Abstract
Purpose
To compare current technology multislice computed tomography angiography (CTA) with magnetic resonance angiography (MRA) in the pre-operative evaluation of vascular anatomy of living renal transplant donors.
Methods and materials
Two hundred and thirty-six kidneys were included in the CTA and MRA analysis. Renal vasculature was evaluated independently by two readers in each modality with a delay of 4 weeks between reading sessions. Surgical correlation on the operated side was available in all patients. The reference standard was defined by surgical correlation and consensus reading of both modalities.
Results
Detection rate of CTA for arteries was 99.1 and 95.0 % for reader 1 and reader 2, respectively. Detection rate of MRA for arteries was 95.0/94.3 %. Most of the undetected arteries were ≤1 mm diameter (reader 1: 2 of 3 in CTA and 9 of 16 in MRA; reader 2: 11 of 16 in CTA, and 8 of 18 in MRA). Detection rates for arteries ≥2 mm for reader 1/reader 2 were 99.7/98.7 % in CTA and 99.1/97.8 % in MRA, respectively. Detection rates for veins were 99.6/97.4 % in CTA and 97.8/96.9 % in MRA, respectively. Both readers misdiagnosed between 0 and 1 non-present arteries and between 2 and 3 non-present veins in both modalities.
Conclusions
Modern multislice CT and MRI scanners allow highly accurate evaluation of the vascular anatomy, especially for vessels of ≥2 mm diameter. CTA may provide slightly better depiction of very small arteries; however, this may be reader-dependent. Additional factors affecting the choice of imaging modality should include local availability, cost, and the desire to avoid ionizing radiation in healthy transplant donors.
Similar content being viewed by others
References
Carter JT, Freise CE, McTaggart RA, Mahanty HD, Kang SM, Chan SH et al (2005) Laparoscopic procurement of kidneys with multiple renal arteries is associated with increased ureteral complications in the recipient. Am J Transplant 5:1312–1318
Fuller TF, Deger S, Buchler A, Roigas J, Schonberger B, Schnorr D et al (2006) Ureteral complications in the renal transplant recipient after laparoscopic living donor nephrectomy. Eur Urol 50:535–540 discussion 40-1
Aktas S, Boyvat F, Sevmis S, Moray G, Karakayali H, Haberal M (2011) Analysis of vascular complications after renal transplantation. Transplant Proc 43:557–561
Chabchoub K, Mhiri MN, Bahloul A, Fakhfakh S, Ben Hmida I, Hadj Slimen M et al (2011) Does kidney transplantation with multiple arteries affect graft survival? Transplant Proc 43:3423–3425
Paragi PR, Klaassen Z, Fletcher HS, Tichauer M, Chamberlain RS, Wellen JR et al (2011) Vascular constraints in laparoscopic renal allograft: comparative analysis of multiple and single renal arteries in 976 laparoscopic donor nephrectomies. World J Surg 35:2159–2166
Yildirim M, Kucuk HF (2011) Outcomes of renal transplantations with multiple vessels. Transplant Proc 43:816–818
Kok NF, Dols LF, Hunink MG, Alwayn IP, Tran KT, Weimar W et al (2008) Complex vascular anatomy in live kidney donation: imaging and consequences for clinical outcome. Transplantation 85:1760–1765
Bhatti AA, Chugtai A, Haslam P, Talbot D, Rix DA, Soomro NA (2005) Prospective study comparing three-dimensional computed tomography and magnetic resonance imaging for evaluating the renal vascular anatomy in potential living renal donors. BJU Int 96:1105–1108
Gluecker TM, Mayr M, Schwarz J, Bilecen D, Voegele T, Steiger J et al (2008) Comparison of CT angiography with MR angiography in the preoperative assessment of living kidney donors. Transplantation 86:1249–1256
Halpern EJ, Mitchell DG, Wechsler RJ, Outwater EK, Moritz MJ, Wilson GA (2000) Preoperative evaluation of living renal donors: comparison of CT angiography and MR angiography. Radiology 216:434–439
Kim T, Murakami T, Takahashi S, Hori M, Takahara S, Ichimaru N et al (2006) Evaluation of renal arteries in living renal donors: comparison between MDCT angiography and gadolinium-enhanced 3D MR angiography. Radiat Med 24:617–624
Rankin SC, Jan W, Koffman CG (2001) Noninvasive imaging of living related kidney donors: evaluation with CT angiography and gadolinium-enhanced MR angiography. AJR Am J Roentgenol 177:349–355
Tsuda K, Murakami T, Kim T, Narumi Y, Takahashi S, Tomoda K et al (1998) Helical CT angiography of living renal donors: comparison with 3D Fourier transformation phase contrast MRA. J Comput Assist Tomogr 22:186–193
Turk IA, Deger S, Davis JW, Giesing M, Fabrizio MD, Schonberger B et al (2002) Laparoscopic live donor right nephrectomy: a new technique with preservation of vascular length. J Urol 167:630–633
Giessing M, Deger S, Schonberger B, Turk I, Loening SA (2003) Laparoscopic living donor nephrectomy: from alternative to standard procedure. Transplant Proc 35:2093–2095
Satyapal KS, Rambiritch V, Pillai G (1995) Additional renal veins: incidence and morphometry. Clin Anat 8:51–55
Pollak R, Prusak BF, Mozes MF (1986) Anatomic abnormalities of cadaver kidneys procured for purposes of transplantation. Am Surg 52:233–235
Laugharne M, Haslam E, Archer L, Jones L, Mitchell D, Loveday E et al (2007) Multidetector CT angiography in live donor renal transplantation: experience from 156 consecutive cases at a single centre. Transpl Int 20:156–166
Tombul ST, Aki FT, Gunay M, Inci K, Hazirolan T, Karcaaltincaba M et al (2008) Preoperative evaluation of hilar vessel anatomy with 3-D computerized tomography in living kidney donors. Transplant Proc 40:47–49
Hodgson DJ, Jan W, Rankin S, Koffman G, Khan MS (2006) Magnetic resonance renal angiography and venography: an analysis of 111 consecutive scans before donor nephrectomy. BJU Int 97:584–586
Monroy-Cuadros M, McLaughlin K, Salazar A, Yilmaz S (2008) Assessment of live kidney donors by magnetic resonance angiography: reliability and impact on outcomes. Clin Transplant 22:29–34
Neville C, House AA, Nguan CY, Beasley KA, Peck D, Thain LM et al (2008) Prospective comparison of magnetic resonance angiography with selective renal angiography for living kidney donor assessment. Urology 71:385–389
Israel GM, Lee VS, Edye M, Krinsky GA, Lavelle MT, Diflo T et al (2002) Comprehensive MR imaging in the preoperative evaluation of living donor candidates for laparoscopic nephrectomy: initial experience. Radiology 225:427–432
Asgari MA, Dadkhah F, Ghadian AR, Razzaghi MR, Noorbala MH, Amini E (2011) Evaluation of the vascular anatomy in potential living kidney donors with gadolinium-enhanced magnetic resonance angiography: comparison with digital subtraction angiography and intraoperative findings. Clin Transplant 25:481–485
Platt JF, Ellis JH, Korobkin M, Reige K (1997) Helical CT evaluation of potential kidney donors: findings in 154 subjects. AJR Am J Roentgenol 169:1325–1330
Kim JK, Park SY, Kim HJ, Kim CS, Ahn HJ, Ahn TY et al (2003) Living donor kidneys: usefulness of multi-detector row CT for comprehensive evaluation. Radiology 229:869–876
Namasivayam S, Kalra MK, Waldrop SM, Mittal PK, Small WC (2006) Multidetector row CT angiography of living related renal donors: is there a need for venous phase imaging? Eur J Radiol 59:442–452
Namasivayam S, Small WC, Kalra MK, Torres WE, Newell KA, Mittal PK (2006) Multidetector-row CT angiography for preoperative evaluation of potential laparoscopic renal donors: how accurate are we? Clin Imaging 30:120–126
Sahani DV, Rastogi N, Greenfield AC, Kalva SP, Ko D, Saini S et al (2005) Multi-detector row CT in evaluation of 94 living renal donors by readers with varied experience. Radiology 235:905–910
Conflict of interest
The authors declare that they have no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Additional information
F. Engelken and F. Friedersdorff equally contributing first authors.
Rights and permissions
About this article
Cite this article
Engelken, F., Friedersdorff, F., Fuller, T.F. et al. Pre-operative assessment of living renal transplant donors with state-of-the-art imaging modalities: computed tomography angiography versus magnetic resonance angiography in 118 patients. World J Urol 31, 983–990 (2013). https://doi.org/10.1007/s00345-012-1022-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00345-012-1022-y