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Published online before print August 23, 2007, 10.1148/radiol.2443061769
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(Radiology 2007;245:186-195.)
© RSNA, 2007

Genitourinary Imaging

Renal Artery Assessment with Nonenhanced Steady-State Free Precession versus Contrast-enhanced MR Angiography1

Rolf Wyttenbach, MD, Antonio Braghetti, MD, Michael Wyss, RT, Mario Alerci, MD, Lukas Briner, MD, Paolo Santini, RT, Luca Cozzi, PhD, Marcello Di Valentino, MD, Marcus Katoh, MD, Claudio Marone, MD, Peter Vock, MD, and Augusto Gallino, MD

1 From the Departments of Radiology (R.W., A.B., M.A., L.B., P.S.), Internal Medicine (C.M., A.G., M.D.V.), and Radiotherapy (L.C.), Ospedale San Giovanni Bellinzona (EOC), CH-6500 Bellinzona, Switzerland; Department of Radiology, University of Aachen, Aachen, Germany (M.K.); Philips Medical Systems, Zürich, Switzerland (M.W.); University of Zürich and Institute of Biomedical Engineering, Eidgenössische Technische Hochschule, Zürich, Switzerland (M.W.); and Department of Radiology, Inselspital, University of Bern, Bern, Switzerland (P.V.). Received October 13, 2006; revision requested December 7; revision received December 20; final version accepted January 23, 2007. R.W. supported by a grant from the Swiss Heart Foundation. Address correspondence to R.W. (e-mail: rolf.wyttenbach{at}bluewin.ch).

Purpose: To prospectively assess the diagnostic accuracy of nonenhanced three-dimensional (3D) steady-state free precession (SSFP) magnetic resonance (MR) angiography for detection of renal artery stenosis (RAS), with breath-hold contrast material–enhanced MR angiography performed as the reference standard.

Materials and Methods: The study was local ethics committee approved; all patients gave written informed consent. Fifty-three patients (30 male, 23 female; mean age, 58 years) with arterial hypertension and suspected of having RAS were examined with 1.5-T 3D SSFP renal MR angiography. Stenosis grade, maximal visible vessel length, and subjective image quality were compared. Sensitivity, specificity, accuracy, and negative predictive value (NPV) were calculated on artery-by-artery and patient-by-patient bases. The significance of the results was assessed with the paired two-sided t test for continuous variables and with the marginal homogeneity test for categorical variables. Cohen {kappa} statistics were used to estimate interobserver agreement.

Results: One hundred eight renal arteries with 20 significant (≥50%) stenoses were detected with contrast-enhanced MR angiography. At artery-by-artery analysis, sensitivity, specificity, accuracy, and NPV of nonenhanced SSFP MR angiography for RAS detection were 100%, 93%, 94%, and 100%, respectively, for observer 1 and 95%, 95%, 95%, and 99%, respectively, for observer 2. Corresponding patient-by-patient values were 100%, 92%, 94%, and 100%, respectively, for observer 1 and 100%, 95%, 96%, and 100%, respectively, for observer 2. Overestimation of stenosis grade with SSFP MR angiography resulted in six and four false-positive findings for readers 1 and 2, respectively. Mean maximal visible lengths of the renal arteries were 69.9 mm at contrast-enhanced MR angiography and 61.1 mm at SSFP MR angiography (P < .001). Both techniques yielded good to excellent image quality.

Conclusion: Slab-selective inversion-prepared 3D SSFP MR angiography had high sensitivity, specificity, accuracy, and NPV for RAS detection, without the need for contrast material. However, RAS severity was overestimated in some patients.

© RSNA, 2007




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