal principal. CONCLUSÃO: Existe maior prevalência das múltiplas artérias renais do que aquela descrita na literatura, sem diferença entre os sexos ou lateralidade. As artérias renais originaram-se com maior frequência entre as vértebras L1 e L2, como divisões pré-hilares da artéria principal e com trajeto ao hilo do rim. O comprimento médio da artéria principal é maior à direita e nos rins com artéria única. Não houve diferença no diâmetro da artéria renal principal entre rins com artérias únicas e múltiplas.
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Abstract
Renovascular disease remains among the most prevalent and important causes of secondary hypertension and renal dysfunction. Many lesions reduce perfusion pressure including fibromuscular diseases and renal infarction, but most are caused by atherosclerotic disease. Epidemiologic studies establish a strong association between atherosclerotic renal-artery stenosis (ARAS) and cardiovascular risk. Hypertension develops in patients with renovascular disease from a complex set of pressor signals, including activation of the renin-angiotensin system (RAS), recruitment of oxidative stress pathways, and sympathoadrenergic activation. Although the kidney maintains function over a broad range of autoregulation, sustained reduction in renal perfusion leads to disturbed microvascular function, vascular rarefaction, and ultimately development of interstitial fibrosis. Advances in antihypertensive drug therapy and intensive risk factor management including smoking cessation and statin therapy can provide excellent blood pressure control for many individuals. Despite extensive observational experience with renal revascularization in patients with renovascular hypertension, recent prospective randomized trials fail to establish compelling benefits either with endovascular stents or with surgery when added to effective medical therapy. These trials are limited and exclude many patients most likely to benefit from revascularization. Meaningful recovery of kidney function after revascularization is limited once fibrosis is established. Recent experimental studies indicate that mechanisms allowing repair and regeneration of parenchymal kidney tissue may lead to improved outcomes in the future. Until additional staging tools become available, clinicians will be forced to individualize therapy carefully to optimize the potential benefits regarding both blood pressure and renal function for such patients.
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Abstract
Although catheter angiography remains the accepted gold standard for imaging of the renal vascular system, rapid progress in cross-sectional imaging techniques has caused a paradigm shift in many diagnostic algorithms toward noninvasive techniques such as computed tomographic angiography (CTA). CTA's cross-sectional imaging techniques provide an opportunity for comprehensive renal investigation that would be impossible with angiography alone. While other competing noninvasive technologies such as ultrasound and magnetic resonance angiography can be used successfully in renal imaging, the benefits of CTA are substantial, including high spatial and temporal resolution, widespread availability, implantable device compatibility, and easy technical reproducibility. This article describes the technical considerations relevant to CTA of the renal vascular system, postprocessing algorithms for volumetric data, and numerous specific applications.
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Affiliation(s)
- Peter S Liu
- Department of Radiology, University of Michigan Medical Center, Ann Arbor, MI 48109-0030, USA.
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Left main renal artery entrapment by diaphragmatic crura: spiral CT angiography. Biomed Imaging Interv J 2010; 6:e11. [PMID: 21611033 PMCID: PMC3097762 DOI: 10.2349/biij.6.2.e11] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2009] [Revised: 11/01/2009] [Accepted: 11/16/2009] [Indexed: 11/17/2022] Open
Abstract
Entrapment of renal artery by the diaphragmatic crus is a rare cause of renal artery stenosis. Spiral computed tomography angiography provides a definitive diagnosis and shows the precise relationship of the artery to the diaphragmatic crus. The authors present a case of hypertension developing in a young 20-year-old female due to entrapment of the left renal artery by the diaphragmatic crus. This condition should be considered in young hypertensive patients with renal artery stenosis without cardiovascular risk factors.
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Ueda N, Iwayama H, Funahashi Y, Suzuki K. Three-dimensional visualization of renal artery stenosis by 64-channel multiple detector-row computed tomographical angiography: review of two paediatric cases. Acta Paediatr 2010; 99:467-9. [PMID: 19863634 DOI: 10.1111/j.1651-2227.2009.01560.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
UNLABELLED Three-dimensional visualization of renal arteries has recently been established by helical contrast-enhanced multiple detector-row computed tomographical angiography (MDCTA) in adults. So far, no information is available on its use in children. We reported two children with renal artery stenosis detected by 64-channel MDCTA. The first patient probably had fibromuscular dysplasia and the other neurofibromatosis type 1. The technique showed a left renal artery stenosis with a small left kidney in the first patient and a right renal artery stenosis in the second. CONCLUSION MDCTA is an accurate and noninvasive imaging technique, easily performed in children, and can be used as an alternative diagnostic modality in children with suspected renovascular hypertension.
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Affiliation(s)
- N Ueda
- Department of Developmental Pediatrics, Nagoya University Graduate School of Medicine, Showa-ku, Nagoya, Aichi, Japan.
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64-Slice CT angiography of the abdominal aorta and abdominal arteries: comparison of the diagnostic efficacy of iobitridol 350 mgI/ml versus iomeprol 400 mgI/ml in a prospective, randomised, double-blind multi-centre trial. Eur Radiol 2009; 20:572-83. [PMID: 19789884 PMCID: PMC2822224 DOI: 10.1007/s00330-009-1600-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2009] [Accepted: 08/13/2009] [Indexed: 12/20/2022]
Abstract
Purpose The purpose of this study was to assess the influence of iodine concentration on diagnostic efficacy in multi-detector-row computed tomography (MDCT) angiography of the abdominal aorta and abdominal arteries. Methods IRB approval and informed consent were obtained. In this double-blind trial, patients were randomised to undergo MDCT angiography of the abdominal arteries during administration of iobitridol (350 mgI/ml) or iomeprol (400 mgI/ml). Each centre applied its own technique for delivery of contrast medium, regardless of iodine concentration. Diagnostic efficacy, image quality, visualisation of the arterial wall and arterial enhancement were evaluated. A total of 153 patients received iobitridol and 154 received iomeprol. Results The ability to reach a diagnosis was “satisfactory” to “totally satisfactory” in 152 (99.3%) and 153 (99.4%) patients respectively. Image quality was rated as being “good” to “excellent” in 94.7 and 94.8% segments respectively. Similar results were observed for image quality of arterial walls (84.3 vs. 83.2%). The mean relative changes in arterial enhancement between baseline and arterial phase images showed no statistically significant differences. Conclusion This study demonstrated the non-inferiority of the 350 versus 400 mgI/ml iodine concentration, in terms of diagnostic efficacy, in abdominal MDCT angiography. It also confirmed the high robustness and reliability of this technique across multi-national practices.
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Meis A, Osada N, Schlegel PM, Fischbach R, Heindel W, Kloska SP. Sonographic follow-up of the access site after arterial angiography: Impact on the detected complication rate. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2009; 28:1151-1157. [PMID: 19710212 DOI: 10.7863/jum.2009.28.9.1151] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE This study prospectively evaluated the impact of sonographic follow-up on the detection rate of access site complications in arterial angiography and determined parameters associated with major complications of the access site after arterial angiography. METHODS Sonographic follow-up (mean +/- SD, 1.46 +/- 1.11 days after) of the access site (transfemoral, n = 896; and transbrachial, n = 44) was obtained prospectively in 940 arterial angiographies and included evaluations for hematoma, pseudoaneurysm, arteriovenous fistula, arterial dissection, and venous/arterial thrombosis. Clotting parameters, anticoagulation therapy, and several patient and procedure characteristics were recorded. Univariate and multivariate logistic regression analyses were performed. RESULTS Sonography depicted major access site complications in 39 of 940 angiographies (4.2%). Major access site complications (major local hematoma, n = 13; retroperitoneal hematoma, n = 1; pseudoaneurysm, n = 18; arterial dissection, n = 1; arteriovenous fistula, n = 1; arterial thrombosis, n = 2; and venous thrombosis, n = 3) required conservative (n = 32 [3.4%]) or surgical (n = 7 [0.7%]) treatment. Independent factors significantly associated with major access site complications were age older than 60.33 years and sheath size greater than 5F (P < .05). CONCLUSIONS Major access site complications were detected in 4.2% of cases and were significantly associated with age and sheath size.
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Affiliation(s)
- Alexandra Meis
- Department of Clinical Radiology, University of Muenster, Germany
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Liu X, Berg N, Sheehan J, Bi X, Weale P, Jerecic R, Carr J. Renal transplant: nonenhanced renal MR angiography with magnetization-prepared steady-state free precession. Radiology 2009; 251:535-42. [PMID: 19261926 DOI: 10.1148/radiol.2512081094] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The institutional review board approved this HIPAA-compliant study and waived informed consent. The purpose was to investigate nonenhanced magnetic resonance (MR) angiography with steady-state free precession (SSFP) with inversion recovery for assessing renal arteries in patients with renal transplants. Thirteen recipients of renal transplants underwent SSFP MR angiography before contrast material-enhanced MR angiography. Three stenoses (two mild, one severe) were identified at SSFP MR angiography in agreement with findings at contrast-enhanced MR angiography. There was no significant difference in image quality between the two methods. Results suggest SSFP MR angiography permits image quality of renal transplant arteries and detection of arterial stenosis comparable with those at contrast-enhanced MR angiography.
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Affiliation(s)
- Xin Liu
- Department of Radiology, Northwestern University, 737 N Michigan Ave, Suite 1600, Chicago, IL 60611, USA.
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Guzzo TJ, Pierorazio PM, Schaeffer EM, Fishman EK, Allaf ME. The accuracy of multidetector computerized tomography for evaluating tumor thrombus in patients with renal cell carcinoma. J Urol 2008; 181:486-90; discussion 491. [PMID: 19100567 DOI: 10.1016/j.juro.2008.10.040] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2008] [Indexed: 11/19/2022]
Abstract
PURPOSE New advances in computerized tomography, including multidetector computerized tomography with 3-dimensional reformatting has recently called into question the absolute need for magnetic resonance imaging for evaluating renal cell carcinoma with suspected venous involvement. We assessed the accuracy of multidetector computerized tomography for predicting tumor thrombus and the level of venous involvement in patients with renal cell carcinoma. MATERIALS AND METHODS We retrospectively reviewed clinical and pathological features in 41 patients with renal cell carcinoma who underwent staging multidetector computerized tomography before surgery. Multidetector computerized tomography findings regarding the presence and level of tumor thrombus were compared to findings at surgery and at final pathological evaluation. All multidetector computerized tomography studies were read by a single radiologist (EKF) before surgery. RESULTS When excluding patients with segmental venous involvement only, the concordance rate between multidetector computerized tomography and pathological findings was 84%. Multidetector computerized tomography accurately predicted the level of tumor thrombus in 26 of 27 patients (96%). Four cases of negative multidetector computerized tomography findings were up staged to renal vein involvement based on pathological findings. All 4 patients had early distal thrombi that did not change operative management. CONCLUSIONS Multidetector computerized tomography with 3-dimensional mapping is an effective imaging modality for accurately characterizing the level of venous thrombus in patients with renal cell carcinoma. This modality effectively identified patients with clinically significant venous thrombus. Patients with renal cell carcinoma in whom multidetector computerized tomography fails to detect tumor thrombus are unlikely to have a tumor thrombus found at surgery that would change the surgical approach.
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Affiliation(s)
- Thomas J Guzzo
- The James Buchanan Brady Urologic Institute, The Johns Hopkins Medical Institutions, Baltimore, Maryland 21287, USA.
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Kramer U, Wiskirchen J, Fenchel MC, Seeger A, Laub G, Tepe G, Finn JP, Claussen CD, Miller S. Isotropic high-spatial-resolution contrast-enhanced 3.0-T MR angiography in patients suspected of having renal artery stenosis. Radiology 2008; 247:228-40. [PMID: 18270376 DOI: 10.1148/radiol.2471070565] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The purpose of this study was to prospectively evaluate the diagnostic performance of contrast material-enhanced magnetic resonance (MR) angiography performed at 3 T for assessment of renal artery stenosis (RAS) by using parallel acquisition techniques with high acceleration factors and with digital subtraction angiography (DSA) as the reference standard. The study was institutional review board approved, and written informed consent was obtained from all patients. Twenty-nine patients (18 men, 11 women; mean age, 57.1 years +/- 14.3 [standard deviation]) suspected of having RAS underwent MR angiography. Images were evaluated qualitatively and quantitatively. The interobserver variability, sensitivity, specificity, and positive and negative predictive values of 3-T MR angiography, as compared with DSA (performed in 15 patients), were calculated. All examinations yielded good or excellent image quality. The sensitivity and specificity of MR angiography in grading significant (>75%) stenosis were 94% and 96%, respectively. Owing to its high sensitivity, contrast-enhanced 3-T MR angiography can be used reliably to exclude RAS and can serve as a useful screening method in the diagnostic work-up of patients with arterial hypertension.
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Affiliation(s)
- Ulrich Kramer
- Department of Diagnostic Radiology, University of Tuebingen, Hoppe-Seyler-Str 3, 72076 Tuebingen, Germany.
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