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Navigator-Gated MR Angiography of the Renal Arteries: A Potential Screening Tool for Renal Artery Stenosis

¹ Department of Radiology (S113), University of Washington, Puget Sound VA Health Care System, 1660 S Colombian Way, Seattle, WA 98108.
² UW Medicine at Lake Union–Vascular Imaging Lab, Seattle, WA.
³ Radia Inc., Everett, WA.
⁴ Philips Medical Systems, Cleveland, OH.

View larger version (71K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1A —68-year-old man with suspected renovascular hypertension. Coronal and axial subvolume maximum intensity projections (MIPs) from navigator-gated steady-state free precession (Nav SSFP) MR angiography (A and C) and contrast-enhanced MR angiography (CE-MRA) (B and D) show concordance for normal right renal artery (0% on CE-MRA, 11% on Nav SSFP MR angiography) and high-grade left renal artery stenosis (arrows) of 95% on CE-MRA and 82% on Nav SSFP. Note that there appears to be more than 11% stenosis on Nav SSFP in right renal artery (A) secondary to MIP artifact from overlapping signal in inferior vena cava. Stenosis measurements were obtained from thin-slice reformatted images rather than from MIPs.

View larger version (62K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1B —68-year-old man with suspected renovascular hypertension. Coronal and axial subvolume maximum intensity projections (MIPs) from navigator-gated steady-state free precession (Nav SSFP) MR angiography (A and C) and contrast-enhanced MR angiography (CE-MRA) (B and D) show concordance for normal right renal artery (0% on CE-MRA, 11% on Nav SSFP MR angiography) and high-grade left renal artery stenosis (arrows) of 95% on CE-MRA and 82% on Nav SSFP. Note that there appears to be more than 11% stenosis on Nav SSFP in right renal artery (A) secondary to MIP artifact from overlapping signal in inferior vena cava. Stenosis measurements were obtained from thin-slice reformatted images rather than from MIPs.

View larger version (71K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1C —68-year-old man with suspected renovascular hypertension. Coronal and axial subvolume maximum intensity projections (MIPs) from navigator-gated steady-state free precession (Nav SSFP) MR angiography (A and C) and contrast-enhanced MR angiography (CE-MRA) (B and D) show concordance for normal right renal artery (0% on CE-MRA, 11% on Nav SSFP MR angiography) and high-grade left renal artery stenosis (arrows) of 95% on CE-MRA and 82% on Nav SSFP. Note that there appears to be more than 11% stenosis on Nav SSFP in right renal artery (A) secondary to MIP artifact from overlapping signal in inferior vena cava. Stenosis measurements were obtained from thin-slice reformatted images rather than from MIPs.

View larger version (61K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1D —68-year-old man with suspected renovascular hypertension. Coronal and axial subvolume maximum intensity projections (MIPs) from navigator-gated steady-state free precession (Nav SSFP) MR angiography (A and C) and contrast-enhanced MR angiography (CE-MRA) (B and D) show concordance for normal right renal artery (0% on CE-MRA, 11% on Nav SSFP MR angiography) and high-grade left renal artery stenosis (arrows) of 95% on CE-MRA and 82% on Nav SSFP. Note that there appears to be more than 11% stenosis on Nav SSFP in right renal artery (A) secondary to MIP artifact from overlapping signal in inferior vena cava. Stenosis measurements were obtained from thin-slice reformatted images rather than from MIPs.

View larger version (105K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2A —47-year-old man with suspected renovascular hypertension. Coronal and axial subvolume maximum intensity projections (MIPs) from navigator-gated steady-state free precession (Nav SSFP) MR angiography (A and C) and contrast-enhanced MR angiography (CE-MRA) (B and D) show agreement for nondiseased renal arteries. Note excellent depiction of small anterior right accessory renal artery on Nav SSFP (white arrow, A–D). Axial Nav SSFP MIP (C) is targeted to show this accessory renal artery and does not show main renal arteries. An inferior left accessory (black arrow, B) was missed on SSFP because it was out of imaging volume.

View larger version (107K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2B —47-year-old man with suspected renovascular hypertension. Coronal and axial subvolume maximum intensity projections (MIPs) from navigator-gated steady-state free precession (Nav SSFP) MR angiography (A and C) and contrast-enhanced MR angiography (CE-MRA) (B and D) show agreement for nondiseased renal arteries. Note excellent depiction of small anterior right accessory renal artery on Nav SSFP (white arrow, A–D). Axial Nav SSFP MIP (C) is targeted to show this accessory renal artery and does not show main renal arteries. An inferior left accessory (black arrow, B) was missed on SSFP because it was out of imaging volume.

View larger version (84K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2C —47-year-old man with suspected renovascular hypertension. Coronal and axial subvolume maximum intensity projections (MIPs) from navigator-gated steady-state free precession (Nav SSFP) MR angiography (A and C) and contrast-enhanced MR angiography (CE-MRA) (B and D) show agreement for nondiseased renal arteries. Note excellent depiction of small anterior right accessory renal artery on Nav SSFP (white arrow, A–D). Axial Nav SSFP MIP (C) is targeted to show this accessory renal artery and does not show main renal arteries. An inferior left accessory (black arrow, B) was missed on SSFP because it was out of imaging volume.

View larger version (71K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2D —47-year-old man with suspected renovascular hypertension. Coronal and axial subvolume maximum intensity projections (MIPs) from navigator-gated steady-state free precession (Nav SSFP) MR angiography (A and C) and contrast-enhanced MR angiography (CE-MRA) (B and D) show agreement for nondiseased renal arteries. Note excellent depiction of small anterior right accessory renal artery on Nav SSFP (white arrow, A–D). Axial Nav SSFP MIP (C) is targeted to show this accessory renal artery and does not show main renal arteries. An inferior left accessory (black arrow, B) was missed on SSFP because it was out of imaging volume.

View larger version (90K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3A —33-year-old man with suspected renovascular hypertension. Coronal subvolume maximum intensity projections from navigator-gated steady-state free precession (Nav SSFP) MR angiography (A) and contrast-enhanced MR angiography (CE-MRA) (B) with digital subtraction angiography correlation show injection of both aorta (C) and accessory (D) renal arteries. Nav SSFP and CE-MRA agreed that both main arteries were nondiseased. Arrows represent the accessory artery, which was seen and thought to be diseased on both Nav SSFP and CE-MRA. Accessory artery was believed to represent intimal fibroplasia (an atypical form of fibromuscular dysplasia) and to be responsible for patient's hypertension.

View larger version (87K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3B —33-year-old man with suspected renovascular hypertension. Coronal subvolume maximum intensity projections from navigator-gated steady-state free precession (Nav SSFP) MR angiography (A) and contrast-enhanced MR angiography (CE-MRA) (B) with digital subtraction angiography correlation show injection of both aorta (C) and accessory (D) renal arteries. Nav SSFP and CE-MRA agreed that both main arteries were nondiseased. Arrows represent the accessory artery, which was seen and thought to be diseased on both Nav SSFP and CE-MRA. Accessory artery was believed to represent intimal fibroplasia (an atypical form of fibromuscular dysplasia) and to be responsible for patient's hypertension.

View larger version (113K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3C —33-year-old man with suspected renovascular hypertension. Coronal subvolume maximum intensity projections from navigator-gated steady-state free precession (Nav SSFP) MR angiography (A) and contrast-enhanced MR angiography (CE-MRA) (B) with digital subtraction angiography correlation show injection of both aorta (C) and accessory (D) renal arteries. Nav SSFP and CE-MRA agreed that both main arteries were nondiseased. Arrows represent the accessory artery, which was seen and thought to be diseased on both Nav SSFP and CE-MRA. Accessory artery was believed to represent intimal fibroplasia (an atypical form of fibromuscular dysplasia) and to be responsible for patient's hypertension.

View larger version (114K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3D —33-year-old man with suspected renovascular hypertension. Coronal subvolume maximum intensity projections from navigator-gated steady-state free precession (Nav SSFP) MR angiography (A) and contrast-enhanced MR angiography (CE-MRA) (B) with digital subtraction angiography correlation show injection of both aorta (C) and accessory (D) renal arteries. Nav SSFP and CE-MRA agreed that both main arteries were nondiseased. Arrows represent the accessory artery, which was seen and thought to be diseased on both Nav SSFP and CE-MRA. Accessory artery was believed to represent intimal fibroplasia (an atypical form of fibromuscular dysplasia) and to be responsible for patient's hypertension.

View larger version (5K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4 —Receiver operating characteristics curve produced by using different positive stenosis thresholds for navigator-gated steady-state free precession (Nav SSFP) MR angiography. As can be seen, sensitivity of 100% was achieved using Nav SSFP stenosis threshold of 45%.

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