1
|
Shivgulam ME, Liu H, Kivell MJ, MacLeod JR, O'Brien MW. Effectiveness of contrast-enhanced duplex ultrasound for detecting renal artery stenosis: A systematic review. JOURNAL OF CLINICAL ULTRASOUND : JCU 2024; 52:763-772. [PMID: 38660883 DOI: 10.1002/jcu.23684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 02/26/2024] [Accepted: 04/01/2024] [Indexed: 04/26/2024]
Abstract
PURPOSE Contrast-enhanced duplex ultrasound (CEUS) might be a useful tool to diagnosing renal artery stenosis (RAS). We amalgamated and reviewed the evidence assessing the diagnostic accuracy of CEUS on detecting RAS compared to angiography. METHODS This preregistered systematic review included studies that compared the presence of RAS via CEUS with angiography. Sources were searched in November 2022 and included Scopus, EMBASE, MEDLINE, CINAHL, and Academic Search Premier (n = 1717). The Quality Assessment of Diagnostic Studies 2 tool assessed study quality. Results are presented narratively. RESULTS The studies included (n = 11) had a total of 447 unique participants (193 females) and average age of 56 ± 9 years. Five of eleven studies investigated CEUS using SonoVue contrast agent and reported an average accuracy (91% ± 2%), sensitivity (91% ± 3%), specificity (90% ± 5%), negative predictive value (86% ± 6%), and positive predictive value (94% ± 1%) with all values >80%. The accuracy of CEUS using other types of contrast agent (n = 6), including Levovsit (n = 3/6), Definity (n = 1/6), perfienapent emulsion (n = 1/6), and perfluorocarbon-exposed sonicated dextrose albumin (n = 1/6) was mixed. These studies detected an average accuracy of 91 ± 11% (n = 2/3% > 80%), sensitivity of 98% ± 4%, (n = 3/3% > 80%), and specificity of 86% ± 10% (n = 2/3% > 80%). Included studies had generally low risk of bias and applicability concerns except for unclear flow and timing (n = 7/11) and applicability of patient selection (n = 4/11). CONCLUSION Despite being limited by the heterogeneity of included studies, our review indicates a high overall diagnostic accuracy for CEUS to detect RAS compared to angiography, with the largest evidence-base for SonoVue contrast. Radiologists and hospital decision makers should consider CEUS as an acceptable alternative to angiography.
Collapse
Affiliation(s)
| | - Haoxuan Liu
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - Matthew J Kivell
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jessica R MacLeod
- Diagnostic Medical Ultrasound, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Myles W O'Brien
- Department of Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
- Centre de Formation Médicale Du Nouveau-Brunswick, Université de Sherbrooke, Moncton, New Brunswick, Canada
| |
Collapse
|
2
|
Sailer AM, van Zwam WH, Wildberger JE, Grutters JPC. Cost-effectiveness modelling in diagnostic imaging: a stepwise approach. Eur Radiol 2015; 25:3629-37. [PMID: 26003789 PMCID: PMC4636534 DOI: 10.1007/s00330-015-3770-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Accepted: 04/03/2015] [Indexed: 01/16/2023]
Abstract
Abstract Diagnostic imaging (DI) is the fastest growing sector in medical expenditures and takes a central role in medical decision-making. The increasing number of various and new imaging technologies induces a growing demand for cost-effectiveness analysis (CEA) in imaging technology assessment. In this article we provide a comprehensive framework of direct and indirect effects that should be considered for CEA in DI, suitable for all imaging modalities. We describe and explain the methodology of decision analytic modelling in six steps aiming to transfer theory of CEA to clinical research by demonstrating key principles of CEA in a practical approach. We thereby provide radiologists with an introduction to the tools necessary to perform and interpret CEA as part of their research and clinical practice. Key Points • DI influences medical decision making, affecting both costs and health outcome. • This article provides a comprehensive framework for CEA in DI. • A six-step methodology for conducting and interpreting cost-effectiveness modelling is proposed.
Collapse
Affiliation(s)
- Anna M Sailer
- Department of Radiology, Maastricht University Medical Center, P.O. Box 5800, P.Debyelaan 25, Maastricht, 6202 AZ, The Netherlands. .,Department of Radiology, Stanford University Hospitals and Clinics, Stanford, CA, USA.
| | - Wim H van Zwam
- Department of Radiology, Maastricht University Medical Center, P.O. Box 5800, P.Debyelaan 25, Maastricht, 6202 AZ, The Netherlands
| | - Joachim E Wildberger
- Department of Radiology, Maastricht University Medical Center, P.O. Box 5800, P.Debyelaan 25, Maastricht, 6202 AZ, The Netherlands
| | - Janneke P C Grutters
- Department for Health Evidence, Radboud University Medical Center, P.O. Box 9101, Geert Grooteplein-Zuid 10, Nijmegen, 6500 HB, The Netherlands
| |
Collapse
|
3
|
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: 26] [Impact Index Per Article: 2.6] [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.
Collapse
|
4
|
Hoefman RJ, van Exel J, Brouwer W. How to include informal care in economic evaluations. PHARMACOECONOMICS 2013; 31:1105-19. [PMID: 24218135 DOI: 10.1007/s40273-013-0104-z] [Citation(s) in RCA: 105] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Economic evaluations of health interventions aim to support decision making in healthcare. To effectively do so, evaluations need to include all relevant costs and effects of an intervention. Informal care provided by family or friends is an important element of care for many patients, but can have a profound impact on the health and well-being of carers. Therefore, informal care should be considered in economic evaluations of health interventions. Different methods to do so exist. This paper provides an overview of state-of-the-art methods available for this purpose, illustrated with practical examples. Since the choice of measurement and valuation technique depends on the type and perspective of the economic evaluation, this paper supports researchers in choosing the appropriate techniques to include informal care in their economic evaluation of a health intervention. We discuss the different approaches to measuring and valuing informal care, covering both partial and full valuation methods, allowing inclusion as costs or effects.
Collapse
Affiliation(s)
- Renske J Hoefman
- Institute of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands,
| | | | | |
Collapse
|
5
|
Pu LJ, Shen Y, Zhang RY, Zhang Q, Lu L, Ding FH, Hu J, Yang ZK, Shen WF. Screening for significant atherosclerotic renal artery stenosis with a regression model in patients undergoing transradial coronary angiography/intervention. J Zhejiang Univ Sci B 2012; 13:631-7. [PMID: 22843183 DOI: 10.1631/jzus.b1201003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVE Early detection of atherosclerotic renal artery stenosis (ARAS) is clinically important with respect to blood pressure control, prevention of renal insufficiency, and even improving survival. We investigated whether the presence of significant ARAS (luminal diameter narrowing ≥70%) could be predicted using a logistic regression model before coronary angiography/intervention. METHODS Initially, we developed a logistic regression model for detecting significant ARAS based upon clinical and angiographic features and biochemical measurements in a cohort of 1813 patients undergoing transfemoral coronary and renal angiography. This model was then prospectively applied to an additional 495 patients who received transradial renal angiography to ascertain its predictive accuracy for the presence of significant ARAS. RESULTS Multivariate regression analysis revealed that older age (≥65 years), resistant hypertension, type 2 diabetes, creatinine clearance (Ccr) ≤60 ml/min, and multivessel coronary disease were independent predictors for significant ARAS. A logistic regression model for detecting ARAS by incorporating conventional risk factors and multivessel coronary disease was generated as: P/(1-P)=exp(-2.618+1.112[age≥65 years]+1.891[resistant hypertension]+0.453[type 2 diabetes]+0.587[Ccr≤60 ml/min]+2.254[multivessel coronary disease]). When this regression model was prospectively applied to the additional 495 patients undergoing transradial coronary and renal angiography, significant ARAS could be detected with a sensitivity of 81.2%, specificity of 88.9%, and positive and negative predictive accuracies of 53.8% and 96.7%, respectively. CONCLUSIONS The logistic regression model generated in this study may be useful for screening for significant ARAS in patients undergoing transradial coronary angiography/intervention.
Collapse
Affiliation(s)
- Li-jin Pu
- Department of Cardiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | | | | | | | | | | | | | | | | |
Collapse
|
6
|
Goodrich K, Kaambwa B, Al-Janabi H. The inclusion of informal care in applied economic evaluation: a review. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2012; 15:975-81. [PMID: 22999150 DOI: 10.1016/j.jval.2012.05.009] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2011] [Revised: 05/09/2012] [Accepted: 05/31/2012] [Indexed: 05/20/2023]
Abstract
OBJECTIVE Theory and guidelines advocating the inclusion of informal care in economic evaluation have, in recent years, been accompanied by developments in the methods for capturing the costs and outcomes related to informal care. The objective of this study was to review applied economic evaluations to identify the methods used for, and implications of, including informal care in practice. METHODS Searches of key databases were conducted to identify all full economic evaluations incorporating costs or outcomes relating to informal care. Information was extracted by using a standard template from all studies meeting the inclusion criteria. RESULTS Thirty economic evaluations were identified that included informal care. Twenty-five of these studies costed carers' time input and 17 measured outcomes for carers. The reported cost-effectiveness of interventions was altered by including informal care, in some cases changing the key conclusions for health care funding. CONCLUSIONS Theory and methods development around informal care are yet to significantly permeate the applied literature; however, the results suggest that some funding priorities may change if they were to do so. The development of 1) a reference case for including informal care; 2) sensitivity analysis for contentious issues; and 3) a statement for the reason for excluding informal care, if this is deemed appropriate, may help to improve the way that informal care is included in economic evaluations in the future.
Collapse
Affiliation(s)
- Kacey Goodrich
- Health Economics Unit, School of Health and Population Sciences, University of Birmingham, Birmingham, UK
| | | | | |
Collapse
|
7
|
Guillerman RP. Newer CT applications and their alternatives: what is appropriate in children? Pediatr Radiol 2011; 41 Suppl 2:534-48. [PMID: 21847736 DOI: 10.1007/s00247-011-2163-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2011] [Revised: 05/18/2011] [Accepted: 05/25/2011] [Indexed: 12/20/2022]
Abstract
Innovations in image acquisition and reconstruction technologies have greatly expanded the range of CT applications available in the routine clinical setting. CT images of sub-millimeter resolution can now be acquired of entire body regions in a few seconds or even sub-second time, allowing depiction of fine anatomical detail uncompromised by motion artifact. With sophisticated visualization software, image data can be processed into multiplanar, volume-rendered, cine and other formats to better display anatomical abnormalities and facilitate newer applications such as CT angiography, enterography, urography, tracheobronchography and cardiac CT. Newer applications including dual-energy material decomposition CT are furthering the transition of CT from a purely morphological to a combined anatomical, functional and metabolic imaging technique. These newer applications have largely been pioneered in adult populations, and heightened concern of the risk of carcinogenesis from ionizing radiation tempers dissemination of their use in children. Similar information can often be gleaned from alternative imaging modalities without ionizing radiation exposure, such as MRI and US, and what is most appropriate in children will depend on relative diagnostic efficacy, cost, availability and local expertise.
Collapse
Affiliation(s)
- R Paul Guillerman
- Department of Pediatric Radiology, Baylor College of Medicine, Texas Children's Hospital, 6701 Fannin St., Suite 470, Houston, TX 77030, USA.
| |
Collapse
|
8
|
Abstract
Fibromuscular dysplasia (FMD) encompasses a heterogeneous group of idiopathic, segmental, nonatherosclerotic diseases of the musculature of arterial walls, leading to the narrowing of small and medium-sized arteries. The most common locations of FMD are renal arteries and carotid arteries. The diagnosis of FMD is made on the "string of beads" appearance of the arteries. The French Health Authority recommends performing a CT scan or an MRA to assess the diagnosis of FMD. A recent meta-analysis showed the cure rates using current definitions of hypertension cure are only 36% and 54% after angioplasty and surgery, respectively.
Collapse
|
9
|
Salehi N, Firouzi A, Gholoobi A, Shakerian F, Sanati HR, Ahmadabadi MN, Moradi M. relationship between distribution of coronary artery lesions and renal artery stenosis in patients undergoing simultaneous coronary and renal angiography. CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2011; 5:35-40. [PMID: 21487456 PMCID: PMC3072210 DOI: 10.4137/cmc.s6819] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Aims: We evaluated the relationship between distribution of lesions in coronary tree and atherosclerotic renal artery stenosis (RAS). Methods and results: Data collected prospectively on 500 consecutive patients who underwent simultaneous renal angiography following coronary angiography. Overall prevalence of RAS was 26.2% (131 patients). Significant (≥50% luminal diameter stenosis) RAS was present in 70 patients (14%). In 346 individuals of the study population, significant CAD was present (69.2%). Significant RAS was more common (18.4%) in this group. Older age, higher intra-arterial systolic blood pressure (SBP) and pulse pressure (PP) at the time of catheterization, and 3-vessel coronary artery disease (CAD) were associated with significant RAS in univariate analysis. Relationship between involved locations of coronary arteries [Left anterior descending (LAD), left circumflex (LCX), Right Coronary Artery (RCA), and their ostio-proximal portions] and RAS were significant except for left main (LM) disease. In multivariate model, age more than 62 years, SBP greater than 150 mmHg, PP in excess of 60 mmHg and RCA involvement were independent predictors of significant RAS. Conclusion: Simultaneous renal angiography following coronary angiography might be justified in patients with significant RCA disease who are older with increased levels of intra-arterial SBP and PP.
Collapse
Affiliation(s)
- Negar Salehi
- Assistant professor, Department of Interventional Cardiology, Shaheed Rajaie Cardiovascular Medical and Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | | | | | | | | |
Collapse
|
10
|
Colyer WR, Cooper CJ. Management of Renal Artery Stenosis: 2010. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2011; 13:103-13. [DOI: 10.1007/s11936-011-0111-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
11
|
Wilson GJ, Maki JH. Non-contrast-enhanced MR imaging of renal artery stenosis at 1.5 tesla. Magn Reson Imaging Clin N Am 2009; 17:13-27. [PMID: 19364597 DOI: 10.1016/j.mric.2009.01.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Balanced steady-state free precession (Bal-SSFP) techniques produce excellent anatomic images of renal arteries without the use of contrast agents and are relatively flow-insensitive. Electrocardiography (ECG)-triggered and non-ECG-triggered sequences have been shown to be quite sensitive for detection of regional arterial stenosis (RAS), and the already high specificity is likely to increase with further refinement of the techniques. Bal-SSFP sequences can be used as a screening tool or as an alternative to contrast-enhanced (CE) magnetic resonance angiography (MRA) when contrast agents are contraindicated. In addition to morphologic imaging of RAS, non-CE techniques can be used in functional assessment of hemodynamic significance. The complimentary tools can be used alone or in combination with CE-MRA for MR imaging of renal vascular hypertension.
Collapse
Affiliation(s)
- Gregory J Wilson
- Department of Radiology (AA010-J), University of Washington, 1959 NE Pacific Street, Seattle, WA 98195, USA; Philips Healthcare, Cleveland, OH, USA.
| | | |
Collapse
|
12
|
Tarride JE, Blackhouse G, Bischof M, McCarron EC, Lim M, Ferrusi IL, Xie F, Goeree R. Approaches for Economic Evaluations of Health Care Technologies. J Am Coll Radiol 2009; 6:307-16. [DOI: 10.1016/j.jacr.2009.01.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2009] [Accepted: 01/22/2009] [Indexed: 01/22/2023]
|
13
|
Paul RK, Lum DP, Consigny DW, Grinde JR, Grist TM. CT Perfusion in the Treatment of a Swine Model of Unilateral Renal Artery Stenosis: Validation with Microspheres. J Vasc Interv Radiol 2009; 20:513-23. [DOI: 10.1016/j.jvir.2008.12.420] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2008] [Revised: 12/20/2008] [Accepted: 12/22/2008] [Indexed: 10/21/2022] Open
|
14
|
He W, Fischman AJ. Nuclear imaging in the genitourinary tract: recent advances and future directions. Radiol Clin North Am 2008; 46:25-43, v. [PMID: 18328878 DOI: 10.1016/j.rcl.2008.01.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
For almost three decades, noninvasive radionuclide procedures for the evaluation of renal disease have been important components of nuclear medicine practice. With the introduction of new imaging agents and procedures, these techniques can provide valuable data on perfusion and function of individual kidneys. In general, these procedures are easy to perform and carry a low radiation burden and sedation is not required. Moreover, radionuclide imaging of the genitourinary tract has become an invaluable asset to clinicians in the evaluation of renal parenchyma and urologic abnormalities.
Collapse
Affiliation(s)
- Wei He
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | | |
Collapse
|