Akademik Veri Yönetim Sistemi
JOURNAL OF CLINICAL AND ANALYTICAL MEDICINE, cilt.6, ss.737-742, 2015 (ESCI)
Aim: Renal artery stenosis (RAS) is a cause of 1-5% of all cases of hypertension. The early diagnosis and treatment of renovascular disease is important in terms of the protection of renal function. Noninvasive, safe, simple and accurate imaging methods should be preferred in the diagnosis of RAS. Material and Method: Seventy patients aged between 17-83 years (average age 47.97 years), including 30 males (42.9%) and 40 females (57.1%) that were diagnosed with RAS by Magnetic Resonance Angiography (MRA) were included in the study. The MRA examinations were performed in 4 different centers between January 2007 and December 2011. Physical examination and laboratory findings of all patients were consistent with RAS. Following the MRA evaluation, the Digital Subtraction Angiography (DSA) examinations of all cases were performed in our clinic. A total of 149 main renal artery MRA and DSA findings from 70 patients were evaluated retrospectively. Results: While 89 out of 149 renal arteries were diagnosed with RAS by using MRA, 49 of them were diagnosed by using DSA. In the diagnosis of RAS the sensitivity and selectivity of MRA were 87.8% and 54%, respectively. Comparison with the literature showed that while sensitivity of MRA was similar to the literature, although the selectivity was lower, which might be due to the technical restrictions and artifacts of MRA. In this study we examined 149 main renal arteries in 70 patients by using DSA. Seventy-eight of were right and seventy- one were left renal arteries. Meanwhile, the evaluation with MRA revealed a total of 140 main renal arteries. Seventy-two of these were right, while sixty-eight were left renal arteries. The MRA showed 1 accessory renal artery in 1 patient, whereas DSA showed 17 accessory renal arteries. The detection and correct evaluation of the degree of stenosis of accessory arteries and finely calibrated renal arteries that are similar to accessory arteries is still low. The main reason for this is the relatively low image resolution as a restrictive factor in thinner arteries. Discussion: Breath-hold three-dimensional (3D) contrast enhanced renal MRA is a noninvasive method preventing invasive angiographic examinations that cause unnecessary radiation exposure. MRA can also determine renal artery stenosis with high accuracy, especially with the use of an automatic injector and bolus timing. However, one should be aware of the limitations and artifacts of the technique and precautions should be used to minimize these artifacts. In conclusion, MRA can be used in the screening of RAS confidently because the sensitivity of this method is considerably high.