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Accuracy of Normal-Dose Contrast-Enhanced MR Angiography in Assessing Renal Artery Stenosis and Accessory Renal Artery Stenosis and Accessory Renal Arteries

¹ Department of Radiology, University Hospital Nijmegen, Geert Grooteplein 10, P. O. Box 9101, 6500 HB Nijmegen, the Netherlands
² Department of Internal Medicine, University Hospital Nijmegen, 6500 HB Nijmegen, the Netherlands
³ Present address: Department of Radiology, Slingeland Ziekenhuis, Kruisbergseweg 25, 7009 BL Doetinchem, the Netherlands

Received July 2, 1999; accepted after revision August 30, 1999.

 
Address correspondence to M. B. J. M. Korst.

Abstract

Top Abstract Introduction Subjects and Methods Results Discussion References

 
OBJECTIVE. The purpose of this study was to evaluate the accuracy of breath-hold contrast-enhanced MR angiography in the assessment of renal artery stenosis and accessory renal arteries using a standard dose of gadolinium.

SUBJECTS AND METHODS. Thirty-eight patients suspected of having renal artery stenosis underwent MR angiography and intraarterial digital subtraction angiography, which was the method of reference. Three-dimensional gradient-echo MR subtraction angiography (TR/TE, 5.8/1.8 msec) was performed on a 1.5-T imager using a phased array body coil. Before imaging, a separate timing bolus sequence was used, administering 1.0 ml of contrast agent. Gadopentetate dimeglumine (15 ml) was injected using an MR power injector. Two observers, who were unaware of each other's interpretation and of MR findings, assessed digital subtraction angiography. Likewise, two other observers assessed MR angiography.

RESULTS. Digital subtraction angiography depicted 75 main and 17 accessory renal arteries (n = 92). All main renal arteries and 13 accessory renal arteries were identified on MR angiography. Compared with digital subtraction angiography, MR imaging correctly classified 57 of 66 arteries without a hemodynamically significant stenosis (0-49%), 22 of 22 arteries as significantly stenotic (50-99%), and four of four occluded arteries; five stenoses were overestimated. There was one false-positive finding of an accessory renal artery on MR angiography that was identified retrospectively on digital subtraction angiography. Interobserver agreement was high. Sensitivity and specificity for grading significant stenosis were 100% and 85%, respectively.

CONCLUSION. Contrast-enhanced MR angiography, using ±0.1 mmol/kg of gadolinium, is an accurate method in the assessment of renal artery stenosis and accessory renal arteries.

Introduction

Top Abstract Introduction Subjects and Methods Results Discussion References

 
Diagnosis of renal artery stenosis is important, because correction of the stenosis by percutaneous transluminal angioplasty, renal stent placement, or surgery can prevent or limit renal insufficiency and can result in cure or better control of hypertension [1,2,3,4]. Intraarterial conventional radiography or digital subtraction angiography is still considered the reference method [5]. Phase-contrast and time-of-flight MR angiography developed quickly as noninvasive screening methods for renal artery stenosis, but the use of these techniques has been limited because of (respiratory) artifacts and the poor visualization of accessory renal arteries [6,7,8]. Recently, three-dimensional contrast-enhanced MR angiography has emerged as a sensitive and specific noninvasive test for the detection of renal artery stenosis and for depicting accessory renal arteries [7, 9]. Contrast-enhanced MR angiography has improved greatly during recent years, specifically by shortening the time of acquisition, which permits breath-hold studies and avoids respiratory artifacts [10,11,12,13,14,15,16]. Many groups of researchers have reported using double or triple doses of gadolinium [10,11,12, 14, 15, 17]. However, if contrast-enhanced MR angiography is to be used as a screening method for renal artery stenosis, it would be better to use a standard dose of gadolinium to reduce costs without degrading the quality of imaging [13, 16, 18, 19]. Adequate timing of the arrival of gadolinium during the acquisition of the central part of the K-space and the use of a subtraction technique can reduce the amount of contrast material used [20,21,22]. In this study, we evaluated the accuracy of breath-hold contrast-enhanced MR angiography using the standard dose of ±0.1 mmol/kg of body weight of gadolinium in the diagnosis of renal artery stenosis and the depiction of accessory renal arteries.

Subjects and Methods

Top Abstract Introduction Subjects and Methods Results Discussion References

 
Patient Population
Between January 1997 and June 1998, 38 consecutive patients underwent MR angiography and digital subtraction angiography. The patients included 25 men and 13 women with an average of 54 years (range, 18-75 years). The patients were referred from the internal medicine outpatient department. The indications for MR angiography and digital subtraction angiography were suspicion of renal artery stenosis based on refractory hypertension or unexplained renal insufficiency. The clinical data of the patients are given in Table 1. Informed consent was obtained in all cases.

MR Imaging Technique
In all patients, MR imaging was performed with a 1.5-T imager (Magnetom Vision; Siemens, Erlangen, Germany) using a phased array body coil. The arms of the patients were placed alongside the abdomen. Initially, a sequence was used to determine the transit time of the contrast bolus from the time of injection until its arrival at the level of the perirenal aorta, using the following parameters: TR/TE, 5.8/2.4 msec; flip angle, 10°; one 10-mm slice in the transverse plane; and 60 acquisitions during 60 sec. During this sequence, patients were allowed to breath normally. With an MR-compatible power injector (Spectris MR Injector; Medrad, Pittsburgh, PA), a bolus of 1.0 ml of gadopentetate dimeglumine (Magnevist, 0.5 mmol/ml; Schering, Berlin, Germany) was administered, followed by a saline flush of 15 ml, at a rate of 2.5 ml/sec IV via a 20-gauge catheter inserted in an antecubital vein. Using the software package (MR angiography software package; Siemens) of the MR imager, we determined the time of arrival of the contrast agent in the perirenal aorta by generating a signal intensity-versus-time curve.

After the timing bolus sequence, two identical breath-hold three-dimensional gradient-echo sequences were performed in the coronal plane, one before and one during contrast injection. In all patients the following parameters were used: TR/TE, 5.8/1.8 msec; flip angle, 30°; field of view, 400 mm; slab thickness, 70 mm; 24 partitions; 160-224 x 512 matrix; and time of acquisition, 24 sec or less. No slice interpolation was used.

For timing of acquisition we used the formula T-delay = T-transit - 1/4 T-acq, where T-delay = time of starting acquisition after beginning of contrast injection, T-transit = time of test bolus arriving in perirenal aorta, and T-acq = acquisition time of sequence. Approximately 0.1 mmol/kg body weight of gadolinium was injected at the same rate as the timing bolus (2.5 ml/sec), also followed by a 15-ml saline flush. In all patients, 15 ml or less of gadopentetate dimeglumine was administered, including the timing bolus of 1 ml.

Digital Subtraction Angiography Technique
Intraarterial digital subtraction angiography was performed with a digital subtraction unit (Polytron 1000; Siemens). A transfemorally inserted 5-French pigtail catheter was positioned to ensure placement of the side holes at the level of the origin of the renal arteries. After IV administration of 20 mg of butyl bromide scopolamine (Buscopan; Boehringer-Ingelheim, Mannheim, Germany) or 0.5-1.0 mg of glucagon hydrochloride (GlucaGen 1 IE; Novo Nordisk, Bagsvaerd, Denmark), a bolus injection of 1:1 diluted 20 ml of iohexol (Omnipaque 350 mg I/ml; Nycomed, Oslo, Norway) was injected intraarterially. A standard 10° left anterior oblique projection was used in most patients. If necessary, additional views (anteroposterior or oblique) were obtained or selective catheterization was performed.

Image Analysis
Digital subtraction angiography images were assessed by two independent observers who were unaware of MR angiography findings and of each other's interpretations. Subsequently, consensus was achieved for final interpretation in all cases. Likewise, two other observers independently interpreted the MR angiograms. The images were assessed for renal artery stenosis and accessory renal arteries. The intrarenal arteries were not assessed because the renal artery was truncated at the hilum in most patients because of the limited slab thickness. Each renal artery was analyzed for the presence of stenosis, which was graded on the basis of the most severe reduction of arterial diameter compared with an uninvolved renal artery segment proximal or distal to the stenosis. A renal artery was graded as normal (grade 0), mildly stenotic (1-49%, grade 1), moderately stenotic (50-75%, grade 2), severely stenotic (75-99%, grade 3), or occluded (100%, grade 4). A stenosis of 50% or more was considered hemodynamically significant. To obtain subtracted source images of MR angiography, the unenhanced images were subtracted from the enhanced images. For analysis of MR angiography, subtracted source images and maximum-intensity-projection images were printed on hard copy. If necessary, additional multiplanar reformation imaging or targeted (subvolume) maximum intensity projection was performed using the console of the MR imager or a workstation (Sienet 1000; Siemens).

Statistical Analysis
Sensitivity, specificity, and predictive values of MR angiography as a diagnostic test for renal artery stenosis were calculated using digital subtraction angiography as the method of reference. Because stenoses of 50% or more were considered hemodynamically significant, grades 0 and 1 stenoses were regarded as negative tests for renal artery stenosis and grades 2, 3, and 4 as positive tests for renal artery stenosis. The parameters were calculated for the patient group: a patient was positive for the disease if a unilateral or bilateral renal artery stenosis was present. Cohen's kappa () analysis was used to test for agreement beyond that of chance between the two observers of MR angiography and of digital subtraction angiography (determination of poor [=0.00], slight [=0.01-0.20], fair [=0.21-0.40], moderate [=0.41-0.60], substantial [=0.61-0.80], and almost perfect [=0.81-1.00] agreement). Kappa value was calculated with respect to the classification of the different grades of stenosis (grades 0-4) and with respect to the presence (grades 2, 3, or 4) or absence (grades 0 and 1) of significant stenosis.

Results

Top Abstract Introduction Subjects and Methods Results Discussion References

 
No adverse reactions or complications occurred during or after digital subtraction angiography and MR angiography. The transit time of the timing bolus ranged from 10 to 30 sec in 36 patients (Fig. 1). In one patient, the transit time could not be determined; for this patient an estimated transit time of 20 sec was used. In another patient, the transit time was not recorded at the time of examination and could not be retrieved afterward.

View larger version (12K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1. —Bar graph shows transit time of contrast material bolus in 38 patients; transit time is unknown in two patients (see text). Note that transit time varied widely, implying that measurement of transit time is essential for optimization of imaging sequence.

In 38 patients, 75 main renal arteries and 17 accessory renal arteries were identified on digital subtraction angiography (one patient had undergone nephrectomy before the study). MR angiography correctly identified all 75 main renal arteries and 13 accessory renal arteries (Fig. 2). Three of the missed accessory renal arteries (all without stenosis) were identified on MR angiography in retrospect only (Fig. 3A,3B) and were considered false-negative findings. The remaining fourth accessory renal artery, identified on digital subtraction angiography, was classified as an early division of the main renal artery on MR angiography; reevaluation of the digital subtraction angiogram confirmed this finding. MR angiography prospectively revealed another accessory renal artery (with a stenosis of 75-99%); reevaluation of the digital subtraction angiogram confirmed these findings (Fig. 4A,4B). In both cases, the digital subtraction angiography images were of moderate quality but were considered diagnostic. The depiction of these two latter vessels on MR angiography were considered false-negative and false-positive findings, respectively, because digital subtraction angiography was used as the method of reference.

View larger version (96K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2. —75-year-old man with bilateral renal artery stenosis and accessory renal artery. MR angiogram (maximum intensity projection) shows stenosis of 50-74% of right renal artery and stenosis of 75-99% of left renal artery. Small accessory renal artery (arrow) supplies left lower pole of kidney. Findings were confirmed on digital subtraction angiography.

View larger version (148K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3A. —47-year-old woman with hypertension and renal insufficiency. Digital subtraction angiogram shows two accessory renal arteries (arrows, A) on left. These accessory renal arteries were not detected on MR angiography prospectively (false-negative findings). They are recognizable (although difficult to see) on maximum intensity projection (arrows, B). Quality of digital subtraction angiogram and MR angiogram was prospectively classified as good.

View larger version (115K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3B. —47-year-old woman with hypertension and renal insufficiency. Digital subtraction angiogram shows two accessory renal arteries (arrows, A) on left. These accessory renal arteries were not detected on MR angiography prospectively (false-negative findings). They are recognizable (although difficult to see) on maximum intensity projection (arrows, B). Quality of digital subtraction angiogram and MR angiogram was prospectively classified as good.

View larger version (158K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4A. —67-year-old man with renal insufficiency. MR angiogram (A) shows stenosis exceeding 50% in right renal artery (arrowhead) and occlusion of main left renal artery (long arrow). Accessory renal artery with stenosis of 75-99% was identified on left side (short arrows). On digital subtraction angiogram (B) of moderate quality, accessory renal artery was not recognized prospectively; after reevaluation, MR findings were confirmed.

View larger version (141K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4B. —67-year-old man with renal insufficiency. MR angiogram (A) shows stenosis exceeding 50% in right renal artery (arrowhead) and occlusion of main left renal artery (long arrow). Accessory renal artery with stenosis of 75-99% was identified on left side (short arrows). On digital subtraction angiogram (B) of moderate quality, accessory renal artery was not recognized prospectively; after reevaluation, MR findings were confirmed.

Ninety-three arteries (in 38 patients) were evaluated for stenosis. The consensus grading of stenosis revealed by contrast-enhanced MR angiography and by intraarterial digital subtraction angiography is presented in Table 2, including the false-positive (n = 1) and false-negative (n = 4) findings already described. As shown in Table 2, slight differences in interpretation of stenosis occurred between grades 0 and 1 and between grades 2 and 3; we noted both over- and underestimation of stenosis on MR angiography within the subgroups ranging from 0% to 50% and ranging from 50% to 99% (Figs. 5A,5B and 6A,6B). If grades 0 and 1 were considered to represent a nonsignificant stenosis and both grades 2 and 3 a hemodynamically significant stenosis, five arteries were judged to have a significant stenosis on MR angiography but were not stenotic on digital subtraction angiography. All occluded arteries were correctly classified on MR angiography.

View larger version (118K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5A. —60-year-old man with hypertension and mild renal insufficiency. Maximum-intensity-projection MR image (A) and intraarterial digital subtraction angiogram (B) show normal right renal artery and stenosis of less than 50% (arrow) of left renal artery.

View larger version (122K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5B. —60-year-old man with hypertension and mild renal insufficiency. Maximum-intensity-projection MR image (A) and intraarterial digital subtraction angiogram (B) show normal right renal artery and stenosis of less than 50% (arrow) of left renal artery.

View larger version (141K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6A. —37-year-old woman with hypertension. Intraarterial digital subtraction angiogram (A) and MR angiogram (maximum intensity projection) (B) show normal left renal artery. On digital subtraction angiogram, stenosis of right renal artery (arrow) was classified as 50-74%; on MR angiogram stenosis was classified as 75-99%.

View larger version (151K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6B. —37-year-old woman with hypertension. Intraarterial digital subtraction angiogram (A) and MR angiogram (maximum intensity projection) (B) show normal left renal artery. On digital subtraction angiogram, stenosis of right renal artery (arrow) was classified as 50-74%; on MR angiogram stenosis was classified as 75-99%.

The sensitivity and specificity for the detection of significant stenosis and occlusion in the 38 patients were 100% and 85.0%, respectively. The positive and negative predictive values were 85.7% and 100%, respectively. Agreement between the two observers of digital subtraction angiography and MR angiography in the classification of all grades of stenosis (grades 0-4) was substantial: = 0.73 on digital subtraction angiography and = 0.70 on MR angiography. The interobserver agreement for the presence or absence of significant stenosis was almost perfect: =0.90 on digital subtraction angiography and =0.91 on MR angiography.

Discussion

Top Abstract Introduction Subjects and Methods Results Discussion References

 
In this study, the accuracy of breath-hold contrast-enhanced MR angiography in the diagnosis of renal artery stenosis was evaluated using a standard dose of ±0.1 mmol/kg body weight of gadolinium at an injection rate of 2.5 ml/sec with an MR power injector, timing bolus, and subtraction technique. Previous reports describe the essentials of the MR technique: administration of paramagnetic contrast material shortens the T1 of blood, thus permitting easy distinction between blood vessels and surrounding tissue [7, 9, 23,24,25]. Further improvement of the technique, in particular shortening the time of acquisition, has permitted breath-hold studies, which improve the imaging of renal arteries. Because contrast-enhanced MR angiography is a noninvasive study and because a safe and non-nephrotoxic contrast agent is used, this technique has important advantages over digital subtraction angiography and (helical) CT angiography of the renal arteries [26, 27].

All MR angiograms were considered technically sufficient for analysis; no study had to be repeated. Adequate timing of the bolus is essential; previous studies showed optimal results if an MR power injector and timing bolus were used [21, 22, 28, 29]. In this study, the transit time varied widely (10-30 sec); this is in accordance with the findings of previous studies [21, 22, 28]. We consider exact measurement of transit time essential for an optimal examination, and this is even more important if a standard dose of ±0.1 mmol/kg at an injection rate of 2.5 ml/sec is used, as in our series. The use of an MR power injector has been described as superior to hand injection; the optimal injection rate for abdominal vessels was reported to be approximately 2 ml/sec [22, 29]. We used a separate timing bolus sequence because the software package of our imager does not allow automated detection of contrast agent and synchronization of the data acquisition in one sequence [30, 31]. In one patient, we could not determine the transit time; by using an estimated transit time, a satisfactory study was generated.

In this series, a phased array body coil was used, which increases signal- and contrast-to-noise ratios if compared with a body coil. However, this coil can limit the field of view and also has the drawback of signal inhomogeneity in the direct vicinity of the coil [32, 33]. To our knowledge, no studies have compared a body coil with a phased array coil in performing MR angiography. It was assumed that the use of phased array coil would improve imaging, but future comparative studies will be needed to determine if such a coil should be preferred.

In this study, 75 main and 17 accessory renal arteries were detected on digital subtraction angiography. MR angiography correctly identified all main and 13 accessory renal arteries. Three accessory arteries (false-negative findings) were not detected on MR angiography. After reevaluation, these accessory renal arteries could be identified. We think that the tortuosity and the relatively small caliber of these particular arteries and the limited spatial resolution of MR angiography caused the difficulty in recognizing these arteries on maximum-intensity-projection, source, and multiplanar reformatted images. A learning curve is definitely present in detecting small accessory arteries on MR angiography. Despite these false-negative findings, we think that identification of accessory renal arteries can be sufficient on MR angiography. Previous studies identified a various number of accessory renal arteries, comparing contrast-enhanced MR angiography and digital subtraction angiography: Steffens et al. [16] identified six of nine accessory renal arteries (in 50 patients), Hany et al. [10] 10 of 11 (in 39 patients), De Cobelli et al. [13] 17 of 18 (in 55 patients), and Bakker et al. [12] 21 of 22 (in 44 patients).

One accessory renal artery was identified as an early division of the main renal artery on MR angiography, and this finding was confirmed after reanalysis of the digital subtraction angiogram. Another accessory renal artery was identified on MR angiography; again, in retrospect only, this artery was identified on digital subtraction angiography. Because digital subtraction angiography was used as the method of reference, these two arteries were classified as false-negative and false-positive findings, respectively. However, because the MR angiography findings were confirmed after reanalysis of digital subtraction angiograms, it raises the question whether digital subtraction angiography is an indisputable method of reference.

MR angiography findings incorrectly suggested a significant stenosis in five renal arteries, rendering a specificity of 85.0%. However, negative predictive value and sensitivity were 100%; the values of these parameters are comparable to those in previous studies, which report a sensitivity and specificity ranging from 93% to 100% and from 90% to 98%, respectively [10, 12,13,14, 16,17,18]. The use of ±0.1 mmol/kg of body weight of contrast agent proved to be sufficient in this study, confirming earlier studies [13, 16, 18, 34]. In a recent study by Lee et al. [34] and an earlier study by Earls et al. [22], a similar technique for performing contrast-enhanced MR angiography was described, using a timing bolus sequence and an MR power injector. This technique generated reliable and diagnostic studies; however, the results were not correlated with angiography in most cases [34]. Because of its high sensitivity, MR angiography can be used reliably to exclude renal artery stenosis and to serve as a useful screening method for renal artery stenosis. Using a single dose of contrast agent will make MR angiography more cost-effective as a screening method. A recent study showed that the dose of ±0.1 mmol/kg could also be sufficient when imaging with a 1.0-T system [19]. The high interobserver agreement expressed in the kappa values (=0.91 for significant stenosis) indicates that contrast-enhanced MR angiography can result in unequivocal grading of stenosis. This is in accordance with a recent study by Gilfeather et al. [35] showing a marginal difference in the interobserver variability of MR angiography and digital subtraction angiography.

In conclusion, MR angiography using ±0.1 mmol/kg of gadolinium, a phased array body coil, subtraction technique, timing bolus, and MR power injector, is a safe and accurate screening method for renal artery stenosis and accessory renal arteries.

References

Top Abstract Introduction Subjects and Methods Results Discussion References

 

1. Mann SJ, Pickering TG. Detection of renovascular hypertension. Ann Intern Med 1992;117:845-853
2. Losinno F, Zuccalà A, Busato F, Zucchelli P. Renal artery angioplasty for renovascular hypertension and preservation of renal function: long-term angiographic and clinical follow-up. AJR 1994;162:853-857[Abstract/Free Full Text]
3. National High Blood Pressure Education Program Working Group. 1995 Update of the working group reports on chronic renal failure and renovascular hypertension. Arch Intern Med 1996;156:1938-1947[Abstract]
4. Harden PN, MacLeod MJ, Rodger RS, et al. Effect of renal artery stenting on progression of renovascular renal failure. Lancet 1997;349:1133-1136[Medline]
5. Hillman BJ. Imaging advances in the diagnosis of renovascular hypertension. AJR 1989;153:5-14[Free Full Text]
6. Postma CT, Joosten FBM, Rosenbusch G, Thien T. Magnetic resonance angiography has a high reliability in the detection of renal artery stenosis. Am J Hypertens 1997;10:957-963[Medline]
7. Schoenberg SO, Prince MR, Knopp MV, Allenberg JR. Renal MR angiography. Magn Reson Imaging Clin N Am 1998;6:351-370[Medline]
8. Wasser MN, Westenberg J, van der Hulst VPM, et al. Hemodynamic significance of renal artery stenosis: digital subtraction angiography versus systolically gated three-dimensional phase-contrast MR angiography. Radiology 1997;202:333-338[Abstract/Free Full Text]
9. Prince MR. Gadolinium-enhanced MR aortography. Radiology 1994;191:155-164[Abstract/Free Full Text]
10. Hany TF, Debatin JF, Leung DA, Pfammatter T. Evaluation of the aortoiliac and renal arteries: comparison of breath-hold, contrast-enhanced, three-dimensional MR angiography with conventional catheter angiography. Radiology 1997;204:357-362[Abstract/Free Full Text]
11. Prince MR, Narasimham DL, Stanley JC, et al. Breath-hold gadolinium-enhanced MR angiography of the abdominal aorta and its major branches. Radiology 1995;197:785-792[Abstract/Free Full Text]
12. Bakker J, Beek FJ, Beutler JJ, et al. Renal artery stenosis and accessory renal arteries: accuracy of detection and visualization with gadolinium-enhanced breath-hold MR angiography. Radiology 1998;207:497-504[Abstract/Free Full Text]
13. De Cobelli F, Vanzulli A, Sironi S, et al. Renal artery stenosis: evaluation with breath-hold, three-dimensional, dynamic, gadolinium-enhanced versus three-dimensional, phase-contrast MR angiography. Radiology 1997;205:689-695[Abstract/Free Full Text]
14. Snidow JJ, Johnson MS, Harris VJ, et al. Three-dimensional gadolinium-enhanced MR angiography for aortoiliac inflow assessment plus renal artery screening in a single breath hold. Radiology 1996;198:725-732[Abstract/Free Full Text]
15. Holland GA, Dougherty L, Carpenter JP, et al. Breath-hold ultrafast three-dimensional gadolinium-enhanced MR angiography of the aorta and the renal and other visceral abdominal arteries. AJR 1996;166:971-981[Abstract/Free Full Text]
16. Steffens JH, Link J, Grassner J, et al. Contrast-enhanced, k-space centered, breath-hold MR angiography of the renal arteries and the abdominal aorta. J Magn Reson Imaging 1997;7:617-622[Medline]
17. Hany TF, Leung DA, Pfammatter T, Debatin JF. Contrast-enhanced magnetic resonance angiography of the renal arteries. Invest Radiol 1998;33:653-659[Medline]
18. Tello R, Thomson KR, Witte D, Becker GJ, Tress BM, Standard dose Gd-DTPA dynamic MR of renal arteries. J Magn Reson Imaging 1998;8:421-426[Medline]
19. Lentschig MG, Reimer P, Rausch-Lentschig UL, Allkemper T, Oelerich M, Laub G. Breath-hold gadolinium-enhanced MR angiography of the major vessels at 1.0 T: dose response findings and angiographic correlation. Radiology 1998;208:353-357[Abstract/Free Full Text]
20. Leung DA, Pelkonen P, Hany TF, Zimmermann G, Pfammatter T, Debatin JF. Value of image subtraction in 3D gadolinium-enhanced MR angiography of the renal arteries. J Magn Reson Imaging 1998;8:598-602[Medline]
21. Earls JP, Rofsky N, DeCorato DR, Krinsky GA, Weinreb JC. Hepatic arterial-phase dynamic gadolinium-enhanced MR imaging: optimization with a test examination and a power injector. Radiology 1997;202:268-273[Abstract/Free Full Text]
22. Earls JP, Rofsky N, DeCorato DR, Krinksy GA, Weinreb JC. Breath-hold single-dose gadolinium-enhanced three-dimensional MR aortography: usefulness of a timing examination and MR power injector. Radiology 1996;201:705-710[Abstract/Free Full Text]
23. Stafford Johnson DB, Prince MR, Chenevert TL. Magnetic resonance angiography: a review. Acad Radiol 1998;5:289-305[Medline]
24. Prince MR. Contrast-enhanced MR angiography. Magn Reson Imaging Clin N Am 1998;6:257-267[Medline]
25. Prince MR. Renal MR angiography: a comprehensive approach. J Magn Reson Imaging 1998;8:511-516[Medline]
26. Nelson KL, Gifford LM, Lauber-Huber C, Gross CA, Lasser TA. Clinical safety of gadopentetate dimeglumine. Radiology 1995;196:439-443[Abstract/Free Full Text]
27. Tublin ME, Murphy ME, Tessler FN. Current concepts in contrast media-induced nephropathy. AJR 1998;171:933-939[Free Full Text]
28. Hany TF, McKinnon GC, Leung DA, Pfammatter T, Debatin JF. Optimization of contrast timing for breath-hold three-dimensional MR angiography. J Magn Reson Imaging 1997;7:551-556[Medline]
29. Kopka L, Vosshenrich R, Rodenwaldt J, Grabbe E. Differences in injection rates on contrast-enhanced breath-hold three-dimensional MR angiography. AJR 1997;170:345-348[Abstract/Free Full Text]
30. Foo TK, Saranathan M, Prince MR, Chenevert TL. Automated detection of bolus arrival and initiation of data acquisition in fast, three-dimensional, gadolinium-enhanced MR angiography. Radiology 1997;203:275-280[Abstract/Free Full Text]
31. Prince MR, Chenevert TL, Foo TK, Londy FJ, Ward JS, Maki JH. Contrast-enhanced abdominal MR angiography: optimization of imaging delay time by automating the detection of contrast material arrival in the aorta. Radiology 1997;203:109-114[Abstract/Free Full Text]
32. Campeau NG, Johnson CD, Felmlee JP, et al. MR imaging of the abdomen with a phased-array multicoil: prospective clinical evaluation. Radiology 1995;195:769-776[Abstract/Free Full Text]
33. Smith RC, Reinhold C, McCauley TR, et al. Multicoli high-resolution fast spin-echo MR imaging of the female pelvis. Radiology 1992;184:671-675[Abstract/Free Full Text]
34. Lee VS, Rofsky NM, Krinsky GA, Stemerman DH, Weinreb JC. Single-dose breath-hold gadolinium-enhanced three-dimensional MR angiography of the renal arteries. Radiology 1999;211:69-78[Abstract/Free Full Text]
35. Gilfeather M, Yoon HC, Siegelman ES, et al. Renal artery stenosis: evaluation with conventional angiography versus gadolinium-enhanced MR angiography. Radiology 1999;210:367-372[Abstract/Free Full Text]

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				S. Willoteaux, M. Faivre-Pierret, O. Moranne, C. Lions, J. Bruzzi, M. Finot, V. Gaxotte, C. Mounier-Vehier, and J.-P. Beregi Fibromuscular Dysplasia of the Main Renal Arteries: Comparison of Contrast-enhanced MR Angiography with Digital Subtraction Angiography Radiology, December 1, 2006; 241(3): 922 - 929. [Abstract] [Full Text] [PDF]

				S. C. Goehde, P. Hunold, F. M. Vogt, W. Ajaj, M. Goyen, C. U. Herborn, M. Forsting, J. F. Debatin, and S. G. Ruehm Full-Body Cardiovascular and Tumor MRI for Early Detection of Disease: Feasibility and Initial Experience in 298 Subjects Am. J. Roentgenol., February 1, 2005; 184(2): 598 - 611. [Abstract] [Full Text] [PDF]

				M. Prokop, G. Schneider, A. Vanzulli, M. Goyen, S. G. Ruehm, P. Douek, M. Dapra, G. Pirovano, M. A. Kirchin, and A. Spinazzi Contrast-enhanced MR Angiography of the Renal Arteries: Blinded Multicenter Crossover Comparison of Gadobenate Dimeglumine and Gadopentetate Dimeglumine Radiology, February 1, 2005; 234(2): 399 - 408. [Abstract] [Full Text] [PDF]

				G. B. C. Vasbinder, P. J. Nelemans, A. G.H. Kessels, A. A. Kroon, J. H. Maki, T. Leiner, F. J.A. Beek, M. B.J.M. Korst, K. Flobbe, M. W. de Haan, et al. Accuracy of Computed Tomographic Angiography and Magnetic Resonance Angiography for Diagnosing Renal Artery Stenosis Ann Intern Med, November 2, 2004; 141(9): 674 - 682. [Abstract] [Full Text] [PDF]

				A. Gupta and R. Tello Accessory Renal Arteries Are Not Related to Hypertension Risk: A Review of MR Angiography Data Am. J. Roentgenol., June 1, 2004; 182(6): 1521 - 1524. [Abstract] [Full Text] [PDF]

				R. C. Carlos, D. A. Axelrod, J. H. Ellis, P. H. Abrahamse, and A. M. Fendrick Incorporating Patient-Centered Outcomes in the Analysis of Cost-Effectiveness: Imaging Strategies for Renovascular Hypertension Am. J. Roentgenol., December 1, 2003; 181(6): 1653 - 1661. [Abstract] [Full Text] [PDF]

				T. J. Kroencke, M. N. Wasser, P. M. T. Pattynama, J. O. Barentsz, E. Grabbe, G. Marchal, M. V. Knopp, G. Schneider, L. Bonomo, D. J. Pennell, et al. Gadobenate Dimeglumine--Enhanced MR Angiography of the Abdominal Aorta and Renal Arteries Am. J. Roentgenol., December 1, 2002; 179(6): 1573 - 1582. [Abstract] [Full Text] [PDF]

				G. M. Israel, V. S. Lee, M. Edye, G. A. Krinsky, M. T. Lavelle, T. Diflo, and J. C. Weinreb Comprehensive MR Imaging in the Preoperative Evaluation of Living Donor Candidates for Laparoscopic Nephrectomy: Initial Experience Radiology, November 1, 2002; 225(2): 427 - 432. [Abstract] [Full Text] [PDF]

				G. B. C. Vasbinder, P. J. Nelemans, A. G.H. Kessels, A. A. Kroon, P. W. de Leeuw, and J. M.A. van Engelshoven Diagnostic Tests for Renal Artery Stenosis in Patients Suspected of Having Renovascular Hypertension: A Meta-Analysis Ann Intern Med, September 18, 2001; 135(6): 401 - 411. [Abstract] [Full Text] [PDF]

				S. C. Rankin, W. Jan, and C. G. Koffman Noninvasive Imaging of Living Related Kidney Donors: Evaluation with CT Angiography and Gadolinium-Enhanced MR Angiography Am. J. Roentgenol., August 1, 2001; 177(2): 349 - 355. [Abstract] [Full Text] [PDF]

				H. Masunaga, Y. Takehara, H. Isoda, T. Igarashi, M. Sugiyama, S. Isogai, N. Kodaira, H. Takeda, A. Nozaki, and H. Sakahara Assessment of Gadolinium-Enhanced Time-Resolved Three-Dimensional MR Angiography for Evaluating Renal Artery Stenosis Am. J. Roentgenol., May 1, 2001; 176(5): 1213 - 1219. [Abstract] [Full Text] [PDF]

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