Detecting Fibromuscular Dysplasia-Related Renal Artery Stenosis: CTA or Doppler US?

To compare the diagnostic efficacy of Doppler ultrasound (DUS) and computed tomography angiography (CTA) in patients with renal artery fibromuscular dysplasia (FMD)-related severe renal artery stenosis (RAS).

In this retrospective study, 78 patients with hypertension were confirmed FMD-related severe RAS based on clinical and angiographical features. All participants underwent standardized renal DUS and CTA. Two blinded readers independently classified lesions and assessed hemodynamics, with discrepancies resolved by a third senior radiologist. Diagnostic performance of DUS and CTA was compared per segment and overall using digital subtraction angiography (DSA) as the reference standard.

A total of 157 renal arteries were analyzed, 86 of which demonstrated severe stenosis accompanied with abnormal arteriographic features of FMD. Integrated analysis showed higher sensitivity for DUS versus CTA in detecting FMD-related severe stenoses (overall: 97.7% versus 67.4%, p < .001; main renal arteries: 98.5% versus 79.4%, p = .001; accessory/branch arteries: 94.4% versus 22.2%, Δ72.2%, p < .001). Both modalities achieved 100% specificity for accessory/branch lesions. DUS demonstrated 100% specificity for main artery lesions and overall, whereas CTA was 97.7% for main artery lesions and 97.2% overall.

DUS outperformed CTA for FMD-related severe RAS, especially with consistent accuracy across vascular territories, supporting its potential as a preferred imaging modality in FMD evaluation.