Evaluation of MR-angiography for pre-operative assessment of living kidney donors

被引:18
作者
Prosst, RL
Fernández, ED
Neff, W
Braun, C
Neufang, T
Post, S
机构
[1] Univ Heidelberg, Univ Klinikum Mannheim, Chirurg Klin, Dept Surg, D-68167 Mannheim, Germany
[2] Univ Heidelberg, Univ Klinikum Mannheim, Dept Clin Radiol, D-68167 Mannheim, Germany
[3] Univ Heidelberg, Univ Klinikum Mannheim, Dept Med Nephrol Endocrinol Rheumatol, D-68167 Mannheim, Germany
关键词
accessory renal arteries; living kidney donation; magnetic resonance tomography; MR-angiography; renal transplantation;
D O I
10.1111/j.1399-0012.2005.00379.x
中图分类号
R61 [外科手术学];
学科分类号
摘要
Introduction: Pre-operative magnetic resonance tomography (MR) and MR-angiography (MRA) have rendered favorable results for the assessment of renal anatomy preceding living-related kidney transplantation. However, limited value of MRA in the detection of accessory renal vasculature is reported. Methods: We compared the results of pre-operative contrast-medium-enhanced MRA of the last 30 consecutively performed nephrectomies in living kidney donors with the intraoperative findings of vascular, parenchymal, and ureteral anatomy. Results: Pre-operative MRA diagnosed a solitary renal artery in 24 cases (80%) and a normal venous, ureteral and parenchymal anatomy in all cases. Intraoperatively, the surgeon confirmed the normal pre-operative MRA findings of ureter and parenchyma. Yet, in 6 out of 30 patients (20%) vascular architecture differed from the pre-operative imaging: four of them, who had a radiologically regular anatomy, were found to have accessory vessels upon surgical preparation. In the fifth patient, MRA revealed an accessory lower polar artery, which was confirmed during surgery. An undiagnosed third arterial vessel, located behind the renal vein, led to an aortic bleeding. In the sixth case, the adrenal gland artery was misinterpreted as an accessory superior polar artery of the kidney in MRA. Additionally, a radiologically undetected inferior polar artery was dissected during nephrectomy and led to partial hypoperfusion of the graft. Subsequent retrospective reevaluation of the MRA by experienced radiologists was unable to identify the intraoperative anatomical discrepancies. Hence, sensitivity of MRA was 60% (6 out of 10 cases) for accessory renal vessel detection and 80% (24 out of 30 cases) for overall sensitivity in determining renal vessel number. Discussion: MRA is a reliable method for the non-invasive investigation of living kidney donors and provides valuable information required by the surgeon. But, as the technique misses small diameter vessels, it cannot be recommended as sole diagnostic tool in unclear cases.
引用
收藏
页码:522 / 526
页数:5
相关论文
共 16 条
[1]   Helical CT angiography for examination of living renal donors [J].
Cochran, ST ;
Krasny, RM ;
Danovitch, GM ;
Rajfer, J ;
Barbaric, ZM ;
Wilkinson, A ;
Rosenthal, JT .
AMERICAN JOURNAL OF ROENTGENOLOGY, 1997, 168 (06) :1569-1573
[2]   First clinical results of ultrafast, gadolinium-enhanced dual-phase 3D MR-angiography in the abdomen. [J].
Gaa, J ;
Laub, G ;
Edelman, RR ;
Georgi, M .
ROFO-FORTSCHRITTE AUF DEM GEBIET DER RONTGENSTRAHLEN UND DER BILDGEBENDEN VERFAHREN, 1998, 169 (02) :135-139
[3]   Non-invasive imaging of abdominal vascular pathologies [J].
Gaa, J ;
Georgi, M .
EUROPEAN RADIOLOGY, 1998, 8 (04) :507-516
[4]   Gadolinium-enhanced three-dimensional magnetic resonance angiography versus conventional digital subtraction angiography: Which modality is superior in evaluating living kidney donors? [J].
Giessing, M ;
Kroencke, TJ ;
Taupitz, M ;
Feldmann, C ;
Deger, S ;
Turk, I ;
Budde, K ;
Ebeling, V ;
Schoenberger, B ;
Loening, SA .
TRANSPLANTATION, 2003, 76 (06) :1000-1002
[5]  
Gourlay WA, 1995, TRANSPLANTATION, V60, P1363
[6]   US, CT, and MR evaluation of accessory renal arteries and proximal renal arterial branches [J].
Halpern, EJ ;
Nazarian, LN ;
Wechsler, RJ ;
Mitchell, DG ;
Outwater, EK ;
Levin, DC ;
Gardiner, GA ;
Feldman, HI .
ACADEMIC RADIOLOGY, 1999, 6 (05) :299-304
[7]   Preoperative evaluation of living renal donors: Comparison of CT angiography and MR angiography [J].
Halpern, EJ ;
Mitchell, DG ;
Wechsler, RJ ;
Outwater, EK ;
Moritz, MJ ;
Wilson, GA .
RADIOLOGY, 2000, 216 (02) :434-439
[8]  
Lorenz D, 2001, CHIRURG, V72, P588, DOI 10.1007/s001040170140
[9]   Potential renal transplant donors: Evaluation with gadolinium-enhanced MR angiography and MR urography [J].
Low, RN ;
Martinez, AG ;
Steinberg, SM ;
Alzate, GD ;
Kortman, KE ;
Bower, BB ;
Dwyer, WJ ;
Prince, SK .
RADIOLOGY, 1998, 207 (01) :165-172
[10]   EVALUATION OF THE RENAL-ARTERIES IN KIDNEY DONORS - VALUE OF 3-DIMENSIONAL PHASE-CONTRAST MR-ANGIOGRAPHY WITH MAXIMUM-INTENSITY-PROJECTION OR SURFACE RENDERING [J].
MEYERS, SP ;
TALAGALA, SL ;
TOTTERMAN, S ;
AZODO, MVU ;
KWOK, E ;
SHAPIRO, L ;
SHAPIRO, R ;
PABICO, RC ;
APPLEGATE, GR .
AMERICAN JOURNAL OF ROENTGENOLOGY, 1995, 164 (01) :117-121