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Complementary roles of color-flow duplex imaging and intravascular ultrasound in the diagnosis of renal artery fibromuscular dysplasia

Should renal arteriography serve as the "gold standard"?

Manohar S. Gowda, MD, MPH^*,, Audrey L. Loeb, MS, RDMS, RDCS, RVT^*, Linda J. Crouse, MD, FACC^* and Paul H. Kramer, MD, FACC^*,*

^* University of Missouri–Kansas City, Mid America Heart Institute, Kansas City, Missouri, USA

View larger version (45K): [in a new window]   Figure 1 (A) Classic "chain of beads" angiographic appearance. (B) Transverse view at the level of the origin of the right renal artery. There is laminar flow in the proximal segment 1 cm (blue) beyond which flow is turbulent (multicolored mosaic pattern). (C) Intravascular ultrasound in the middle segment of the right renal artery, demonstrating a membrane (arrow). Ao = aorta.

View larger version (45K): [in a new window]   Figure 2 (A) Right renal artery angiogram with subtle irregularities at the edges of the arterial lumen, producing a slightly scalloped appearance. (B) Transverse view at the level of the origin of the right renal artery showing laminar flow in the proximal segment (red), becoming turbulent in the middle segment, beginning with the first curve on the angiogram. (C) Intravascular ultrasound in the middle segment of the right renal artery, demonstrating a membrane (arrow). Ao = aorta.

View larger version (46K): [in a new window]   Figure 3 (A) Normal left renal arteriogram. (B) Transverse view at the level of the left renal artery with normal flow proximally (blue) and a narrowing and turbulent flow (spiraling mosaic pattern) in the mid-portion. (C) Intravascular ultrasound demonstrating a membrane in the artery (arrow). Ao = aorta.

View larger version (94K): [in a new window]   Figure 4 (A) Intravascular ultrasound (IVUS) of a normal renal artery. (B) IVUS demonstrating discrete, fixed, eccentric ridge.

View larger version (77K): [in a new window]   Figure 5 (A) Preangioplasty with abnormal color-flow duplex imaging (CFDI) and elevated flow velocity (200 cm/s). (B) Postangioplasty with normalization of CFDI and flow velocity (84 cm/s).

View larger version (47K): [in a new window]   Figure 6 Systolic blood pressure (BP) measurements: baseline, postangioplasty, outpatient follow-up.