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Kidney: Renal Artery Stenosis Imaging Pearls - Educational Tools | CT Scanning | CT Imaging | CT Scan Protocols - CTisus
Imaging Pearls ❯ Kidney ❯ Renal Artery Stenosis

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  • Renal Artery Stenosis
    • Role of revascularization vs medical therapy for atherosclerotic renal artery stenosis remains controversial
    • Restenosis rate is lower in renal arteries than coronary arteries
    • Emboli into renal vascular bed and elsewhere remains a major concern
  • RAS: Benefits of Stenting
    • improves hypertension
    • stabilizes renal failure
    • reduces recurrent cardiac events such as flash pulmonary edema
  • Fibromuscular Dysplasia
    • medial fibroplasia
    • perimedial fibroplasia
    • medial hyperplasia
    • medial dissection
    • intimal fibroplasia
    • adventitial fibroplasia
    • medial fibroplasia- mid to distal RA
    • perimedial fibroplasia
    • medial hyperplasia
    • medial dissection
    • intimal fibroplasia
    • adventitial fibroplasia
    • “string-of-beads”
       - beading is larger than normal artery diameter
    • focal, concentric stenos(es)
    • smooth, long stenosis
    • aneurysm(s)
    • dissection
       - intimal and periarterial FMD
    • thrombosis
       - intimal and periarterial FMD
  • Renal Artery Stenosis: Facts
    - The cause of hypertension in adults in less than 5% of cases
    - Potentially curable
    - Diameter stenosis greater than 50% often hemodynamically significant
  • “ MDCT is a minimally invasive study for evaluating the renal arteries in normal individuals and patients with suspected renal pathology. The ability to obtain thin sections and cover a large area may improve the detection and characterization of renal artery anomalies and disease.”
    Multidetector Computed Tomographic Evaluation of the Renal Artery
    Pannu HK, Fishman EK
    Abdom Imaging 27:611-619 (2002)
  • Renal Artery Fibromuscular Dysplasia (FMD): Facts
    -Younger patient
    - Predominately female population
    - “String of pearls” appearance (due to multiple stenosis) are classic appearance
  • Fibromuscular Dysplasia: Classification
    - Medial fibromuscular disease
    - 65-70% of cases
    - String of beads appearance
    - Perimedial (subadventitial form)
    - 15-20% of cases
    - Aneurysm formation or focal stenosis
  • Fibromuscular Dysplasia: Classification
    - Medial hyperplasia
    - 8-10% of cases
    - No classic radiologic appearance
    - 1-2% of cases
    - Isolated intimal or adventitial involvement
  • “ More recently, in a study comparing 4-slice MDCT to digital subtraction angiography, the sensitivity and specificity for all degrees of renal artery stenosis were 100% and 98.6%, respectively. For stenosis greater than 50%, sensitivity was 100% and specificity 97.3%.”
    Computed Tomography Angiography of the Renal and Mesenteric Vasculature: Concepts and Applications
    Johnson PT, Fishman EK
    Seminars in Roentgenology
    2011: 115-124
  • CT Angiography of the Renal Arteries: Fibromuscular Dysplasia
    -Causes less than 10% of cases of renal artery stenosis
    -More common in young or middle aged woman
    -Associations include smoking, hormones, and vasa vasorum disorders
    -FMD may appear as a “string of beads” appearance
    -May be bilateral in 71% of cases when symptomatic
  • CT Angiography of the Renal Arteries: Renal Artery Stenosis

    Etiology
    -Atherosclerotic disease (90%)
    -Age
    -Diabetes
    -Aortoiliac occlusive disease
    -Hypertension
    -Presence of coronary artery disease
  • CT Angiography of the Renal Arteries: Renal Artery Stenosis
    -Reconstruction of data required to define and quantify presence and degree of stenosis
    -MIP can lead to overcalling the degree of stenosis
    -VRT when used correctly has a 95-100% accuracy

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