No radiation/nephrotoxic contrast 3-D imaging shows arterial ostium to advantage Reproducible 3-D
Resolution improving all the time Cost
Nuclear medicine May predict response to treatment Gives information on kidney function Angiography Accurate
Pressures can be measured May proceed directly to intervention
May overestimate stenosis Contraindicated for/not tolerated by some patients
Accuracy may fall with inexperience of operator Less reproducible Misses accessory renal arteries High technical-failure rate Not as accurate as other methods
Complications Contrast dose
Ostial lesions may be projected over the aorta and missed
Abbreviations: MRI, magnetic resonance imaging; CT, computed tomography.
between 1% and 5% in an unselected hypertensive population. Clinical markers of RAS may be employed to allow a more selective investigation of patients. An overview of the strengths and weaknesses of the available imaging modalities is given in Table 11. At the moment MRA seems to be the best choice with its safety and accuracy. If MRA is not available or is contraindicated, a strong case can also be made for CTA. However in patients with renal impairment, contrast media-induced nephro-pathy is a major source for concern. In this group and others, contrast-enhanced Doppler ultrasound may be of assistance if there is local expertise in the technique.
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