Duplex evaluation of a hypertensive 40-year-old woman shows a peak systolic velocity of 260 cm/s in the mid portion of the right main renal artery. The peak systolic velocity in the aorta at the same level is 70 cm/s. Which conclusion follows from these values?

• A The findings indicate renal vein thrombosis
• B The study is technically inadequate because velocities above 200 cm/s cannot be measured
• C Haemodynamically significant right renal artery stenosis is present ✓
• D The findings indicate a normal study because the resistive index is not elevated

Explanation

C main renal artery peak systolic velocity exceeding approximately 200 cm/s together with a renal-to-aortic velocity ratio above 3.5 indicates a haemodynamically significant stenosis of sixty percent or more. Here the PSV is 260 cm/s and the ratio is 260 divided by 70, about 3.7, so both criteria are met. Elevated resistive index is neither required nor reliable for diagnosing renovascular disease, and high velocities are readily measured by duplex equipment.

Reference: Brant and Helms Fundamentals of Diagnostic Radiology, 5th ed.

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