Professor Marc Sapoval trained at the Medical School of the Université Paris XI. He has been Professor of Radiology at the Université Paris VI Broussais-Hotel Dieu since 1997, and is Chairman of the Department of Cardiovascular Radiology at the Hôpital Européen Georges Pompidou.

Marc Sapoval, Benoit Mader, Arshid Azarine and Bertrand Louail
Cardiovascular Radiology, Hôpital Européen Georges Pompidou, Paris, France

Address for correspondence:
Professor M Sapoval
Hôpital Européen Georges Pompidou
Cardiovascular Radiology
20 rue Leblanc
75015 Paris, France
Tel: +33 (0)1 56 09 37 41 Fax: +33 (0)1 56 09 23 39
Email: marc.sapoval@hop.egp.ap-hop-paris.fr

Abstract
Renovascular hypertension (RVHT) is hypertension caused by renal artery stenosis (RAS). For patients identified from clinical assessment as being at high risk for RAS, non-invasive imaging techniques can diagnose RAS and identify patients likely to benefit from intervention. Duplex ultrasonography, contrast tomography angiography (CTA) and magnetic resonance angiography (MRA) are non-invasive alternatives to intra-arterial angiography for identifying the anatomic presence of stenosis. CTA or MRA provide high sensitivity and specificity in identifying RAS, with CTA providing additional abdominal pathology. Duplex ultrasonography enables morphologic examination and haemodynamic assessment, the calculation of renal resistivity being a possible method to predict the response to intervention. Angiotensin-converting enzyme inhibitor-augmented renography identifies the functional consequences of a renal artery obstruction. Therefore, this technique tests directly for the presence of RVHT and should be included in the diagnostic work-up of RVHT when RAS is recognised. Non-invasive imaging techniques are continuing to improve due to advances in contrast agents, image acquisition and post-processing techniques. Careful evaluation of individual patients by these methods will enable recommendation for angioplasty and stenting only when necessary.