THE DIAGNOSTIC VALUE OF LEVOVIST IN DOPPLER IMAGING OF RENAL ARTERY STENOSIS IN PATIENTS WITH RENOVASCULAR HYPERTENSION BEFORE AND AFTER ANGIOPLASTY

Purpose: To assess the diagnostic value of Levovist in ultrasound imaging of renal artery stenosis in patients with renovascular hypertension before and after percutaneous angioplasty (PTA). Methods and Materials: During 12 months 185 patients were referred to our department for renal artery Doppler examinations. Arterial hypertension was an indication for duplex scanning. Ultrasound examinations were performed using color and spectral Doppler technique before and after intra-venous Levovist injection. We assessed: color doppler images, maximum blood flow velocity, AT and RAR. PTA was performed in patients with renal artery stenosis. 6 months after PTA ultrasound examinations were performed before and after Levovist administration to assess the interventional effect. Results: In the group of 185 patients renal artery stenosis was diagnosed in 25 patients. Between them in 17 patients conventional Doppler sonography did not allow proper evaluation of renal arteries, because of weak color and spectral Doppler signal and in 8 patients renal arteries were not visualized. In all cases strong enhancement of color and spectral Doppler signal was obtained with the use of Levovist. Hemodynamically significant stenosis was diagnosed in 23 patients unilateral and in 2 patients stenosis of both renal arteries was found. In 6 patients post PTA ultrasound examination prior to Levovist injection allowed to visualize previously stenosed artery. In 19 patients only Doppler sonography with the use of Levovist allowed to have diagnostic images of renal arteries. Ultrasound examinations performed 6 months after endovascular procedures confirmed successful PTA in all cases. Conclusions: Application of Levovist increases diagnostic efficiency of Doppler examinations.It allows an unequivocal diagnosis of renal arteries stenosis in patients with renovascular hypertension and qualify them for angioplasty interventions. The Doppler examination with the use of Levovist is a method of choice in follow-up after renal artery PTA.