Evaluation of renovascular hypertension - Comparison of functional MRI and contrast-enhanced MRA with a routinely performed renal scintigraphy and DSA
ABSTRACT The main objective of this study was to evaluate a clinically suspected renovascular hypertension (RVH) by means of MRI. It was to find out if functional MRI (fMRI) is able to provide adequate results with regard to MAG3 captopril scintigraphy and if contrast-enhanced MR angiography (MRA) is able to provide adequate results in the stenosis grading compared with the nonselective digital subtraction angiography (DSA).
This open, monocentric, prospective, phase 3 study included patients with a clinically suspected RVH. For fMRI a dynamic TurboFLASH sequence and for MRA a single-shot breath-hold flash 3D sequence was performed. Gadodiamide was injected as contrast medium.
Sixty patients were included in the study. The correlation between fMRI and scintigraphy had an accuracy, a sensitivity, and a specificity of 69%, 5%, and 92%, respectively, and correlations between MRA and DSA of 95%, 92%, and 96%.
The noninvasive MRA can replace DSA in the diagnosis of renal artery stenosis. However, fMRI can not replace renal scintigraphy.
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Article: Secondary Forms of Hypertension
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ABSTRACT: To study the etiology, clinical spectrum. image findings, management and outcome of children with renovascular hypertension (RVH). Twenty children (aged 5 days to 15 years) were studied and treated for RVH during 1977-1998. In 14 cases hypertension was found during a routine examination. Six cases had heart failure and/or hypertensive encephalopathy. Diagnosis was made with aortography. Post-captopril renography and Doppler ultrasonography were obtained in 8 patients and spiral computed tomography angiography in 2. Treatment consisted of surgery (8 patients), percutaneous transluminal angioplasty (PTA) (5) or antihypertensive drugs only (8). Initial blood pressure was 62 +/- 31 mmHg > 95th percentile for systolic and 44 +/- 22 mmHg for diastolic blood pressure. Twelve children had unilateral and 8 had bilateral arterial stenosis. In 3 cases lesions were intrarenal. RVH was due to fibromuscular dysplasia (7 patients) and associated to middle aortic syndrome (5). neurofibromatosis (3), William's syndrome (2). Takayasu's arteritis (1) and pheochromocytoma (1). Treatment of choice was decided depending on the size of the child and location and severity of the stenosis. At the end of the follow-up (78 +/- 49 months), 9 patients are normotensive without medication and 7 are normotensive with drugs. Three patients have died, 2 for unrelated causes and I for cardiac failure; 1 child was lost to the follow-up. Although symptoms are relatively uncommon. renovascular disease is a frequent cause of severe hypertension in childhood. Non-invasive diagnostic techniques appear useful as screening methods. Treatment by surgery or PTA is successful if patients are carefully selected.Current Urology Reports 07/2001; 2(3):181-2. DOI:10.1007/s11934-001-0074-0 · 1.51 Impact Factor
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ABSTRACT: Noninvasive modalities, including duplex ultrasonography, renal scintigraphy, CT angiography and magnetic resonance angiography (MRA), may usefully contribute to diagnosis and treatment planning in patients with suspected renal artery stenosis. Important technical developments have increased the accuracy and feasibility of MRA for the detection of renal artery stenosis. A number of different MRA techniques can be applied to the study of renal arteries, but contrast-enhanced MRA represents the most valuable approach; several studies corroborate the high diagnostic accuracy of this technique, especially for the detection of atherosclerotic renal artery stenosis. A combined MRA protocol, which might include angiographic information provided by contrast-enhanced technique in addition to renal flow information derived from phase-contrast imaging, could help in classifying patients appropriately. Limitations of renal MRA include low accuracy in the evaluation of renal fibromuscular dysplasia and in the assessment of patients who undergo stenting of the renal arteries. This review describes the MRA techniques applied to the study of renal artery stenosis, including the technical features of current approaches and forthcoming developments. An overview of the clinical role of MRA, in conjunction with the other diagnostic modalities, in the identification and management of patients with renal artery stenosis, is also presented.Nature Clinical Practice Cardiovascular Medicine 07/2006; 3(6):329-38. DOI:10.1038/ncpcardio0556 · 7.04 Impact Factor