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1
Department of Radiology, CHUM, Hôpital
Notre-Dame, 1560 Sherbrooke St. E., Montréal,
Quebec H2L 4M1, Canada.
2
Department of Radiology, CHUM, Hôpital
Hotel-Dieu de Montréal, University of
Montréal, 3840 St. Urbain, H2W 1T8
Montréal, Quebec, Canada.
3
Department of Nuclear Medicine, CHUM, Hôpital
Hotel-Dieu de Montréal, University of
Montréal, H2W 1T8
Montréal, Quebec, Canada.
4
Department of Medicine, CHUM, Hôpital
Notre-Dame, Montréal, Quebec H2L 4M1,
Canada.
5
Department of Biostatistics, Hotel-Dieu de
Montréal, University of
Montréal,
Montréal, Quebec H2L 4M1, Canada.
OBJECTIVE. The objective of our study was to compare the value of captopril-enhanced Doppler sonography, captopril-enhanced renal scintigraphy, and gadolinium-enhanced MR angiography for detecting renal artery stenosis.
SUBJECTS AND METHODS. Forty-one patients with suspected renovascular hypertension were prospectively examined with captopril-enhanced Doppler sonography, captopril-enhanced renal scintigraphy, gadolinium-enhanced MR angiography, and catheter angiography. The sensitivity and specificity of each technique for detecting renal artery stenosis measuring 50% or greater and 70% or greater were compared using the McNemar test. Positive and negative predictive values were estimated for populations with 5% and 30% prevalence of renal artery stenosis. Kappa values for interobserver agreement were assessed for both gadolinium-enhanced MR angiography and catheter angiography.
RESULTS. For detecting renal artery stenosis measuring 50% or
greater, the sensitivity of gadolinium-enhanced MR angiography (96.6%) was
greater than that of captopril-enhanced Doppler sonography (69%, p =
0.005) and captopril-enhanced renal scintigraphy (41.4%, p = 0.001).
No significant difference in specificity was observed among modalities. For
renal artery stenosis measuring 50% or greater, positive and negative
predictive values were respectively 62% and 86% for captopril-enhanced Doppler
sonography, 49% and 76% for captopril-enhanced renal scintigraphy, and 53% and
98% for gadolinium-enhanced MR angiography. Interobserver agreement was high
for both gadolinium-enhanced MR angiography (
= 0.829) and catheter
angiography ( = 0.729).
CONCLUSION. Gadolinium-enhanced MR angiography is the most accurate noninvasive modality for detecting renal artery stenosis greater than or equal to 50%. The use of captopril-enhanced Doppler sonography in combination with gadolinium-enhanced MR angiography for identifying renal artery stenosis needs to be evaluated with a cost-effectiveness analysis.
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