RENAL-ARTERY STENOSIS - SHOULD WE STUDY THE MAIN RENAL-ARTERY OR SEGMENTAL VESSELS

PURPOSE: To compare the sonographic diagnosis of renal artery stenosis (RAS) with Doppler interrogation of the main renal artery versus Dopp ler ultrasonography of segmental vessels. MATERIALS AND METHODS; The m ain renal artery-to-aortic peak systolic velocity ratio (RAR) and earl y systolic acceleration in segmental arteries were obtained in 186 pat ients. Conventional arteriographic correlation was available fbr 42 ki dneys in 21 patients. Paired receiver operating characteristic (ROC) a nalyses were performed to evaluate RAR and minimum, average, and maxim um early systolic acceleration in these 42 kidneys. RESULTS: Minimum e arly systolic acceleration was a better test than RAR (P = .05). Minim um early systolic acceleration plus RAR resulted in improved sensitivi ty for detection of RAS, but this improvement was not significant (P = .16).CONCLUSION: Minimum early systolic acceleration is the ultrasono graphic method of choice to screen for RAS. RAR may provide marginal i mprovement in sensitivity but is probably not warranted in most clinic al situations.