Doppler Ultrasound in the Diagnosis of Renal Artery Stenosis: Re-evaluation of Current Criteria with Single-Center Experience

Abstract

Background[SA1.1][rb1.2]: Hypertension is a leading cause of premature mortality worldwide and remains a treatable condition. Approximately 5% of cases are secondary, with renal artery stenosis (RAS) being a major underlying cause. Doppler ultrasonography is the first-line imaging modality for evaluating suspected RAS. The aim of this study is to determine optimal Doppler ultrasonography threshold values for detecting ≥60% RAS using digital subtraction angiography (DSA) as the reference standard.Materials and Methods: This retrospective study included 51 patients (25 women, 26 men; age range: 25–89 years) who underwent both Doppler ultrasonography and DSA for suspected RAS between September 2011 and May 2015. A total of 101 renal arteries were evaluated. Receiver operating characteristic (ROC) curve analysis was used to determine optimal cutoff values for peak systolic velocity (PSV), end-diastolic velocity (EDV), and reno–aortic ratio (RAR).Results: Using DSA as the reference standard, the optimal cutoff values for detecting ≥60% RAS were determined as >247 cm/s for PSV (sensitivity 96%, specificity 87%), >60 cm/s for EDV (sensitivity 79%, specificity 81%), and >2.88 for RAR (sensitivity 96%, specificity 83%). Area under the curve analysis showed that PSV had the highest diagnostic accuracy, followed by RAR and EDV.Conclusion:The application of Doppler ultrasonography with appropriately defined threshold values in the evaluation of RAS may enhance diagnostic confidence and contribute to the reduction of unnecessary invasive procedures.