The Korean Journal of Nuclear Medicine (대한핵의학회지)

The Korean Society of Nuclear Medicine (대한핵의학회)
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Diagnostic Criteria of $^{99m}Tc$-diethylenetriaminepentaacetic acid Captopril Renal Scan for the Diagnosis of Renovascular Hypertension by Unilateral Renal Artery Stenosis

$^{99m}Tc$-diethylenetriaminepentaacetic acid 캅토프릴 신장스캔의 단측 신동맥 협착에 의한 신혈관성고혈압 진단 기준

  • Choi, Seung-Jin (Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Hong, Il-Ki (Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Chang, Jae-Won (Department of Internal Medicines, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Park, Su-Kil (Department of Internal Medicines, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Moon, Dae-Hyuk (Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine)
  • 최승진 (울산대학교 의과대학 서울아산병원 핵의학과) ;
  • 홍일기 (울산대학교 의과대학 서울아산병원 핵의학과) ;
  • 장재원 (울산대학교 의과대학 서울아산병원 신장내과) ;
  • 박수길 (울산대학교 의과대학 서울아산병원 신장내과) ;
  • 문대혁 (울산대학교 의과대학 서울아산병원 핵의학과)
  • Published : 2004.12.31
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Abstract

Purpose: We compared captopril renal scintigraphic criteria for the diagnosis of renovascular hypertension by unilateral renal artery stenosis. Materials and Methods: The study group consisted of 24 patients (m/f : 16/8, age: $39{\pm}18$ years) with unilateral renal artery stenosis who underwent renal artery revascularization and captopril renal scintigraphy with $^{99m}Tc$-diethylenetriaminepentaacetic acid between May 1995 and April 2004. The blood pressure response was classified as cure/improvement or failure. We evaluated captopril-induced changes in relative function (BCfun) and renogram grade (0 to 5: 0=normal, and 5=renal failure pattern without measurable uptake) (CBren) and the difference of renograms between the normal and stenotic kidney on captopril scan (CNren). Results: light of 24 patients were cured and 11 improved and 5 patients were classified as failed revascularization. Significant predictors of a cure or improvement of blood pressure were younger age, stenosis by fibromuscular dysplasia or arteritis, BCfun, CBren and CNren. Areas under the receiver operating characteristic curve of age, BCfun, CBren and CNren were not significantly different. Positive and negative predictive values of predictors were 100% and 42% (age ${\leq}38$): 92% and 50% (BCfun ${\geq}1%$): 92% and 75% (CBren ${\geq}1$), and 90% and 60% (CNren ${\geq}1$), respectively. Conclusion: Captopril induced changes in renal function and renogram can reliably predict hypertension response to revascularization. Renogram pattern on captopril scan can diagnose renovascular hypertension without baseline data in patients with unilateral renal artery stenosis.

목적: 신혈관성고혈압의 진단에서 캅토프릴 투여후 $^{99m}Tc$-DTPA 신기능곡선 및 신기능의 기준 별로 비교된 바 없다. 이 연구는 단측 신동맥협착에 의한 신혈관성고혈압에서 캅토프릴 스캔의 진단 기준별 성적을 비교함이었다. 대상 및 방법: 1995년 5월에서 2004년 5월까지 신혈관성고혈압이 의심되어 캡토프릴신장스캔과 신혈관조영술을 시행한 64명 중 신혈관협착 있어서(n=51), 혈관재성형술을 받은 37명 중 양측성 신혈관협착 13명을 제외한 24명을 대상으로 하였다. 동맥경화가 14예, 섬유근성이형성증이 4명, 기타 혈관염이 6명이었다. 캅토프릴 및 기저 스캔은 The Society of Nuclear Medicine의 표준화된 지침에 의하여, 신기능곡선(5등급) 및 상대적 신기능, 협착이 있는 신장의 캅토프릴과 기저 스캔의 신기능곡선의 등급차이(CBren), 신기능의 차이(BCfun) 및 캅토프릴스캔시 반대측 신기능곡선과의 등급 간의 차이(CNren) 를 구하였다. 결과: 24명(남/여=16/8, 나이 $39.2{\pm}18.4$세)중 8명이 완치, 11명이 호전되어 신혈관성고혈압으로 진단되었고, 5명이 혈압의 변화가 없었다. 신혈관성고혈압과 본태성고혈압군 간에 나이(median 30 vs. 52; p<0.05), 원인(동맥 경화/기타: 9/10 vs. 5/0, p<0.05), CBren (median 2.5 vs. 0; p<0.005), BCfun (median 4 vs -0.5; p<0.05), CNren (median 2 vs. 0; p<0.05)의 유의한 차이가 있었다. 성별, creatinine과 기저 및 캅토프릴시 신기능은 차이가 없었다. 수신자판단특성곡선하의 면적은 나이 0.826, CBren 0.929, BCfun 0.804, CNren 0.784로 곡선하의 면적은 유의한 차이가 없었다. 양성 및 음성예측도는 나이 38세 이하의 기준으로 100%(12/12), 42%(5/l2), BCfun 1% 이상 92%(11/12), 50%(3/6), CBren 1이상 92%(13/14), 75%(3/4), CNren 1이상 90% (17/19), 60% (3/5)였다. 유용한 진단기준으로 알려진 BCfun 5% 이상은 100%(4/4), 29%(4/14)였다. 결론: 캅토프릴스캔에서 신기능곡선과 신기능 모두 유용한 신혈관성고혈압의 기준이 되며, 신기능곡선은 기저스캔과의 비교없이도 정상 신장의 신기능곡선을 비교하여 신혈관성고혈압을 진단할 수 있다.

Keywords

References

  1. Safian RD, Textor SC. Renal artery stenosis. N Engl J Med 2001; 344:431-42 https://doi.org/10.1056/NEJM200102083440607
  2. Bouyounes BT, Libertino JA. Renovascular hypertension. Curr Opin Urol 1999;9:111-14 https://doi.org/10.1097/00042307-199903000-00004
  3. Setaro JF, Chen CC, Hoffer PB, Black HR. Captopril renography in the diagnosis of renal artery stenosis and the prediction of improvement with revascularization: the Yale vascualr center experience. Am J Hypertens 1991;4:698s-705s https://doi.org/10.1093/ajh/4.12.698S
  4. Geyskes GG, de Bruyn AJG. Captorpil renography and the effect of percutaneous transluminal angioplasty on blood pressure in 94 patients with renal artery stenosis. Am J Hypertens 1991;4:685s-89s https://doi.org/10.1093/ajh/4.12.685S
  5. Soulez G, Therasse E, Qanadli SD, Froment D, Leveille M, Nicolet V, et al. Prediction of clinical response after renal angioplasty: respective value of renal doppler sonography and scintigraphy. AJR 2003;181:1029-35 https://doi.org/10.2214/ajr.181.4.1811029
  6. Giroux MF, Soulez G, Therasse E, Nicolet V, Froment D, Courteau M, et al. Percuteneous revascularization of the renal arteries: predictors of outcome. JVIR 2000;11:713-720 https://doi.org/10.1016/S1051-0443(07)61629-7
  7. Helin KH, Lepntalo M, Edgren J, Liewendahl K, Tikkanen T, Tikkanen I. Predicting the outcome of invasive treatment of renal artery disease. J Intern Med 2000;247:105-10 https://doi.org/10.1046/j.1365-2796.2000.00584.x
  8. Meier GH, Sumpio B, Black HR, Gusberg RJ. Captopril renal scintigraphy-an advance in the detection and treatment of renovascular hypertension. J Vasc Surg 1990;11:770-77 https://doi.org/10.1067/mva.1990.20329
  9. Dondi M, Fanti S, De Fabritiis A, Zuccala A, Gaggi R, Mirelli M, et al. Prognostic value of captopril renal scintigraphy in renovascular hypertension. J Nucl Med 1992;33:2040-44
  10. Jensen G, Moonen M, Aurell M, Granerus G, Volkmann R. Reliability of ACE inhibitor-enhanced $^{99m}$Tc-DTPA gamma camera renography in the detection of renovascular hypertension. Nucl Med Commun 1993;14:169-75 https://doi.org/10.1097/00006231-199303000-00004
  11. Roccatello D, Picciotto G, Rabbia C, Pozzato M, De Filippi PG, Piccoli G. Prospective study on captopril renography in hypertensive patients. Am J Nephrol 1992;12:406-11 https://doi.org/10.1159/000168490
  12. Sfakianakis GN, Bourgoignie JJ, Jaffe D, Kyriakides G, Stable EP, Duncan RC. Single-dose captopril scintigraphy in the diagnosis of renovascular hypertension. J Nucl Med 1987;28:1383-92
  13. Muller FB, Sealey JE, Case DB, Atlas SA, Pickering TG, Pecker MS, et al. The captopril test for identifying renovascular disease in hypertensive patients. Am J Med 1986;80:633-44 https://doi.org/10.1016/0002-9343(86)90819-3
  14. Clorius JH, Allenberg J, Hupp T, Strauss LG, Schmidlin P, Irngartinger G, et al. Predictive value of exercise renography for presurgical evaluation of nephrogenic hypertension. Hypertension 1987;10:280-86 https://doi.org/10.1161/01.HYP.10.3.280
  15. Geyskes GG, Puylaert CBAJ, Oei HY, Mees EJD. Follow up study of 70 patients with renal artery stenosis treated by percutaneous transluminal dilatation. BMJ 1983;287:333-36 https://doi.org/10.1136/bmj.287.6388.333
  16. Liard JF, Cowley AW, McCaa RE, McCCa CS, Guyton AC. Renin, aldosterone, body fluid volumes,and the baroreceptor reflex in the development and reversal of goldblatt hypertension in conscious dogs. Circ Res 1974;34:549-60 https://doi.org/10.1161/01.RES.34.4.549
  17. Bianchi G, Tenconi LT, Lucca R. Effect in the conscious dog of constriction of the renal artery to a sole remaining kidney on hemodynamics, sodium balance, body fluid volumes,plasma renin concentration and pressor responsiveness to angiotensin. Clin Sci 1970;38:741-66 https://doi.org/10.1042/cs0380741
  18. Fommei E, Ghione S, Hilson AJW, Mezzasalma L, Oei HY, Piepsz A, et al. Captopril radionuclide test in renovascular hypertension: a european multicentre study. European Multicentre Study Group. Eur J Nucl Med 1993;20:617-23
  19. Nally JV Jr., Chen C, Fine E, Fommei E, Ghione S, Geyskes GG, et al. Diagnostic criteria of renovascular hypertension with captopril renography: a consensus statement. Am J Hypertens 1991;4: 749S-52S https://doi.org/10.1093/ajh/4.12.749S
  20. Prigent A. The diagnosis of renovascular hypertension: the role of captopril renal scintigraphy and related issues. Eur J Nucl Med 1993;20:625-44
  21. Taylor A, Nally J, Aurell M, Blaufox D, Dondi M, Dubovsky E, et al. Consensus report on ACE inhibitor renography for detecting renovascular hypertension. J Nucl Med 1996;37:1876-82
  22. Mann SJ, Pickering TG, Sos TA, Uzzo RG, Sarkar S, Friend K, et al. Captopril renography in the diagnosis of renal artery stenosis: accuracy and limitations. Am J Med 1991;90:30-40 https://doi.org/10.1016/0002-9343(91)90503-P
  23. Qanadli SD, Soulez G, Therasse E, Nicolet V, Turpin S, Froment D, et al. Detection of renal artery stenosis: prospective comparison of captopril-enhanced doppler sonography, captopril-enhanced scintigraphy, and MR angiography. AJR 2001;177:1123-29 https://doi.org/10.2214/ajr.177.5.1771123
  24. Vasbinder GBC, Nelemans PJ, Kessels AGH, Kroon AA, De Leeuw PW,van Engelshoven JMA. Diagnostic tests for renal artery stenosis in patients suspected of having renovascular hypertension: a meta-analysis. Ann Intern Med 2001;135:401-11 https://doi.org/10.7326/0003-4819-135-6-200109180-00009
  25. Soulez G, Oliva VL, Turpin S, Lambert R, Nicolet V, Therasse E. Imaging of renovascular hypertension: respective values of renal scintigraphy, renal doppler US, and MR angiography. Radiographics 2000;20:1355-68 https://doi.org/10.1148/radiographics.20.5.g00se131355
  26. Maxwell MH, Bleifer KH, Franklin SS, Varady PD. Cooperative study of renovascular hypertension. demographic analysis of the study. JAMA 1972;220:1195-204
  27. Taylor AT Jr., Fletcher JW, Nally JV Jr., Blaufox D, Dubovsky EV, Fine EJ, et al. Procedure guideline for diagnosis of renovascular hypertension. J Nucl Med 1998;39:1297-302
  28. Mittal BR, Kumar P, Arora P, Kher V, Singhal MK, Maini A, et al. Role of captopril renography in the diagnosis of renovascular hypertension. Am J Kidney Dis 1996;28:209-13 https://doi.org/10.1016/S0272-6386(96)90303-0
  29. Itoh K, Tsukamoto E, Nagao K, Nakada K, Kanegae K, Furudate M. Captopril renoscintigraphy with Tc-99m DTPA in patients with suspected renovascular hypertension. prospective and retrospective evaluation. Clin Nucl Med 1993;18:463-71
  30. Sos TA, Pickering TG, Sniderman K, Saddekni S, Case DB, Silane MF, et al. Percutaneous transluminal renal angioplasty in renovascular hypertension due to atheroma or fibromuscular dysplasia. N Engl J Med 1983;309:274-79 https://doi.org/10.1056/NEJM198308043090504
  31. Grim CE, Luft FC, Yune HY, Klatte EC, Weinberger MH. Percutaneous transluminal dilation in the treatment of renal vascular hypertension. Ann Intern Med 1981;95:439-42 https://doi.org/10.7326/0003-4819-95-4-439
  32. Canzanello VJ, Millan VG, Spiegel JE, Ponce SP, Kopelman RI, Madias NE. Percutaneous transluminal renal angioplasty in management of atherosclerotic renovascular hypertension: results in 100 patients. Hypertension 1989;13:163-72 https://doi.org/10.1161/01.HYP.13.2.163