Non-contrast MR angiography versus contrast enhanced MR angiography for detection of renal artery stenosis: a comparativ
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KIDNEYS, URETERS, BLADDER, RETROPERITONEUM
Non‑contrast MR angiography versus contrast enhanced MR angiography for detection of renal artery stenosis: a comparative analysis in 400 renal arteries Hira Lal1 · Rani Kunti Randhir Singh1 · Priyank Yadav2 · Ankusha Yadav1 · Dharmendra Bhadauria3 · Anuradha Singh1 Received: 12 July 2020 / Revised: 16 October 2020 / Accepted: 20 October 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose In this study, we compared non-contrast MR angiography (NC-MRA) with conventional 3D contrast-enhanced MRA (CE-MRA) in patients suspected to have renal artery stenosis (RAS). Methods From March 2014 to March 2020, patients who were evaluated for RAS and had a glomerular filtration rate > 30 ml/ min/1.73 m2 underwent MR imaging on a 3T MR Scanner (Signa Hdxt General Electrics, Milwaukee, USA) using a Torso PA coil. The NC-MRA sequence was performed using a 3D fat-suppressed inflow inversion recovery balanced steady state free precession (SSFP) sequence (Inhance 3D Inflow IR, GE Medical) whereas the CE-MRA sequence was a 3D fast spoiled gradient echo (FSPGR). Overall quality of images was rated 1 to 4. Stenosis was reported as grade 1 (Normal), 2 ( 50% narrowing) and 4 (Total occlusion). Grade 3 and 4 were considered haemodynamically significant. Results During the study period, 201 patients were enrolled (400 renal arteries). For hemodynamically significant (grade 3/4) stenosis, NC-MRA correctly diagnosed 72 patients (95 arteries) while in 2 patients (2 arteries), NC-MRA underdiagnosed the stenosis as grade 2 (these were found to have grade 3 stenosis on CE-MRA). The kappa value of agreement between NC-MRA and CE-MRA for detection of RAS showing excellent agreement (p 50% luminal narrowing were calculated for NC MRA on both artery by artery basis and patient by patient basis taking CE-MRA as the reference standard. Kappa values were calculated both on artery by artery basis and patient by patient basis for agreement between two techniques
During the study period, 201 patients were enrolled. There were 122 males and 79 females. The mean age of patients was 35.0 ± 14 years (range: 18–65 years). Hypertension was present in 194 patients and diabetes mellitus was present in 26 patients. There were 23 smokers and 22 had pre-existing coronary artery disease.
Image quality assessment Both NC-MRA and CE MRA were diagnostic in all the patients (Score 2–4). The image quality of NC-MRA and CE MRA was similar (Wilcoxon signed rank test, P = 0.51). The average image quality score was slightly
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higher for negative cases than positive cases in both NCMRA and CE MRA (Table 2), but the difference was not statistically significant (Independent t test, P > 0.05). Visualization of intraparenchymal vessels was better with NCMRA and a greater number of patients in NC-MRA group had grade 4 image quality compared to the CE MRA group (Fig. 2, Table 3). Where there was reduced image quality, the cause was venous contamination (6 patients), renal parenchymal enha
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