MR angiography of the renal arteries

MR angiography (MRA) has shown considerable promise as a noninvasive tool in the evaluation of renal vascular morphology. There are two fundamental approaches to MRA of the renal arteries: time of flight and phase contrast imaging. Recently, three-dimensional, gradient-echo, gadolinium-enhanced MRA using breath-hold techniques also has been introduced. These techniques have made MRA of the renal arteries a very promising, noninvasive tool in the detection of main renal artery stenosis, with sensitivities between 90% and 100%. MRA is used most often in the evaluation of renal arteries of patients with abdominal aortic aneurysms or allergies to iodinated contrast media, or when other noninvasive screening examinations have been inconclusive. One of the most helpful and unique applications of MRA is in patients who have accelerating hypertension and accelerating renal insufficiency. These patients often have preexisting unilateral renal artery stenosis with a new contralateral renal artery stenosis. Conventional angiography is risky in these patients because of possible contrast nephropathy. MRA, in such cases, is very helpful for differentiating between bilateral renal artery stenosis and end-stage nephrosclerosis.