Diagnosis of renovascular hypertension: feasibility of captopril- sensitized dynamic MR imaging and comparison with captopril scintigraphy

Angiotensin-converting enzyme inhibitors may decrease glomerular filtration rate when a significant renal artery stenosis is present. The purpose of this preliminary study is to evaluate the feasibility of captopril-sensitized, dynamic MR imaging of the kidney in a series of patients with a high suspicion of renovascular hypertension and to compare the results with those of captopril scintigraphy. Fifteen hypertensive patients with renal artery stenosis shown by angiography were studied with sequential gadolinium-enhanced MR imaging after oral administration of 50 mg of captopril, an inhibitor of angiotensin-converting enzyme. Symmetry of onset and evolution of tubular phases between the two kidneys were analyzed, and medullary signal intensity time curves were drawn for each kidney. When asymmetry between kidneys was noted, the same dynamic study was repeated 24 hr later, without captopril sensitization. All patients also underwent renal scintigraphy after administration of captopril to compare captopril-induced changes in both techniques. Three-dimensional time-of-flight MR angiography was also performed on all patients. MR imaging with normal and symmetric tubular phases showed that 11 patients had no impairment of glomerular filtration after administration of captopril. MR imaging showed that four had impairment of glomerular filtration: studies without captopril were symmetric (n = 2) or slightly asymmetric (n = 2), but administration of captopril induced severe functional impairment on the side of stenosis--that is, a delayed tubular phase with late corticomedullary decrease of signal intensity in the first two patients and absence of tubular phase in the other two. The results of scintigraphy were concordant in all but one case, in which the segmental distribution of filtration impairment, shown by MR imaging, was not shown by scintigraphy. The renal artery stenosis was shown by MR angiography in 10 of 15 patients (67%). Captopril-sensitized dynamic MR imaging of the kidney is feasible in patients with renovascular hypertension. However, captopril-induced changes are not present in all patients proven to have the disease. Scintigraphy provides similar results but may ignore segmental functional involvement.