ÖMER KİTİŞ, Cem ÇALLI, Gülgün DEMİRPOLAT, Mustafa PARILDAR, M. Refik KİLLİ, Nilgün YÜNTEN

Renal arterlerin değerlendirilmesinde kontraslı 3D anjiografi'nin rolü ve Doppler USG ile korelasyonu

Bu çalışmada renal arter stenozlarında, üç boyutlu kontrastlı manyetik rezonans anjiografinin tanısal rolü irdelenmiştir ve renkli Doppler ultrasonografi bulguları ile korele edilmiştir. Renal hipertansiyon ön tanısı ile gönderilen 25 olgu, otomatik enjektör kullanımı ile nefes tutmalı 3 boyutlu kontrastlı manyetik rezonans anjiografi ve renkli Doppler ultrasonografi ile değerlendirildi. Bu iki modalite ile renal arter stenozu bulguları olan 5 olguya digital subtraksiyon anjiografi uygulandı. Olguların %36'sında, renal arter stenozuna ait bulgular saptandığından anjiografik değerlendirme önerildi. Geri kalan %64'lük hasta grubunda ise, manyetik rezonans anjiografi ve renkli Doppler ultrasonografi inceleme sonuçları normaldi ve bu olgular kateter anjiografi uygulanmadan medikal tedavi altında takibe alındılar. Nefes tutmalı kontrastlı renal manyetik rezonans anjiografi, özellikle otomatik enjektör kullanımı elde olunduğunda, renal arter stenozlarını yüksek doğrulukta belirleyebilen noninvaziv bir tarama yöntemidir.

Anahtar Kelimeler:

Ultrasonografi, doppler, renkli, Daralma, patolojik, Tanı teknikleri, ürolojik, Renal arter, Manyetik rezonans anjiyografi

Contrast-enhanced three-dimensional MR angiography in the assesment of renal artery stenosis and correlation with color Doppler sonography

The purpose of this study was to evaluate the diagnostic role of three-dimensional magnetic resonance angiography in the detection of renal artery stenosis. Additionally, the results of magnetic resonance angiography were correlated with color Doppler sonographic findings. 25 patients with clinical suspicion of renovascular hypertension were examined with breath-hold, contrast-enhanced, three-dimensional magnetic resonance angiography and color Doppler sonography. In 5 patients, who had renal artery stenosis findings in magnetic resonance angiography and color Doppler sonography, digital subtraction angiography was performed. Breath-hold, contrast-enhanced, three dimensional magnetic resonance angiography, especially using with otomated injector, is a highly sensitive, noninvasive screening method for assesment of renovascular hypertension. In 36% of all patients, catheter angiographic examination was proposed, because this patients had renal artery stenosis findings in magnetic resonance angiography and color Doppler sonography. However, in the rest of the patients (64%), the renal artery and branches were normal in magnetic resonance angiography and color Doppler sonography. Zu This proup, catheter angiography was not performed and these patients were taken into follow-up under medical treatment.

Keywords:

Ultrasonography, Doppler, Color, Constriction, Pathologic, Diagnostic Techniques, Urological, Renal Artery, Magnetic Resonance Angiography,

PDF

___

1. Dean RH. Renovascular hypertension: an overvievv. İn: Rutherford RB, ed. Vascular surgery. 3rd ed. Philedelphia, Pa: Saunders,1989;1211-1218.
2. Working group on renovascular hypertension. Detection, evaluation, and treatment of renovascular hypertension: final report. ArchIntern Med 1987; 147:820-829.
3. Abrams Angiography on CD-ROM. Version 2.13 (11-14-97). Copyright 1987-1997 by Lippincott-Raven Publishers.
4. Bakker J, Beek FJA, Beutler JJ, et al. Renal artery stenosis and accessory renal arteries: Accuracy of detection and visualizationwith gadolinium-enhanced breath-hold MR angiography. Radiology 1998; 207:497-504.
5. Strandness DE. Natural history of renal artery stenosis. Am J Kidney Dis 1994;24:630-635.
6. Lossino F, Zuccala A, Busato F, Zucchelli P. Renal artery angioplasty for renovascular hypertension and preservation of renalfunction: long-term angiographic and clinical follow-up. AJR 1994; 162:853-857
7. Harden PN, Macleod MJ, Rodger RSC, et al. Effect of renal-artery stenting on progression of renovascular renal failure. Lancet1997; 349:1133-1136.
8. Hillman BJ. Imaging advances in the diagnosis of renovascular hypertension. AJR 1989; 153:5-14.
9. Gilfeather M, Yoon HC, Siegelman ES, et al. Renal artery stenosis: Evaluation with conventional angiography versus gadolinium-enhanced MR angiography. Radiology 1999; 210:367-372.
10. Postma CT, van Aalen J, de Boo T, Rosenbusch G, Thien T. Doppler ultrasound scanning in the detection of renal artery stenosis inhypertensive patients. Br J Radiol 1992;65:857-860.
11. Rieumont MJ, Kaufman JA, Geller SC, et al. Evaluation of renal artery stenosis with dynamic gadolinium-enhanced MRangiography. AJR Am J Roentgenol 1997; 169:39-44.
12. Thornton MJ, Thornton F, O'Callaghan J, et al. Evaluation of dynamic gadolinium-enhanced breath hold MR angiography in thediagnosis of renal artery stenosis. AJR Am J Roentgenol 1999;173:1279-1283.
13. Beregi J-P, Elkohen M, Deklunder G, Artaud D, Coullet JM, Wattinne L. Helical CT angiography compared with arteriography in thedetection of renal artery stenosis. AJR 1996;167-495-501.
14. Prince MR. Gadolinium-enhanced MR aortography. Radiology. 1994; 191: 155-164.
15. Debatin JF, Ting RH, Wegmüller H, et al. Renal artery blood flow: quantification with phase contrast imaging with and vvithoutbreath-holding. Radiology 1994; 190:371-378.
16. Prince MR, Narasimham DL, Stanley JC, et aî. Breath-hold gadolinium-enhanced MR angiography of the abdominal aorta and majorbranches. Radiology 1995; 197:785-792.
17. Hahn U, Miller S, Nagele T, et al. Renal MR angiography at 1.0T: Three-dimensional (3D) phase-contrast tecniques versusgadolinium-enhanced 3D fast low-angle shot breath-hold imaging. AJR Am J Roentgenol 1999;172:1501-1508.