Dataset Information

Application of simple ultrasound Doppler hemodynamic parameters in the diagnosis of severe renal artery stenosis in routine clinical practice.

ABSTRACT:

Background

Doppler ultrasound (DUS) is recommended in first-line imaging for the diagnosis of renal artery stenosis (RAS). However, the correct selection of Doppler direct or indirect parameters and their optimal thresholds remain controversial. This study explored simple ultrasound Doppler parameters to diagnose severe RAS (RAS ≥70%) in routine clinical practice.

Methods

In this retrospective study, patients with clinically suspected renovascular hypertension who first underwent renal artery DUS and contrast-enhanced ultrasound (CEUS) and subsequent digital subtraction angiography (DSA) or computed tomography angiography (CTA) were consecutively included. Clinical characteristics and ultrasound Doppler hemodynamic parameters were collected, including peak systolic velocity (PSV), the ratio of the peak velocities in the renal artery and the aorta (RAR), the ratio of the peak velocities in the renal artery and the segmental artery (RSR), and the ratio of the peak velocities in the renal artery and the interlobar artery (RIR). All enrolled patients were divided into two groups based on the degree of diameter reduction: a severe stenosis group (diameter reduction ≥70%) and a non-severe stenosis group (diameter reduction <70%). Logistic regression analysis was performed to determine the independent predictors for severe stenosis. Receiver operating characteristic curves and areas under the curve were used to evaluate the diagnostic performance of the ultrasound Doppler parameters.

Results

A total of 85 patients (106 renal arteries) with RAS were included in this study. The optimal thresholds of PSV in the main renal artery and the PSV ratios for diagnosing severe RAS obtained via receiver operating characteristic curves were 249.5 cm/s for PSV, 2.94 for RAR, 5.1 for RSR, and 7.5 for RIR. The areas under the curve of PSV and the ratios all exhibited good diagnostic efficiency (all >0.8). The combination of these four Doppler variables demonstrated a significant benefit to the overall diagnostic value compared with any factor alone [area under the curve (AUC) =0.962; 95% confidence interval (CI): 0.906-0.989; P<0.05]. The combination of PSV and RSR (AUC =0.925; 95% CI: 0.858-0.967) exhibited comparable diagnostic efficiency to the combination of four ultrasonographic variables (z statistic =1.882; P=0.06).

Conclusions

This simple and accurate method to evaluate severe RAS based on the velocity obtained via basic DUS may facilitate the detection of severe RAS in the majority of medical institutions and provide a reliable basis for the selection of proper candidates for further angiography or revascularization.

SUBMITTER: Zhang Y

PROVIDER: S-EPMC10722057 | biostudies-literature | 2023 Dec

REPOSITORIES: biostudies-literature

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Publications

Application of simple ultrasound Doppler hemodynamic parameters in the diagnosis of severe renal artery stenosis in routine clinical practice.

Zhang Yuewei Y Wang Yang Y Ma Na N Li Yan Y Li Yongjun Y Ren Junhong J

Quantitative imaging in medicine and surgery 20231019 12

<h4>Background</h4>Doppler ultrasound (DUS) is recommended in first-line imaging for the diagnosis of renal artery stenosis (RAS). However, the correct selection of Doppler direct or indirect parameters and their optimal thresholds remain controversial. This study explored simple ultrasound Doppler parameters to diagnose severe RAS (RAS ≥70%) in routine clinical practice.<h4>Methods</h4>In this retrospective study, patients with clinically suspected renovascular hypertension who first underwent ...[more]

PMID: 38106270

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Project description:Background and purposeAs a non-invasive, side effect-free and cost-effective method, ultrasonography represents the method of choice for the diagnosis of renal artery stenosis. Four different criteria in total, including two direct criteria in peak systolic velocity (PSV) and renal aortic ratio (RAR) and two indirect criteria in resistance index (RI) and acceleration time (AT) for the measurement of relevant renal artery stenosis are described, each demonstrating highly variable accuracy in studies. Furthermore, there is controversy over the degree beyond which stenosis becomes therapeutically relevant and which ultrasound PSV is diagnostically relevant in terms of stenosis grading.Material and methodsThis article gives a critical review based on a selective literature search on measurement methodology and the validity of ultrasound in renal artery stenosis. A critical evaluation of methods and a presentation of measurement principles to establish the most precise measurement method possible compared with the gold standard angiography, as well as an evaluation of the importance of computed tomography angiography (CTA) and magnetic resonance angiography (MRA).Results and conclusionsThe PSV provides high sensitivity and specificity as a direct measurement method in stenosis detection and grading. Most studies found sensitivities and specificities of 85-90 % for > 50 % stenosis at a PSV > 180-200 cm/s in ROC curve analysis. Other methods, such as the ratio of the PSV in the aorta to the PSV in the renal artery (RAR) or indirect criteria, such as side to side differences in RI (dRI) or AT can be additionally used to improve accuracy. Contrast-enhanced ultrasound improves accuracy by means of echo contrast enhancement. Although in the past only high-grade stenosis was considered relevant for treatment, a drop in pressure of > 20 mmHg in > 50 % stenosis (PSV 180 cm/s) is classified as relevant for increased renin secretion. Stenosis in fibromuscular dysplasia can be reliably graded according to the continuity equation. Although the available studies on the grading of in-stent restenosis are the subject of controversy, there is a tendency to assume higher cut-off values for PSV and RAR. Whilst MRA and CTA demonstrate an accuracy of > 90 %, this is at the cost of possible side effects for patients, particularly in the case of pre-existing renal parenchymal damage.Additional online materialThis article includes two additional video sequences on visualizing renal artery stenosis. This supplemental material can be found under: dx.doi.org/10.1007/s00772-015-0060-3.

Project description:BackgroundInternal carotid artery stenosis (ICAS) can cause stroke and cognitive decline. Associated hemodynamic impairments, which are most pronounced within individual watershed areas (iWSA) between vascular territories, can be assessed with hemodynamic-oxygenation-sensitive MRI and may help to detect severely affected patients. We aimed to identify the most sensitive parameters and volumes of interest (VOI) to predict high-grade ICAS with random forest machine learning. We hypothesized an increased predictive ability considering iWSAs and a decreased cognitive performance in correctly classified patients.Materials and methodsTwenty-four patients with asymptomatic, unilateral, high-grade carotid artery stenosis and 24 age-matched healthy controls underwent MRI comprising pseudo-continuous arterial spin labeling (pCASL), breath-holding functional MRI (BH-fMRI), dynamic susceptibility contrast (DSC), T2 and T2* mapping, MPRAGE and FLAIR. Quantitative maps of eight perfusion, oxygenation and microvascular parameters were obtained. Mean values of respective parameters within and outside of iWSAs split into gray (GM) and white matter (WM) were calculated for both hemispheres and for interhemispheric differences resulting in 96 features. Random forest classifiers were trained on whole GM/WM VOIs, VOIs considering iWSAs and with additional feature selection, respectively.ResultsThe most sensitive features in decreasing order were time-to-peak (TTP), cerebral blood flow (CBF) and cerebral vascular reactivity (CVR), all of these inside of iWSAs. Applying iWSAs combined with feature selection yielded significantly higher receiver operating characteristics areas under the curve (AUC) than whole GM/WM VOIs (AUC: 0.84 vs. 0.90, p = 0.039). Correctly predicted patients presented with worse cognitive performances than frequently misclassified patients (Trail-making-test B: 152.5s vs. 94.4s, p = 0.034).ConclusionRandom forest classifiers trained on multiparametric MRI data allow identification of the most relevant parameters and VOIs to predict ICAS, which may improve personalized treatments.

Project description:ObjectivesTo examine the relationship of ophthalmic artery (OA) Doppler indices with uterine artery (UtA) Doppler indices, selected maternal hemodynamic parameters and gestational age, and to evaluate the intraobserver reproducibility of OA Doppler indices.MethodsThis was a prospective cohort study of women recruited between 11 + 0 and 23 + 6 weeks' gestation using a stratified and random sampling approach to ensure adequate distribution across the gestational-age range. OA pulsatility index (PI), first peak systolic velocity (PSV1), second peak systolic velocity (PSV2) and peak systolic velocity ratio (PSV ratio), calculated as PSV2/PSV1, were measured twice in each eye by the same observer. UtA-PI was also measured twice on each side by the same observer. Maternal hemodynamic assessment was undertaken using an ultrasonic cardiac output monitor (USCOM 1A). Pearson's and Spearman's rank correlation coefficients were used to assess the correlations between variables, and Bland-Altman plots were used to evaluate the intraobserver reproducibility of OA Doppler indices.ResultsOf 194 women invited to participate in the study, 169 were eligible for inclusion, of whom 16 were excluded following an obstetric ultrasound scan and a further three owing to inadequate or incomplete OA or UtA Doppler assessment, leaving 150 women in the final analysis. Log UtA-PI had a weak correlation with both OA-PI (r = -0.19 (95% CI, -0.34 to -0.03), P = 0.021) and OA-PSV ratio (r = 0.31 (95% CI, 0.15-0.45), P < 0.001). The correlation between gestational age and OA-PI was non-significant (r = 0.14 (95% CI, -0.03 to 0.29), P = 0.097), and that between gestational age and OA-PSV ratio was weak (r = -0.23 (95% CI, -0.38 to -0.07), P = 0.004), as opposed to the strong correlation between gestational age and UtA-PI (r = -0.68 (95% CI, -0.76 to -0.58), P < 0.001). No strong correlations were observed between OA-PI or OA-PSV ratio and maternal hemodynamic indices. The correlations were unaltered by adjustment for maternal age and body mass index. The intraobserver reproducibility of OA-PI and OA-PSV ratio in the same eye was high. The correlation between the right and left eyes was moderate for OA-PI (r = 0.63 (95% CI, 0.53-0.72), P < 0.001) and strong for OA-PSV ratio (r = 0.81 (95% CI, 0.75-0.86), P < 0.001).ConclusionsOA-PI and OA-PSV ratio had a weak or no correlation with UtA-PI and maternal hemodynamic parameters, meaning that they can be used as independent predictors for pre-eclampsia. Gestational age had no clinically relevant effect on OA-PI and OA-PSV ratio, suggesting that these indices could be measured without adjustment at any time between 11 and 23 weeks' gestation. OA Doppler indices had high intraobserver reproducibility and were strongly correlated between the right and left eyes. © 2025 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Project description:BackgroundBedside non-invasive techniques, such as radial artery tonometry, to estimate hemodynamic parameters have gained increased relevance as an attractive alternative and efficient method to measure hemodynamics in outpatient departments. For our pilot study, we sought to compare cardiac output (CO), and stroke volume (SV) estimated from a radial artery tonometry blood pressure pulse analyzer (BPPA) (DMP-Life, DAEYOMEDI Co., Gyeonggi-do, South Korea) to pulsed-wave Doppler (PWD) echocardiography derived parameters.MethodsFrom January 2015 to December 2016, all patients scheduled for coronary artery bypass (CABG) surgery at our department were screened. Exclusion criteria were, inter alia, moderate to severe aortic- or Mitral valve disease and peripheral arterial disease (PAD) > stage II. One hundred and seven patients were included (mean age 66.1 ± 9.9, 15 females, mean BMI 27.2 ± 4.1 kg/m2). All patients had pre-operative transthoracic echocardiography (TTE). We measured the hemodynamic parameters with the BPPA from the radial artery, randomly before or after TTE. For the comparison between the measurement methods we used the Bland-Altman test and Pearson correlation.ResultsMean TTE-CO was 5.1 ± 0.96 L/min, and the mean BPPA-CO was 5.2 ± 0.85 L/min. The Bland-Altman analysis for CO revealed a bias of -0.13 L/min and SD of 0.90 L/min with upper and lower limits of agreement of -1.91 and +1.64 L/min. The correlation of CO measurements between DMP-life and TTE was poor (r = 0.501, p < 0.0001). The mean TTE-SV was 71.3 ± 16.2 mL and the mean BPPA-SV was 73.8 ± 19.2 mL. SV measurements correlated very well between the two methods (r = 0.900, p < 0.0001). The Bland-Altman analysis for SV revealed a bias of -2.54 mL and SD of ±8.42 mL and upper and lower limits of agreement of -19.05 and +13.96 mL, respectively.ConclusionOur study shows for the first time that the DMP-life tonometry device measures SV and CO with reasonable accuracy and precision of agreement compared with TTE in preoperative cardiothoracic surgery patients. Tonometry BPPA are relatively quick and simple measuring devices, which facilitate the collection of cardiac and hemodynamic information. Further studies with a larger number of patients and with repeated measurements are in progress to test the reliability and repeatability of DMP-Life system.

Dataset Information

Application of simple ultrasound Doppler hemodynamic parameters in the diagnosis of severe renal artery stenosis in routine clinical practice.

Background

Methods

Results

Conclusions

Publications

Application of simple ultrasound Doppler hemodynamic parameters in the diagnosis of severe renal artery stenosis in routine clinical practice.

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