CT & MRI for renal artery stenosis - metanalysis - A story of how rubbish articles get published

A meta-analysis of articles published between 1998 and 2001 on the accuracy of CT and MRI in diagnosing renal artery stenosis, has been published recently in the Annals of Internal Medicine.

It concludes that these two modalities are not good enough to replace DSA.

And also reinforces my oft-repeated claim that journals need to publish articles in perspective. With the advent of 64-slice CT scanners and newer MRI scanners, there is no question that the accuracy of CT and MRI angiography has improved by leaps and bounds as far as renal angiography is concerned. And in practice, they have replaced DSA. Period.

This must be one of the worst articles that could have been published on this subject.

MRI better than CT in detecting hemorrhage

It is generally assumed that CT is best at detecting acute hemorrhage. It is definitely quicker and logistically easier to perform CT.

However a new study published in JAMA, by Kidwell C et al from Washington DC, shows that MRI is at least as good as CT if not better for diagnosing acute hemorrhage and far better for picking up chronic hemorrhage. In fact this study was stopped after an unplanned interim analysis of the first 200 patients.

A gradient echo sequence was used for the MRI images.

Pointers on a cardiac CT & MRI practice

Diagnostic Imaging has an article written by Dr. James Earl from Fairfax where he talks about how they have gone about building a successful cardiac CT & MRI practice. In brief, he talks about building bridges with cardiologists and other referring physicians. Their main areas of thrust are calcium scoring, coronary CTA, contrast-enhanced MRI for viability imaging and MRI for congenital heart disease. This pretty much follow the trend in most clinical practices worldwide.