Deprecated: Implicit conversion from float 209.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534
Deprecated: Implicit conversion from float 209.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534
Deprecated: Implicit conversion from float 209.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534
Deprecated: Implicit conversion from float 209.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534
Deprecated: Implicit conversion from float 209.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534
Deprecated: Implicit conversion from float 209.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534
Deprecated: Implicit conversion from float 209.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534
Deprecated: Implicit conversion from float 209.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534
Deprecated: Implicit conversion from float 243.2 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534
Warning: imagejpeg(C:\Inetpub\vhosts\kidney.de\httpdocs\phplern\27034579
.jpg): Failed to open stream: No such file or directory in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 117 Gefasschirurgie
2016 ; 21
(ä): 4-13
Nephropedia Template TP
gab.com Text
Twit Text FOAVip
Twit Text #
English Wikipedia
Ultrasound diagnostics of renal artery stenosis: Stenosis criteria, CEUS and
recurrent in-stent stenosis
#MMPMID27034579
Schäberle W
; Leyerer L
; Schierling W
; Pfister K
Gefasschirurgie
2016[]; 21
(ä): 4-13
PMID27034579
show ga
BACKGROUND AND PURPOSE: As a non-invasive, side effect-free and cost-effective
method, ultrasonography represents the method of choice for the diagnosis of
renal artery stenosis. Four different criteria in total, including two direct
criteria in peak systolic velocity (PSV) and renal aortic ratio (RAR) and two
indirect criteria in resistance index (RI) and acceleration time (AT) for the
measurement of relevant renal artery stenosis are described, each demonstrating
highly variable accuracy in studies. Furthermore, there is controversy over the
degree beyond which stenosis becomes therapeutically relevant and which
ultrasound PSV is diagnostically relevant in terms of stenosis grading. MATERIAL
AND METHODS: This article gives a critical review based on a selective literature
search on measurement methodology and the validity of ultrasound in renal artery
stenosis. A critical evaluation of methods and a presentation of measurement
principles to establish the most precise measurement method possible compared
with the gold standard angiography, as well as an evaluation of the importance of
computed tomography angiography (CTA) and magnetic resonance angiography (MRA).
RESULTS AND CONCLUSIONS: The PSV provides high sensitivity and specificity as a
direct measurement method in stenosis detection and grading. Most studies found
sensitivities and specificities of 85-90?% for >?50?% stenosis at a PSV
>?180-200 cm/s in ROC curve analysis. Other methods, such as the ratio of the PSV
in the aorta to the PSV in the renal artery (RAR) or indirect criteria, such as
side to side differences in RI (dRI) or AT can be additionally used to improve
accuracy. Contrast-enhanced ultrasound improves accuracy by means of echo
contrast enhancement. Although in the past only high-grade stenosis was
considered relevant for treatment, a drop in pressure of >?20 mmHg in >?50?%
stenosis (PSV 180 cm/s) is classified as relevant for increased renin secretion.
Stenosis in fibromuscular dysplasia can be reliably graded according to the
continuity equation. Although the available studies on the grading of in-stent
restenosis are the subject of controversy, there is a tendency to assume higher
cut-off values for PSV and RAR. Whilst MRA and CTA demonstrate an accuracy of
>?90?%, this is at the cost of possible side effects for patients, particularly
in the case of pre-existing renal parenchymal damage. ADDITIONAL ONLINE MATERIAL:
This article includes two additional video sequences on visualizing renal artery
stenosis. This supplemental material can be found under:
dx.doi.org/10.1007/s00772-015-0060-3.