1987 Volume 78 Issue 11 Pages 1982-1991
Intravenous Digital Subtraction Angiography (IVDSA) was performed on 140 cases with the following urogenital diseases: 48 idiopathic hematuria, 40 vascular disease, 19 urogenital tumor, 11 renal trauma, 6 urogenital anomaly, 5 chronic renal failure and 11 others.
All of these cases were examined in the supine position. IVDSA in the sitting position and pharmaco-IVDSA were also performed on 80 and 20 cases, respectively. IVDSA in the sitting position employed in this study has several advantages as follows: (1) Reduced amount of bowel gas in the Image Intensifier with less artifact, (2) Improved visualization of abdominal vessels, particularly the renal artery, and (3) Better identification of the displacement of abdominal vessels. Pharmaco-IVDSA performed with a concominant use of Dopamine (Dose of 5ng/kg/min. for 3 minutes before the injection of contrast material) could provide more distinct images of renal vasculature and a dense nephrogram as compared with those obtained by conventional IVDSA.
In 95% of the 140 cases, IVDSA provided actual and well-opacified vascular images serving for the diagnosis of these urogenital diseases. The accuracy of diagnosis was 69% on the average in this series. The rate of correct diagnosis was 98% for vascular disease, 91% for renal trauma, 83% for urogenital vascular anomaly, 80% for contracted kidney, 63% for mass lesion, and 46% for idiopathic hematuria. Surprisingly, IVDSA provided a correct diagnostic rate of 100% for renal cell carcinoma which was the most challenging disease to be screened. IVDSA proved to be the most useful especially for vascular diseases such as aneurysm or renovascular hypertension. Moreover, it had a relative indication for the screening of renal mass resulting from renal bleeding and moderate renal trauma as well as for the evaluation of vascular anomaly and compromised renal function in chronic renal failure. However, IVDSA was contra-indicated to infectious renal diseases and severe renal trauma.
From these results, we concluded that the indication of IVDSA was extended by the sitting position IVDSA and pharmaco-IVDSA, and that this technique proved to be a practical, noninvasive, well-tolerated method for the screening and follow-up evaluation of several urogenital diseases.
