Diagnosis of renal arterial stenosis and quantification of the degree of stenosis: multidetector computed tomography angiography versus digital subtraction angiography

Amaç: Renal arteriyel stenozun (RAS) tespiti ve derecelendirmesinde çok kesitli bilgisayarlı tomografik anjiyografinin (ÇKBTA) tanısal değeri belirlendi. Çalışma planı: Hipertansiyonu olan ve ÇKBTA’da RAS saptanan veya ÇKBTA’da abdominal aort anevrizması nedeni ile abdominal aort anevrizmasının endovasküler tedavisi uygun bulunan 78 hastaya (53 erkek, 25 kadın; ort. yaş 60.8±14.9 yıl; dağılım 18-86 yıl) dijital subtraksiyon anjiyografisi (DSA) incelemeleri yapıldı. Çok kesitli bilgisayarlı tomografik anjiyografi bulguları DSA bulguları ile karşılaştırıldı. İstatistiksel değerlendirmeler renal arter stenozunun saptanması ve renal arter stenoz derecesinin çapa göre değerlendirilmesi için yapıldı. Çalışma prospektif olarak gerçekleştirildi, hastane kurumsal inceleme kurulu tarafından onaylandı. Tüm hastalardan bilgilendirilmiş onam formları alındı. Bulgular: Yüz elli altı renal arterin 79’unda stenoz, altısında oklüzyon saptanır iken 71’i ÇKBTA’da normal idi. Dijital subtraksiyon anjiyografide 156 renal arterden 70’inde stenoz, altısında oklüzyon saptanır iken 80’i normal idi. Genel duyarlılık, özgüllük, pozitif kestirim değeri (PKD), negatif kestirim değeri (NKD) ve doğruluk oranı sırasıyla %97.4, %86.3, %87.1, %97.2 ve %91.7 olarak hesaplandı. Stenoz derecesinin saptanmasında duyarlılık %74.1-100 a ralığında, özgüllük %93.7-100 aralığında, PKD %55-100 aralığında, NKD %94.5-100 ve doğruluk oranı %90.4-100 aralığındaydı. Sonuç: Çokkesitli bilgisayarlı tomografik anjiyografi RAS değerlendirmesinde yüksek duyarlılık, özgüllük ve tanısal doğruluk oranlarına sahip noninvazif ve güvenilir bir yöntem olarak kabul edilebilir.

Renal arter stenoz tanısı ve stenoz derecesinin belirlenmesinde çokkesitli bilgisayarlı tomografik anjiyografi ve dijital subtraksiyon anjiyografi

Background: We determined the diagnostic value of multidetector computed tomography angiography (MDCTA) for detection and gradation of renal arterial stenosis (RAS). Methods: Seventy-eight patients (53 males, 25 females; mean age 60.8±14.9 years; range 18 to 86 years) who suffered from hypertension and were found to have RAS on MDCTA or who were found suitable for endovascular treatment of an abdominal aortic aneurysm during the evaluation with MDCTA underwent digital subtraction angiographic (DSA) examinations. The MDCTA findings were compared with the DSA findings. Statistical analysis of data was performed to detect renal arterial stenosis and the degree of stenosis based on diameter measurement. The study was carried out prospectively and approved by the hospital institutional review board. Informed consent was obtained from all patients. Results: Seventy-nine of 156 renal arteries were found to have stenosis and six were found to have occlusion while 71 were normal on MDCTA. Seventy of 156 renal arteries were found to have stenosis and six to have occlusion while 80 were normal on DSA. Overall sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy rate were found to be 97.4%, 86.3%, 87.1%, 97.2% and 91.7%, respectively. For determination of the degree of stenosis, the sensitivity was in the range of 74.1-100%, the specificity was in the range of 93.7-100%, the PPV was in the range of 55-100%, the NPV was in the range of 94.5-100%, and the accuracy rate was in the range of 90.4-100%. Conclusion: Multidetector computed tomography angiography can be accepted as a noninvasive and reliable modality for the evaluation of RAS with high sensitivity, specificity, and diagnostic accuracy rates.

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