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How to measure renal artery stenosis - a retrospective comparison of morphological measurement approaches in relation to hemodynamic significance
Linköping University, Department of Medical and Health Sciences, Division of Radiological Sciences. Linköping University, Center for Medical Image Science and Visualization (CMIV). Linköping University, Faculty of Medicine and Health Sciences.
Linköping University, Department of Medical and Health Sciences, Division of Radiological Sciences. Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Center for Medical Image Science and Visualization (CMIV). Not Found:Linkoping Univ, Ctr Med Image Sci and Visualizat CMIV, Linkoping, Sweden; Linkoping Univ, Dept Radiol, Linkoping, Sweden; Linkoping Univ, Dept Med and Hlth Sci, Linkoping, Sweden.
Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Region Östergötland, Heart and Medicine Center, Department of Rheumatology. Linköping University, Faculty of Medicine and Health Sciences.ORCID iD: 0000-0002.3555-7162
Linköping University, Department of Medical and Health Sciences, Division of Radiological Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Diagnostics, Department of Radiology in Linköping. Linköping University, Center for Medical Image Science and Visualization (CMIV).ORCID iD: 0000-0002-9446-6981
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2015 (English)In: BMC Medical Imaging, ISSN 1471-2342, E-ISSN 1471-2342, Vol. 15, no 42Article in journal (Refereed) Published
Abstract [en]

Background: Although it is well known that renal artery stenosis may cause renovascular hypertension, it is unclear how the degree of stenosis should best be measured in morphological images. The aim of this study was to determine which morphological measures from Computed Tomography Angiography (CTA) and Magnetic Resonance Angiography (MRA) are best in predicting whether a renal artery stenosis is hemodynamically significant or not. Methods: Forty-seven patients with hypertension and a clinical suspicion of renovascular hypertension were examined with CTA, MRA, captopril-enhanced renography (CER) and captopril test (Ctest). CTA and MRA images of the renal arteries were analyzed by two readers using interactive vessel segmentation software. The measures included minimum diameter, minimum area, diameter reduction and area reduction. In addition, two radiologists visually judged the diameter reduction without automated segmentation. The results were then compared using limits of agreement and intra-class correlation, and correlated with the results from CER combined with Ctest (which were used as standard of reference) using receiver operating characteristics (ROC) analysis. Results: A total of 68 kidneys had all three investigations (CTA, MRA and CER + Ctest), where 11 kidneys (16.2 %) got a positive result on the CER + Ctest. The greatest area under ROC curve (AUROC) was found for the area reduction on MRA, with a value of 0.91 (95 % confidence interval 0.82-0.99), excluding accessory renal arteries. As comparison, the AUROC for the radiologists visual assessments on CTA and MRA were 0.90 (0.82-0.98) and 0.91 (0.83-0.99) respectively. None of the differences were statistically significant. Conclusions: No significant differences were found between the morphological measures in their ability to predict hemodynamically significant stenosis, but a tendency of MRA having higher AUROC than CTA. There was no significant difference between measurements made by the radiologists and measurements made with fuzzy connectedness segmentation. Further studies are required to definitely identify the optimal measurement approach.

Place, publisher, year, edition, pages
BIOMED CENTRAL LTD , 2015. Vol. 15, no 42
Keyword [en]
Renal artery stenosis; Computed tomography angiography; Magnetic resonance angiography; Renography; Fuzzy connectedness segmentation; Vessel diameter; Cross-sectional area
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Clinical Medicine
Identifiers
URN: urn:nbn:se:liu:diva-122418DOI: 10.1186/s12880-015-0086-8ISI: 000362535400001PubMedID: 26459634OAI: oai:DiVA.org:liu-122418DiVA: diva2:866313
Note

Funding Agencies|Research Council of South-Eastern Sweden (FORSS); Swedish Research Council (VR)

Available from: 2015-11-02 Created: 2015-11-02 Last updated: 2017-12-01

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Eriksson, PerPersson, AndersGranerus, GöranWang, ChunliangSmedby, Örjan

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Division of Radiological SciencesCenter for Medical Image Science and Visualization (CMIV)Faculty of Medicine and Health SciencesDivision of Neuro and Inflammation ScienceDepartment of RheumatologyDepartment of Radiology in LinköpingDivision of Cardiovascular MedicineDepartment of Clinical Physiology in Linköping
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