Renal Artery Stenosis: Evaluation with Conventional Angiography versus Gadolinium-enhanced MR Angiography
Maryellyn Gilfeather, MD1,
Hyo-Chun Yoon, MD, PhD1,
Evan S. Siegelman, MD2,
Leon Axel, MD, PhD2,
Alan H. Stolpen, MD, PhD2,
Richard D. Shlansky-Goldberg, MD2,
Richard A. Baum, MD2,
Michael C. Soulen, MD2 and
Mitchell D. Schnall, MD, PhD2
1 Department of Radiology, University of Utah Health Sciences Center, 50 N Medical Dr, Salt Lake City, UT 84132 (M.G., H.C.Y.)
2 Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia (E.S.S., L.A., A.H.S., R.D.S.G., R.A.B., M.C.S., M.D.S.).
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Figure 1a. Reported degree of maximal stenosis for all renal arteries and all readers. Graphs show the degree of maximal renal artery stenosis determined with (a) MR angiography (mra) by three readers and (b) conventional angiography (angio) by three readers. Both graphs demonstrate a large range in the reported degree of stenosis. The average values of the range of MR angiographic readings and the average values of the range of conventional angiographic readings were not significantly different. Numbers along the horizontal axis indicate the vessel number.
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Figure 1b. Reported degree of maximal stenosis for all renal arteries and all readers. Graphs show the degree of maximal renal artery stenosis determined with (a) MR angiography (mra) by three readers and (b) conventional angiography (angio) by three readers. Both graphs demonstrate a large range in the reported degree of stenosis. The average values of the range of MR angiographic readings and the average values of the range of conventional angiographic readings were not significantly different. Numbers along the horizontal axis indicate the vessel number.
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Figure 2a. Agreement between results of MR angiography and conventional angiography. (a) Conventional angiogram and (b) MR angiogram (5.2/1.1) were interpreted by both sets of readers as not showing stenosis of the right renal artery (large arrow). Note the accessory renal artery to the right upper pole (small arrow).
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Figure 2b. Agreement between results of MR angiography and conventional angiography. (a) Conventional angiogram and (b) MR angiogram (5.2/1.1) were interpreted by both sets of readers as not showing stenosis of the right renal artery (large arrow). Note the accessory renal artery to the right upper pole (small arrow).
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Figure 3a. Agreement between results of MR angiography and conventional angiography. (a) Conventional angiogram and (b) MR angiogram (6.2/1.2) were interpreted by both sets of readers as showing occlusion of the right renal artery (large arrow) and a normal left renal artery (small arrow).
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Figure 3b. Agreement between results of MR angiography and conventional angiography. (a) Conventional angiogram and (b) MR angiogram (6.2/1.2) were interpreted by both sets of readers as showing occlusion of the right renal artery (large arrow) and a normal left renal artery (small arrow).
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Figure 4a. Agreement between results of MR angiography and conventional angiography. (a) Conventional angiogram and (b) MR angiogram (5.2/1.1) were interpreted by both sets of readers as showing greater than 80% stenosis. It is difficult to see the narrow lumen (arrow in a) of the stenotic portion of the right renal artery on the MR angiogram (straight arrow in b). The distal right renal artery appears narrowed on the MR angiogram (curved arrow in b) because that portion of the vessel lies outside the reformatted imaging volume, not because of stenosis.
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Figure 4b. Agreement between results of MR angiography and conventional angiography. (a) Conventional angiogram and (b) MR angiogram (5.2/1.1) were interpreted by both sets of readers as showing greater than 80% stenosis. It is difficult to see the narrow lumen (arrow in a) of the stenotic portion of the right renal artery on the MR angiogram (straight arrow in b). The distal right renal artery appears narrowed on the MR angiogram (curved arrow in b) because that portion of the vessel lies outside the reformatted imaging volume, not because of stenosis.
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Figure 5a. Disagreement between results of MR angiography and conventional angiography. (a) Conventional angiogram was interpreted by all three readers as showing a normal right renal artery (straight arrow). (b) MR angiogram (6.3/1.3) was interpreted by all three readers as showing clinically important stenosis (>60%) of the right renal artery (straight arrow). Note the common origin of the inferior phrenic and capsular-adrenal arteries (curved arrow in a and b).
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Figure 5b. Disagreement between results of MR angiography and conventional angiography. (a) Conventional angiogram was interpreted by all three readers as showing a normal right renal artery (straight arrow). (b) MR angiogram (6.3/1.3) was interpreted by all three readers as showing clinically important stenosis (>60%) of the right renal artery (straight arrow). Note the common origin of the inferior phrenic and capsular-adrenal arteries (curved arrow in a and b).
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Figure 6a. Disagreement between results of MR angiography and conventional angiography. (a) Conventional angiogram was interpreted by all three readers as showing clinically important stenosis (>80%) of the left renal artery (arrow). (b) MR angiogram (6.3/1.3) was interpreted by all three readers as showing less than 50% stenosis of the left renal artery (arrow). There was agreement between both sets of readers on the presence of severe right renal artery stenosis.
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Figure 6b. Disagreement between results of MR angiography and conventional angiography. (a) Conventional angiogram was interpreted by all three readers as showing clinically important stenosis (>80%) of the left renal artery (arrow). (b) MR angiogram (6.3/1.3) was interpreted by all three readers as showing less than 50% stenosis of the left renal artery (arrow). There was agreement between both sets of readers on the presence of severe right renal artery stenosis.
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Copyright © 1999 by the Radiological Society of North America.
