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Stephanie R Wilson

Publications and source records attributed to Stephanie R Wilson.

At least 19 recordsLinked to original sources
PubMed2006

Focal liver masses: enhancement patterns on contrast-enhanced images--concordance of US scans with CT scans and MR images.

PURPOSE: To assess prospectively the concordance of enhancement patterns of focal liver masses on contrast material-enhanced ultrasonographic (US) scans with patterns on contrast-enhanced computed tomographic (CT) scans or magnetic resonance (MR) images. MATERIALS AND METHODS: This study was approved by the institutional review board; patients gave informed consent. Contrast-enhanced US and contrast-enhanced CT or MR imaging were performed in 135 patients (62 men, 73 women; mean age, 51 years) with 144 confirmed liver masses. Masses included 49 hepatocellular carcinomas, 13 metastases, 30 hemangiomas, 41 lesions of focal nodular hyperplasia, and 11 others. Randomized image sets from each modality were shown independently to three blinded readers, who answered identical questions about enhancement of the lesion and liver in the arterial and portal venous phases and changes with time. Concordance for modalities was calculated from answers of readers and consensus answers between readers, with 95% confidence intervals (CIs). The kappa values were calculated for interreader agreement. RESULTS: Features of arterial phase enhancement showed concordance of more than 76% for modalities. The highest concordance of 92% (132 of 144), with 95% CI of 86% and 95% (kappa>0.84), was for the presence of peripheral pools and centripetal progression. Concordance in the portal venous phase was lower, with agreement for predominant enhancement of the lesion in 61% (86 of 142), with 95% CI of 52% and 68% (kappa>0.83). Portal venous phase washout occurred in 75% (106 of 142), with 95% CI of 67% and 81% (kappa>0.81). The majority of discordances were for malignancies for which only US depicted no sustained enhancement in the portal venous phase. CONCLUSION: US shows high concordance with CT or MR imaging, especially for the arterial phase. Discordance in the portal venous phase may reflect the tendency of CT and MR contrast agents, unlike microbubbles, to diffuse into interstitium.

Adult↗
PubMed2006

Transvaginal sonography as an adjunct to endorectal sonography in the staging of rectal cancer in women.

OBJECTIVE: The purpose of this study was to evaluate the contribution of transvaginal sonography (TVS) in the staging of rectal cancer in women. MATERIALS AND METHODS: Sixty women with rectal tumors underwent TVS. Forty-five of the 60 women also underwent endorectal sonography. Forty-nine of the women had rectal carcinoma; nine, tubulovillous adenoma; and two, gastrointestinal stromal tumor confirmed at surgical pathologic examination (n = 41) and biopsy before chemoradiation therapy (n = 19). Four of the 49 rectal carcinomas were T1; seven, T2; 35, T3; and three, T4. Images from TVS and endorectal sonography were shown independently to two blinded reviewers, who staged the tumors and assessed examination adequacy for tumor presence, size, and depth and nodal status. Staging results with TVS were compared with those obtained with endorectal sonography and histopathologic examination. RESULTS: All tumors were seen with TVS. In 30 of the 49 rectal carcinomas confirmed at surgical pathologic examination TVS tumor staging was accurate in 25 (83.3%) of the cases. Two (6.7%) of the 30 tumors were understaged, and 3 (10%) were overstaged. All tumors selected for chemoradiation (n = 19) were correctly staged T3. Endorectal sonography was suboptimal for tumors that were stenotic (n = 3), large (n = 2), high at the rectosigmoid junction (n = 4), or low at the anal canal (n = 3). In these 12 cases, TVS successfully depicted the lesion, and the images gave enough information for prediction of stage. In interpretation of the images of 45 patients who underwent both TVS and endorectal sonography, the blinded reviewers had good agreement and comparable accuracy for staging in adequate examinations with each technique. Four of the nine villous adenomas were overstaged as T1 on TVS. Gastrointestinal stromal tumors manifested as intramural vascular masses. CONCLUSION: TVS is an excellent adjunct to endorectal sonography in the staging of rectal cancer in women. It helps resolve the findings after endorectal sonography has been unsuccessful because the tumors are stenotic or in a high or low position.

Adenoma, Villous↗
PubMed2006

An algorithm for the diagnosis of focal liver masses using microbubble contrast-enhanced pulse-inversion sonography.

OBJECTIVE: The objective of this study was to develop an algorithm for liver mass diagnosis using microbubble contrast-enhanced pulse-inversion sonography. SUBJECTS AND METHODS: Ninety-six lesions in 92 patients were evaluated with DMP 115 (Definity)-enhanced pulse-inversion sonography, comprising 44 malignancies (29 hepatocellular carcinomas, 12 metastases, two peripheral cholangiocarcinomas, and one hepatic lymphoma) and 52 benign lesions (26 hemangiomas, 20 focal nodular hyperplasias, and six others). All had continuous low-mechanical-index imaging through the arterial and portal venous phase. A three-person blind review evaluated single images at baseline, early and peak arterial phases, and through the extended portal phases with a movie showing arterial phase wash-in. Reviewers assessed lesional vascularity and enhancement blindly but did not make a diagnosis. Combinations of answers were compared with independently determined final diagnoses to develop an algorithm for liver mass diagnosis. RESULTS: Portal phase enhancement comprises the first step of the algorithm, with positive or sustained enhancement identifying 48 (92%) of 52 benign lesions and negative enhancement or washout present in 41 (93%) of 44 malignancies. Sustained portal phase enhancement with arterial phase peripheral nodularity and centripetal progression predicted 24 (92%) of 26 of the hemangiomas; diffuse arterial phase enhancement greater than the liver identified 19 (95%) of 20 of the focal nodular hyperplasias. With negative portal phase enhancement, arterial phase information was less effective at differentiating hepatocellular carcinoma (25 [86%] of 29 cases) from another hepatic malignancy (11 [73%] of 15 cases). CONCLUSION: A simple diagnostic algorithm for interpretation of microbubble-enhanced sonography provides sensitive and accurate diagnosis of commonly encountered liver masses.

Adolescent↗
PubMed2006

Microbubble contrast for radiological imaging: 1. Principles.

Microbubble contrast for ultrasound imaging in radiology has finally come of age, adding entirely new capabilities to real time imaging. Following a bolus injection into a peripheral vein of as little as 0.1mL of an aqueous suspension, contrast specific imaging modes show parenchymal and lesional perfusion in real time in the major organs of the abdomen and pelvis as well as breast, thyroid and prostate. These new imaging modes exploit the unique interaction between ultrasound and microbubbles, which gives rise to nonlinear echoes that are readily distinguishable from those of tissue. Furthermore, microbubbles can be deliberately disrupted by the ultrasound imaging field. The rate at which fresh bubbles then replenish the scanplane can be metered in subsequent images, offering a means to quantify both flowrate and relative vascular volume of the microvasculature in both organs and solid lesions.

Contrast Media↗
PubMed2006

Microbubble contrast for radiological imaging: 2. Applications.

Conventional Doppler provides information on blood flow including both flow and direction and flow velocity. Information on the slowly flowing blood at the capillary level, however, has not previously been available on state of the art Doppler. Contrast enhanced ultrasound provides, for the first time, information on tissue perfusion such that CEUS may now play a role in liver mass characterization and the evaluation of masses in other solid viscera similar to the role of contrast enhanced CT and MR scan. Renal applications include similar mass characterization and evaluation of renal perfusion and the renal vasculature. Surveillance of aortic stent grafts, monitoring RFA, and evaluation of both prostate and breast masses are further areas of interest. Our experience with ultrasound contrast expands progressively, and essentially adds vascular information to any region when blood flow information is required. The addition of CEUS to clinical practice has significant impact on patient management. In patients with an incidental liver mass on sonography, for example, characterization at the time of tis detection reduces the time to diagnosis and decreases referrals to CT or MR scan. Ultrasound contrast agents are easy to use, have a very low incidence of adverse events, and are unaffected by renal function. As they add no radiation for their use, they are highly appropriate in pediatric and young adult patients. Ultrasound is enhanced by addition of contrast agents.

Contrast Media↗
PubMed2006

Imaging of malignant liver masses: characterization and detection.

Noninvasive characterization of focal liver lesions is largely based on their enhancement patterns on contrast-enhanced imaging. The use of microbubble contrast agents combined with specialized ultrasound (US) techniques has significantly expanded the role of US in the diagnosis of focal liver lesions based on their vascularity and specific enhancement features. With the advantage of real-time scanning, contrast-enhanced ultrasound (CEUS) can evaluate small lesions that are indeterminate on computed tomography (CT) or magnetic resonance imaging (MR), because CEUS is far less affected by timing issues. Hepatocellular carcinoma is typically characterized by increased arterial flow with frequent dysmorphic tumor vessels and decreased portal venous flow. However, negative enhancement in the portal phase is often not obvious until late (>2 minutes). On the other hand, metastasis shows prompt brief arterial hypervascularity, with either a rim or diffuse pattern and rapid washout, seen as perfusion defects during the portal venous phase. This pattern of complete rapid washout of metastases within the homogeneously enhanced background liver parenchyma can improve their detection and also improve differentiation from hepatocellular carcinoma or benign focal lesions. All malignant lesions generally show negative enhancement or washout during the extended portal venous phase, and this pattern is useful to differentiate them from benign lesions. Microbubble agents, confined to the intravascular space, may infrequently characterize malignancy by showing washout whereas CT or MR shows persistent enhancement due to interstitial distribution.

Carcinoma, Hepatocellular↗
PubMed2006

Benign liver masses: imaging with microbubble contrast agents.

Benign focal liver lesions are frequently encountered in routine ultrasound (US) scanning as well as in staging US examination for the patients with known malignancy. Noninvasive characterization of benign liver masses by imaging features has been a challenge for the radiologist. Some benign liver masses show typical findings on US; however, these findings are not highly specific. Contrast-enhanced ultrasound (CEUS) is useful to make an instant, confident diagnosis of benign liver masses. Contrast-enhanced multiphasic computed tomography (CT) is an excellent imaging technique to detect and characterize focal liver masses. But there are a considerable number of indeterminate focal liver lesions, which require further evaluation. CEUS provides the evaluation of perfusion and hemodynamics of nodular liver lesions as well as real-time morphologic evaluation of lesion vascularity. Most benign liver masses show characteristic features on CEUS, allowing an accurate diagnosis. This review article describes typical enhancement features of common benign liver masses.

Adenoma↗
PubMed2005

Imaging diagnosis of hepatocellular carcinoma with differentiation from other pathology.

Recent advances in liver imaging techniques and better understanding of imaging findings have facilitated the detection and characterization of hepatocellular nodules in a cirrhotic liver. It is important to recognize that various types of benign nodules and pseudolesions are identified on all imaging scans performed for the diagnosis of hepatocellular carcinoma. An accurate differentiation between them is critical for adequate management of cirrhotic patients. Unfortunately, any of the imaging tests and even percutaneous biopsy are not diagnostic for borderline lesions. Intimate collaboration of hepatologists, pathologists, surgeons, and radiologists with reasonable imaging and clinical criteria estimating the degree of malignancy is imperative.

Biopsy, Needle↗
PubMed2004

Clinical and radiological responses after infliximab treatment for perianal fistulizing Crohn's disease.

OBJECTIVES: Infliximab is an effective therapy for fistulizing Crohn's disease of the perineum. We sought to determine whether the clinical improvement after infliximab is associated with radiological closure of fistula tracts. METHODS: Clinical responses and radiological imaging studies by transperineal ultrasound were evaluated in 35 patients with Crohn's disease perianal fistulas after treatment with infliximab 5 mg/kg up to 48 wk. Paired comparison of baseline and follow-up imaging studies at 8 wk and at 56 wk or discontinuation were assessed by an imaging score of perianal fistula severity, based on the Parks criteria. Complete clinical fistula closure and radiological healing were primary outcome measures. RESULTS: At 8 wk, after two infusions of infliximab at 0 and 2 wk, clinical fistula closure occurred in 49% of patients. The radiological score at 8 wk was higher for patients with clinical fistula closure than for patients with no clinical improvement (p= 0.023) and two patients showed complete radiological healing. At 56 wk, clinical fistula closure occurred in 46% patients. Clinical fistula scores correlated with radiological scores (R2= 0.52; p < 0.001) but were not associated with fistula complexity, number of fistulas, or number of collections at baseline imaging. The proportion of patients with marked radiological improvement increased from 14% at 8 wk to 43% at 56 wks (p= 0.015) and complete radiological healing occurred in 4 (11%) patients. CONCLUSIONS: For perianal fistulizing Crohn's disease, repeat dose infliximab improves clinical and radiological outcomes, although complete radiological healing occurs in a minority of patients.

Adult↗
PubMed2004

Sonographic diagnosis of primary malignant tumors of the fallopian tube.

The purpose of this study is to illustrate the sonographic features of primary malignant tumors of the fallopian tube and to heighten awareness of their existence. This is a retrospective review of the imaging and clinical files of 7 patients with a primary malignant tumor of the fallopian tube found in the medical records of 4500 patients with primary gynecologic malignancies seen during the last 6 years at the authors' institution. All patients had transvaginal sonography before surgery. Images were reviewed to determine common features of this rarely encountered pathology. Transvaginal sonography showed normal ovaries in 5 patients in association with a discrete solid adnexal mass in 4. The fallopian tube origin of the mass was shown directly in 2 of these 4 patients and was inferred in the other 2 on the basis of a mass in the expected location of the fallopian tube. In the 3 patients without a discrete adnexal mass, there were more extensive changes, including large, solid adnexal masses of unknown origin (n = 2) and gross peritoneal carcinomatosis (n = 1). Fallopian tube malignancies should be considered when unexplained solid masses corresponding with the expected location of the fallopian tubes are seen in association with normal ovaries. Disease dissemination may show carcinomatosis or more extensive pelvic disease.

Diagnosis, Differential↗
PubMed2004

Spectrum of imaging findings in abdominal extraosseous myeloma.

OBJECTIVE: Extraosseous multiple myeloma is rare (< 5%) and has not been systematically documented in the abdomen. Our aim is to catalogue and describe the manifestations of multiple myeloma affecting abdominal organs. CONCLUSION: Extraosseous myeloma may involve multiple abdominal organs and may mimic other malignancies. Clinicians and radiologists should be aware of the potential for myeloma to involve extraosseous sites to avoid unnecessary interventions when this occurs.

Abdominal Neoplasms↗
PubMed2003

Low-malignant-potential tumor of the ovary: sonographic features with clinicopathologic correlation in 41 patients.

The biologic, behavioral, and pathologic features of low-malignant-potential (LMP) tumor of the ovary are distinct from their invasive counterpart. LMP tumors affect patients at a younger age and have a much better 5- and 20-year survival rate compared with invasive ovarian malignancy. The authors retrospectively reviewed the records and sonograms of 41 patients (51 masses) with LMP tumor of the ovary. They demonstrated a wide variety of morphologies on the presentation sonograms with six masses favored to be benign, four indeterminate, 18 likely malignant, and 23 clearly malignant. Eighteen of 51 masses (35.3%) had a unique appearance-a cyst within the ovary of small to medium size with vascular mural nodularity and preserved surrounding ovarian parenchyma. Low-level echoes within the cystic components of the mass, reminiscent of typical endometrioma, were present in 19 of 51 masses (37.2%). Peritoneal dissemination was present in six patients at presentation, all! whom were alive at follow-up between 45 and 120 months. The authors think that many LMP tumors may be recognized and treated while they are still small. Ovary-sparing surgery may preserve patient fertility. LMP tumors may present initially with a benign morphology, although temporal evolution tends to show more suspicious features. Because these tumors may also appear frankly malignant or show peritoneal dissemination, the possibility of LMP tumor must be considered in light of their much better prognosis compared with invasive ovarian malignancy.

Adult↗
PubMed2003

Hilar biliary obstruction: preliminary results with Levovist-enhanced sonography.

OBJECTIVE: The aim of this study was to investigate the value of using Levovist in the postvascular phase of sonography performed to assess hepatic hilar biliary obstruction. SUBJECTS AND METHODS: In our prospective study, 50 patients underwent routine sonography followed by postvascular Levovist-enhanced pulse inversion imaging of the liver. Thirty-six patients had malignant disease (28 invasive parenchymal tumors and eight intraductal tumors), and 14 had benign disease. The 36 malignancies included 29 cholangiocarcinomas, six invasive gallbladder carcinomas, and one colon metastasis. Fourteen patients had benign disease: benign strictures (n = 5), primary sclerosing cholangitis (n = 5), chronic Mirizzi's syndrome (n = 1), varicosities of the parabiliary venous plexus (n = 1), and inflammatory liver lesions (n = 2). Sonographic findings in all 50 patients were correlated with findings from other imaging modalities (n = 50) as well as surgical specimens (n = 20), core biopsies (n = 3), and both clinical and imaging follow-ups (n = 24). RESULTS: Seventeen (61%) of the 28 invasive intraparenchymal malignancies were visualized on routine sonograms, whereas all 28 (100%) were visualized on enhanced sonograms (p < 0.01). In 15 (88%) of 17 patients in whom tumor was seen on routine sonograms, contrast-enhanced sonography showed further mass extent, increased conspicuity, or satellite nodules not visualized on the baseline image. All eight noninvasive intraductal malignancies were correctly identified and staged on the routine sonography. In one of these patients, hepatic invasion was prospectively overcalled on the enhanced image. Of the 14 benign lesions, three had inflammatory periductal abnormalities seen exclusively or to advantage on the enhanced study. Correct prediction of resectability in the 16 patients with malignant disease who underwent surgery improved from 11 (69%) of 16 on unenhanced sonography to 15 (94%) of 16 on enhanced sonography (p = 0.13). CONCLUSION: Detection and staging of malignant hilar obstructions are improved by the use of Levovist in the postvascular phase of sonography compared with routine sonography.

Adult↗
PubMed2002

Focal hepatic masses: enhancement patterns with SH U 508A and pulse-inversion US.

PURPOSE: To evaluate the role of SH U 508A-enhanced ultrasonography (US) in the differentiation of focal hepatic masses. MATERIALS AND METHODS: Contrast material-enhanced pulse inversion US was performed on 58 unknown hepatic lesions: 23 hepatocellular carcinomas, 10 focal nodular hyperplasias, 16 hemangiomas, and nine metastases. Selected images were sequentially reviewed by readers blinded to the final diagnosis. On a baseline image, they determined lesion echogenicity, and on a vascular image, the presence or absence of distinct vascularity. On an arterial phase interval-delay flash image and a postvascular image, they assessed enhancement of the lesion and liver. Responses were compared with confirmed diagnoses. RESULTS: Focal nodular hyperplasia was characterized by detectable vascularity and positive enhancement on interval-delay and postvascular scans (sensitivity, 83% [eight of 10 lesions]; specificity, 98% [40 of 41 lesions]). Hepatocellular carcinoma also showed detectable vascularity and positive enhancement on interval-delay images but no postvascular enhancement (sensitivity, 68% [14 of 20 lesions]; specificity, 74% [23 of 31 lesions]). Vascular imaging with SH U 508A did not contribute to the diagnosis of metastasis or hemangioma. However, no or weak enhancement during the arterial phase flash without postvascular enhancement produced a sensitivity of 83% (seven of eight lesions) and sensitivity of 77% (33 of 43 lesions) for metastasis. Peripheral nodular enhancement on arterial phase flash images was highly specific (98% [37 of 38 lesions]) but not sensitive (44% [six of 13 lesions]) for hemangioma. CONCLUSION: SH U 508A-enhanced pulse-inversion interval-delay flash and postvascular phase imaging are helpful in differential diagnosis of focal hepatic lesions.

Adult↗
PubMed2002

Echogenic ovarian foci without shadowing: are they caused by psammomatous calcifications?

PURPOSE: To determine and report the spectrum of ultrasonographic appearances of echogenic ovarian foci (EOF) without shadowing in otherwise normal ovaries and the histopathologic and physical characteristics of these foci. MATERIALS AND METHODS: The appearances of foci on transvaginal pelvic sonograms obtained in 189 patients with EOF were prospectively analyzed. The foci were classified according to bilaterality, size, number (<5, 5-10, or >10), and location (peripheral, central, or diffuse). At histopathologic analysis, resected normal ovaries, seven with and 10 without echogenic foci, in a water bath were scanned. The foci were then localized for histopathologic correlation. To assess the physical properties of the foci, tissue-mimicking water- and glycerol-based phantoms, with voids of different diameters, in a water bath were scanned with 8- and 70-MHz transducers. RESULTS: At appearance analysis, EOF (mean diameter, 1.8 mm +/- 0.6 [SD]) were detected unilaterally in 103 (54.5%) of 189 patients. EOF were distributed peripherally in 183 (66.5%), centrally in 15 (5.5%), and diffusely in 77 (28.0%) of 275 ovaries. There were fewer than five foci in 123 (44.7%), five to 10 foci in 91 (33.1%), and more than 10 foci in 61 (22.2%) of 275 ovaries. At histopathologic analysis of the seven ovaries with EOF, the foci had tiny cysts with no evidence of calcifications. A single cyst cluster was identified in two of 10 ovaries that did not have echogenic foci. At physical property analysis, single echogenic foci were associated with specular reflection from the walls of unresolved cysts that were comparable in size to the ultrasound wavelength (about 0.50 mm). CONCLUSION: EOF without shadowing are caused by a specular reflection from the walls of tiny unresolved benign cysts rather than by psammomatous calcifications.

Adult↗
PubMed2002

Impact of Levovist ultrasonographic contrast agent on the diagnosis and management of hypertensive patients with suspected renal artery stenosis: a Canadian multicentre pilot study.

OBJECTIVES: To compare the diagnoses obtained with unenhanced ultrasonography (US), contrast-enhanced US and captopril-enhanced renal scintigraphy and to determine whether use of a contrast agent improves ability to assess the renal arteries with duplex Doppler US. SUBJECTS AND METHODS: The study was an open-label controlled trial involving 78 patients with hypertension suspected to have a renovascular cause. The patients underwent captopril-enhanced scintigraphy or routine unenhanced US (the usual diagnostic methods at the centres where the study was conducted) and contrast-enhanced US (with Levovist, Berlex Canada, Lachine, Que.). The patients were followed for 3 months after the diagnostic tests were performed. RESULTS: Enhanced US yielded a diagnosis for a significantly greater proportion of patients than did unenhanced US (77 [99%] v. 64 [82%] of 78 patients; p = 0.002) or captopril-enhanced scintigraphy (71 [99%] v. 58 [81%] of 72 patients; p = 0.002). Diagnosis was possible with both enhanced and unenhanced duplex Doppler US in only 64 (82%) of the 78 patients, and the diagnosis was the same with both methods for 63 (98%) of these 64 patients. In contrast, diagnosis was possible for only 58 (81%) of the 72 patients who underwent both enhanced US and captopril-enhanced scintigraphy; the same diagnosis was reported in 53 (91%) of these 58 cases. During follow-up, 11 patients (21 kidneys) underwent angiography. Significant stenosis was detected in 6 (55%) of the patients (8 [38%] of the kidneys). Both the enhanced and unenhanced US results agreed more often with angiography than did captopril-enhanced scintigraphy (9 [82%] v. 8 [73%] of the 11 patients). The proportion of patients in whom the left and right renal artery could be assessed by duplex Doppler US increased significantly (by 58% and 43%, respectively) with use of the contrast agent. CONCLUSION: Enhanced US had a higher rate of successful diagnosis than unenhanced US and captopril-enhanced renal scintigraphy. Enhanced US might therefore be suitable as a screening method for hypertensive patients with suspected renal artery stenosis.

Adult↗
PubMed2002

Economic impact of an ultrasonographic contrast agent on the diagnosis and initial management of patients with suspected renal artery stenosis.

OBJECTIVES: To determine resource use in the diagnosis and management of Canadian hypertensive patients with suspected renal artery stenosis and to estimate the impact of diagnosis with contrast-enhanced duplex Doppler ultrasonography (US) on resource use. SUBJECTS AND METHODS: Seventy-eight patients with suspected renal artery stenosis underwent usual diagnostic tests (captopril-enhanced renal scintigraphy or duplex Doppler US) and contrast-enhanced US. A management pathway ("planned") describing the medical resources required for further patient care was outlined on the basis of results from each test (separately), and a modified management pathway ("recommended"), which considered data from both diagnostic methods, was also outlined. Medical resources and productivity losses were assessed prospectively for a 3-month period after patients underwent both tests ("actual" management pathway). RESULTS: With usual diagnostic methods, 14 (18%) of the tests were inconclusive, whereas only 1 (1%) of the enhanced US examinations was inconclusive; the cost-efficacy ratio was $422 and $343 per successful diagnosis, respectively. Further management costs for patients with an inconclusive diagnosis were estimated at $6370 after the usual diagnostic tests, but only $1278 with enhanced US. Although the costs of the planned and recommended management pathways were similar ($227 and $294 per patient respectively), the proportion of patients requiring further resources was lower with enhanced US (56% v. 46%). Three-month actual management costs ranged from $121 to $1605 per patient (mean $360). Diagnostic tests and surgical procedures were the major cost drivers in all pathways, and costs were highest for patients in whom stenosis was diagnosed. CONCLUSIONS: For patients with suspected renal artery stenosis, contrast-enhanced US had a higher diagnostic success rate than usual diagnostic methods and afforded savings through lower administrative costs and lower medical resource consumption for patients whose diagnosis was unclear after usual diagnostic tests.

Adult↗