How does conventional angiography compare to gadolinium-enhanced magnetic resonance angiography (MRA) for the diagnosis of renal artery stenosis (RAS)?

Updated: Nov 02, 2020
  • Author: Bruce S Spinowitz, MD, FACP; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Gilfeather et al performed a study evaluating conventional angiography versus gadolinium-enhanced MRA in 54 patients and 107 kidneys. [25] The study showed that in 70 kidneys (65%), the average degree of stenosis reported by readers of both modalities differed by 10% or less. In 22 cases (21%), MRA overestimated the degree of stenosis by more than 10% relative to the results of conventional angiography; in 15 cases (14%), MRA underestimated the stenosis by more than 10%.

The obvious advantages of conventional angiography are its ability to determine the clinical importance of suggestive lesions and the ability to concurrently perform endovascular therapy. In addition, measurement of the pressure gradient across a stenotic lesion may be helpful in determining the clinical significance of a lesion. [26] However, specialists should weigh these advantages against the higher cost and greater morbidity of conventional angiography. The slightly inferior variability of MRA in diagnostic interpretation further supports the use of this technique as potentially the most appropriate tool for screening patients strongly suggested to have atherosclerotic RVD.

See Imaging in Renal Artery Stenosis/Renovascular Hypertension for a complete discussion of this topic.

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