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Prediction of Clinical Response After Renal Angioplasty: Respective Value of Renal Doppler Sonography and Scintigraphy

¹ Department of Radiology, CHUM—Notre-Dame Hospital, 1560 Sherbrooke St. E., Montreal, QC H2L 4M1, Canada.
² Department of Radiology, CHUV, University of Lausanne, 46 rue du Bugnan, Lausanne 1011, Switzerland.
³ Department of Medicine, CHUM—Notre-Dame Hospital, Montreal, QC H2L 4M1, Canada.
⁴ Department of Nuclear Medicine, CHUM—Notre-Dame Hospital, Montreal, QC H2L 4M1, Canada.
⁵ Department of Biostatistics, Montreal Heart Institute, University of Montreal, 5000 Bélanger St., Montreal, QC H1T 1C8, Canada.

OBJECTIVE. The goal of our study was to compare Doppler sonography and renal scintigraphy as tools for predicting the therapeutic response in patients after undergoing renal angioplasty.

SUBJECTS AND METHODS. Seventy-four hypertensive patients underwent clinical examination, Doppler sonography, and renal scintigraphy before and after receiving captopril in preparation for renal revascularization. The patients were evaluated for the status of hypertension 3 months after the procedure. The predictive values of the findings of clinical examination, Doppler sonography, renal scintigraphy, and angiography were assessed.

RESULTS. For prediction of a favorable therapeutic outcome, abnormal results from renal scintigraphy before and after captopril administration had a sensitivity of 58% and specificity of 57%. Findings of Doppler sonography had a sensitivity of 68% and specificity of 50% before captopril administration and a sensitivity of 81% and specificity of 32% after captopril administration. Significant predictors of a cure or reduction of hypertension after revascularization were low unilateral (p = 0.014) and bilateral resistive (p = 0.016) indexes on Doppler sonography before (p = 0.009) and after (p = 0.028) captopril administration. On multivariate analysis, the best predictors were a unilateral resistive index of less than 0.65 (odds ratio [OR] = 3.7) after captopril administration and a kidney longer than 93 mm (OR = 7.8). The two best combined criteria to predict the favorable therapeutic outcome were a bilateral resistive index of less than 0.75 before captopril administration combined with a unilateral resistive index of less than 0.70 after captopril administration (sensitivity, 76%; specificity, 58%) or a bilateral resistive index of less than 0.75 before captopril administration and a kidney measuring longer than 90 mm (sensitivity, 81%; specificity, 50%).

CONCLUSION. Measurements of kidney length and unilateral and bilateral resistive indexes before and after captopril administration were useful in predicting the outcome after renal angioplasty. Renal scintigraphy had no significant predictive value.

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