An international multicenter comparison of time-SLIP unenhanced MR angiography and contrast-enhanced CT angiography for assessing renal artery stenosis: the renal artery contrast-free trial.

OBJECTIVE: The unenhanced MR angiography (MRA) technique time-spatial labeling inversion pulse (time-SLIP) may provide a safe alternative for evaluating the renal arteries for stenosis. This international multicenter trial tested the hypothesis that time-SLIP unenhanced MRA is accurate and robust for assessing the renal arteries for stenosis in comparison with contrast-enhanced CT angiography (CTA). SUBJECTS AND METHODS: Four centers (United States, Europe, Asia) enrolled 75 patients (average age ± SD, 58 ± 13 years; 41 [55%] men and 34 [45%] women). Each patient underwent abdominal contrast-enhanced CTA and abdominal unenhanced MRA using time-SLIP with balanced steady-state free precession. All images were visually assessed for quality (arterial signal intensity) and for the absence or presence of renal artery stenosis (≤ 50% or > 50% stenosis, respectively). In addition, for arteries with any visible disease, the severity of the stenosis was quantified. Two blinded readers evaluated each study. No arteries were excluded from analysis. RESULTS: Unenhanced MRA image quality was excellent for 56 of 75 patients (75%) and good for 16 of 75 patients (21%). CTA was used as the reference standard and showed that 23 of 161 renal arteries (14.3%) had stenosis > 50%. Unenhanced MRA correctly classified 17 of the 23 renal arteries with > 50% stenosis and correctly classified 128 of the 138 renal arteries as not having disease (≤ 50% stenosis) to yield a sensitivity of 74%, specificity of 93%, and accuracy of 90% (χ(2) = 0.56; p = 0.45, no statistically significant difference). Of the 16 misclassified arteries, only three had a clinically relevant misclassification (CTA ≥ 70% stenosis and unenhanced MRA ≤ 50% stenosis or unenhanced MRA ≥ 70% stenosis and CTA ≤ 50% stenosis). On average, measured stenotic severity (n = 28 arteries) was similar for unenhanced MRA (64% ± 17%) and CTA (62% ± 16%) (p = 0.51). CONCLUSION: Compared with contrast-enhanced CTA, the unenhanced MRA technique time-SLIP shows promise for assessing the renal arteries for stenosis. The unenhanced MRA technique time-SLIP may provide a safe alternative for evaluating the renal arteries for stenosis.

Renal artery stenosis evaluation in chronic kidney disease patients: nonenhanced time-spatial labeling inversion-pulse three-dimensional MR angiography with regulated breathing versus DSA.

PURPOSE: To evaluate the diagnostic performance of nonenhanced magnetic resonance (MR) angiographic flow-in technique with three-dimensional balanced steady-state free precession (SSFP) (flow-in balanced SSFP), compared with digital subtraction angiography (DSA) as reference standard, for assessment of renal artery stenosis (RAS) in chronic kidney disease (CKD) patients. MATERIALS AND METHODS: Institutional review board approval and written informed consent were obtained for this prospective HIPAA-compliant study. Twenty-three patients, 13 men (mean age, 67.6 years ± 8.1 [standard deviation]; age range, 58-86 years) and 10 women (mean age 73.1 years ± 12.4; age range, 49-89 years), were evaluated with flow-in balanced SSFP and DSA. Coronal and axial flow-in balanced SSFP images were obtained with 1.5-T system, with regulated breathing (recorded voice instruction). The quality of flow-in balanced SSFP images was visually evaluated; the degree of stenosis was compared between flow-in balanced SSFP source images and DSA images by using the Wilcoxon signed-rank test. Correlation between images from both modalities was calculated as the Spearman rank-order correlation coefficient; bias was examined with Bland-Altman plots. RESULTS: Diagnostic images were obtained in all patients. Flow-in balanced SSFP image quality was good in 87% (20 of 23) and moderate in 13% (three of 23) of patients. Forty-five renal arteries were included in the statistical analysis. Of 36 stenoses detected with flow-in balanced SSFP, 28 were relevant (degree of stenosis, ≥ 50%). The stenosis measurements of flow-in balanced SSFP were highly correlated (ρ = 0.91, P < .001) with those of DSA. The Bland-Altman plot showed a slight overestimation of the degree of stenosis (mean bias, 2.33% ± 11.95). The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of flow-in balanced SSFP relative to DSA for the diagnosis of a stenosis of 50% or greater were 93% (26 of 28), 88% (15 of 17), 93% (26 of 28), 88% (15 of 17), and 91% (41 of 45), respectively. CONCLUSION: Flow-in balanced SSFP with regulated breathing is an appropriate nonenhanced MR angiographic technique for RAS assessment in CKD patients. SUPPLEMENTAL MATERIAL: http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.11101422/-/DC1.