[Current methods for diagnosing renal artery stenosis].

Abstract

PURPOSE: Today, the methods for detecting renal artery stenosis are numerous. They lead to the identification either of anatomic stenosis or functional stenosis (onset of renin-angiotensin system). The purpose of this review is to emphasize the performances, limitations and diagnostic criteria for each technique. CURRENT KNOWLEDGE AND KEY POINTS: For detection of anatomic stenosis, the feasibility of Doppler examination has been increased by the improvement of US systems and the development of contrast agents. However, the criteria used nowadays still need wider evaluation. Helical CT angiography allows a better detection of accessory arteries and calcifications but MR angiography has a better spatial resolution and uses a non-nephrotoxic contrast agent. The performances of these two techniques have never been compared. The choice between these techniques depends on the operators' experience and the availability of the systems. For functional stenosis, detection is now based on captopril-sensitized scintigraphy. FUTURE PROSPECTS AND PROJECTS: It would be necessary to better compare performances and cost-effectiveness ratios of these methods and of the two imaging strategies (detection of anatomic stenosis versus functional stenoses). Probably in the future, MR will gain a major place, providing, in the same imaging session, morphologic and functional data.