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Helical CT angiography compared with arteriography in the detection of renal artery stenosis
J P Beregi1, M Elkohen, G Deklunder
1Department of Vascular Radiology, Hôpital Cardiologique, Centre Hospitalier Regional Universitaire de Lille, France.
Insights
This study improved helical CT angiography for detecting renal artery stenosis. The enhanced protocol showed high accuracy and detection rates compared to arteriography.
Area of Science:
- Radiology
- Vascular Imaging
- Medical Diagnostics
Background:
- Renal artery stenosis is a significant cause of hypertension.
- Accurate diagnosis is crucial for effective treatment.
- Helical CT angiography offers potential for improved visualization.
Purpose of the Study:
- To enhance the accuracy and detection rate of renal vascular lesions using helical CT angiography.
- To evaluate an improved acquisition protocol and postprocessing technique.
- To compare helical CT angiography with digital renal arteriography.
Main Methods:
- Prospective study of 50 hypertensive patients with suspected renal artery stenosis.
- Utilized digital renal arteriography and helical CT angiography.
- Employed a 20-second helical scan with specific collimation and pitch, followed by advanced postprocessing reconstructions.
Main Results:
- Helical CT angiography detected 14 out of 16 significant renal artery stenoses (88% sensitivity).
- Overall specificity was 98%, with 100% sensitivity for main renal arteries.
- Two cases of Conn's syndrome, a cause of hypertension, were identified.
Conclusions:
- The described helical CT angiography protocol significantly improves accuracy and detection rates for renal artery stenosis.
- This technique provides a valuable, accurate diagnostic tool for renal vascular lesions.
- Enhanced imaging protocols can optimize the diagnostic performance of CT angiography.
Objective:
The aim of the study was to improve the accuracy and detection rate for renal vascular lesions on helical CT angiography with an improved acquisition protocol and postprocessing.
Subjects And Methods:
Fifty hypertensive patients (man age, 53 years old) referred because of clinical suspicion on renal artery stenosis were prospectively studied with digital renal arteriography and helical CT angiography. A 20-sec helical scan (collimation, 3 mm; pitch, 1) was obtained after injection of contrast medium. Interpretation was base on transverse sections, shaded-surface-display and maximum-intensity-projection reconstructions, and two-dimensional multiplanar reconstruction cuts obtained from shaded-surface-display reconstructions.
Results:
Arteriography visualized 131 renal arteries (including 32 accessory arteries). Sixteen had significant (greater than 50% in diameter) stenosis. On helical CT angiography, 14 of these 16 stenoses were detected; two were missed (false-negatives), and two additional stenoses (false-positives) were reported. Sensitivity and specificity were 88% and 98%, respectively. Considering only main renal arteries, the sensitivity and the specificity of helical CT angiography were 100% and 98%, respectively. Helical CT angiography detected Conn's syndrome, which was responsible for hypertension, in two other patients.
Conclusion:
The accuracy and detection rate for renal artery stenosis on helical CT angiography compared with arteriography is improved with the described protocol.