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Roditi G, Wieben O, Prince MR, Hecht EM. MR Angiography Series: Abdominal and Pelvic MR Angiography. Radiographics 2022; 42:E94-E95. [PMID: 35245106 DOI: 10.1148/rg.210224] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This review guides readers through the selection and setup of standardized MR angiography (MRA) protocols for the abdomen and pelvis for common clinical applications. Topics covered include renovascular MRA in potential kidney donors and in patients with hypertension; hepatic and mesenteric MRA in potential liver donors, patients with portal hypertension, and patients with chronic mesenteric ischemia; pelvic MRA for pretreatment planning before uterine fibroid embolization and in patients with pelvic congestion syndrome; and abdominal wall MRA for planning of breast reconstructive surgery. This module is the fifth in a series created on behalf of the Society for Magnetic Resonance Angiography (SMRA), a group of researchers and clinicians who are passionate about the benefits of MRA but understand its challenges. The full digital presentation is available online. ©RSNA, 2022.
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Affiliation(s)
- Giles Roditi
- From the Department of Radiology, NHS Greater Glasgow & Clyde and Glasgow University, Glasgow Royal Infirmary, 16 Alexandra Parade, Glasgow G31 2ER, Scotland (G.R.); Departments of Medical Physics and Radiology, University of Wisconsin-Madison, Madison, Wis (O.W.); and Department of Radiology, Weill Cornell Medicine, New York, NY (M.R.P., E.M.H.)
| | - Oliver Wieben
- From the Department of Radiology, NHS Greater Glasgow & Clyde and Glasgow University, Glasgow Royal Infirmary, 16 Alexandra Parade, Glasgow G31 2ER, Scotland (G.R.); Departments of Medical Physics and Radiology, University of Wisconsin-Madison, Madison, Wis (O.W.); and Department of Radiology, Weill Cornell Medicine, New York, NY (M.R.P., E.M.H.)
| | - Martin R Prince
- From the Department of Radiology, NHS Greater Glasgow & Clyde and Glasgow University, Glasgow Royal Infirmary, 16 Alexandra Parade, Glasgow G31 2ER, Scotland (G.R.); Departments of Medical Physics and Radiology, University of Wisconsin-Madison, Madison, Wis (O.W.); and Department of Radiology, Weill Cornell Medicine, New York, NY (M.R.P., E.M.H.)
| | - Elizabeth M Hecht
- From the Department of Radiology, NHS Greater Glasgow & Clyde and Glasgow University, Glasgow Royal Infirmary, 16 Alexandra Parade, Glasgow G31 2ER, Scotland (G.R.); Departments of Medical Physics and Radiology, University of Wisconsin-Madison, Madison, Wis (O.W.); and Department of Radiology, Weill Cornell Medicine, New York, NY (M.R.P., E.M.H.)
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Li X, Xia F, Chen L, Zhang X, Mo C, Shen W. One-stop preoperative assessment of renal vessels for living donors with 3.0 T non-contrast-enhanced magnetic resonance angiography: compared with computerized tomography angiography and surgical results. Br J Radiol 2021; 94:20210589. [PMID: 34558306 DOI: 10.1259/bjr.20210589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE The study was to investigate the feasibility and accuracy of assessment for living renal donors before transplantation by using 3.0 T non-contrast-enhanced magnetic resonance angiography (NCE-MRA). METHODS 30 renal donors were investigated and underwent computed tomography angiography (CTA) and 3.0 T NCE-MRA before nephrectomy. Two radiologists independently assessed arterial and venous anatomy and potential kidney lesions. The image quality score, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), diameters and lengths of renal arteries and veins were compared between CTA and NCE-MRA. Imaging findings were compared with the surgical results served as reference standard. Agreement was assessed using κ test. The Wilcoxon test and paired sample t test were used for statistically significant differences. RESULTS The results of image quality score for renal arteries and veins were highly consistent between the two radiologists in NCE-MRA (p < 0.001). There was no significant difference in the scores of renal arterial and venous branches between NCE-MRA and CTA (p > 0.05). The SNR and CNR of renal vessels were higher than CTA (p < 0.001). There were no statistically significant differences in the length of renal vessels measured by the two methods (p > 0.05), and the diameter was smaller than that of CTA (p < 0.05). The detection of normal renal arteries and early branches by both examination techniques was consistent with intraoperative findings. Both methods showed good consistency between the anatomical variation of renal vein and the intraoperative diagnosis (p < 0.001). CONCLUSION 3.0 T NCE-MRA can be used for evaluation of main renal arteries and veins with high accuracy for anatomy and variation classification, and can be used for pre-operative vascular evaluation of living donor kidney transplantation. ADVANCES IN KNOWLEDGE 3.0 T NCE-MRA can be used for evaluation of main renal arteries and veins with high accuracy for anatomy and variation classification, and can be used for pre-operative vascular evaluation of living donor kidney transplantation.
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Affiliation(s)
- Xiaotian Li
- School of Medicine, Nankai University, Tianjin, China
| | - Fangjie Xia
- Department of Radiology, Tianjin First Center Hospital, Tianjin Medical University, Tianjin, China
| | - Lihua Chen
- Department of Radiology, Tianjin First Center Hospital, School of Medicine, Nankai University, Tianjin, China
| | - Xiaodong Zhang
- Department of Radiology, Tianjin First Center Hospital, School of Medicine, Nankai University, Tianjin, China
| | - Chunbai Mo
- Department of Kidney Transplantation, Tianjin First Center Hospital, School of Medicine, Nankai University, Tianjin, China
| | - Wen Shen
- Department of Radiology, Tianjin First Center Hospital, School of Medicine, Nankai University, Tianjin, China
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Ebad CA, Brennan D, Chevarria J, Hussein MB, Sexton D, Mulholland D, Doyle C, O'Kelly P, Williams Y, Dunne R, O'Seaghdha C, Little D, Morrin M, Conlon PJ. Is Bigger Better? Living Donor Kidney Volume as Measured by the Donor CT Angiogram in Predicting Donor and Recipient eGFR after Living Donor Kidney Transplantation. J Transplant 2021; 2021:8885354. [PMID: 34336253 PMCID: PMC8286185 DOI: 10.1155/2021/8885354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 06/30/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The role of kidney volume measurement in predicting the donor and recipient kidney function is not clear. METHODS We measured kidney volume bilaterally in living kidney donors using CT angiography and assessed the association with the donor remaining kidney and recipient kidney (donated kidney) function at 1 year after kidney transplantation. Donor volume was categorized into tertiles based on lowest, middle, and highest volume. RESULTS There were 166 living donor and recipient pairs. The mean donor age was 44.8 years (SD ± 10.8), and donor mean BMI was 25.5 (SD ± 2.9). The recipients of living donor kidneys were 64% male and had a mean age of 43.5 years (SD ± 13.3). Six percent of patients experienced an episode of cellular rejection and were maintained on dialysis for a mean of 18 months (13-32) prior to transplant. Kidney volume was divided into tertiles based on lowest, middle, and highest volume. Kidney volume median (range) in tertiles 1, 2, and 3 was 124 (89-135 ml), 155 (136-164 ml), and 184 (165-240 ml) with donor eGFR ml/min (adjusted for body surface area expressed as ml/min/1.73 m2) at the time of donation in each tertile, 109 (93-129), 110 (92-132), and 101 ml/min (84-117). The median (IQR) eGFR in tertiles 1 to 3 in kidney recipients at 1 year after donation was 54 (44-67), 62 (50-75), and 63 ml/min (58-79), respectively. The median (IQR) eGFR in tertiles 1 to 3 in the remaining kidney of donors at 1 year after donation was 59 (53-66), 65 (57-72), and 65 ml/min (56-73), respectively. CONCLUSION Bigger kidney volume was associated with better eGFR at 1 year after transplant in the recipient and marginally in the donor remaining kidney.
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Affiliation(s)
- Chaudhry Adeel Ebad
- Department of Nephrology and Kidney Transplantation, Beaumont Hospital, Dublin, Ireland
| | - David Brennan
- Department of Radiology, Beaumont Hospital, Dublin, Ireland
| | - Julio Chevarria
- Department of Nephrology and Kidney Transplantation, Beaumont Hospital, Dublin, Ireland
| | - Mohammad Bin Hussein
- Department of Nephrology and Kidney Transplantation, Beaumont Hospital, Dublin, Ireland
| | - Donal Sexton
- Department of Nephrology and Kidney Transplantation, Beaumont Hospital, Dublin, Ireland
| | | | - Ciaran Doyle
- Department of Nephrology and Kidney Transplantation, Beaumont Hospital, Dublin, Ireland
| | - Patrick O'Kelly
- Department of Nephrology and Kidney Transplantation, Beaumont Hospital, Dublin, Ireland
| | - Yvonne Williams
- Department of Nephrology and Kidney Transplantation, Beaumont Hospital, Dublin, Ireland
| | - Ruth Dunne
- Department of Radiology, Beaumont Hospital, Dublin, Ireland
| | - Conall O'Seaghdha
- Department of Nephrology and Kidney Transplantation, Beaumont Hospital, Dublin, Ireland
| | - Dilly Little
- Department of Urology and Kidney Transplantation, Beaumont Hospital, Dublin, Ireland
| | - Martina Morrin
- Department of Radiology, Beaumont Hospital, Dublin, Ireland
| | - Peter J. Conlon
- Department of Nephrology and Kidney Transplantation, Beaumont Hospital, Dublin, Ireland
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Sarier M, Callioglu M, Yuksel Y, Duman E, Emek M, Usta S. Evaluation of the Renal Arteries of 2,144 Living Kidney Donors Using Computed Tomography Angiography and Comparison with Intraoperative Findings. Urol Int 2020; 104:637-640. [DOI: 10.1159/000507796] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 04/02/2020] [Indexed: 11/19/2022]
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Whooley J, Ferede A, Smyth G, Little D. Venous anomalies in renal transplantation: an accessory left-sided IVC in a live kidney donor. BMJ Case Rep 2019; 12:12/12/e232695. [PMID: 31848141 DOI: 10.1136/bcr-2019-232695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Duplication of the inferior vena cava (IVC) resulting in an accessory left-sided IVC is a relatively rare vascular anomaly with a reported prevalence of 0.7%. Radiologically, a duplicated left-sided IVC is usually seen as a continuation of the left common iliac vein, crossing anterior to the aorta at the level of the renal vein to join the right-sided IVC. We present a rare case in which an accessory left-sided IVC was discovered intraoperatively, in a 47-year-old living donor, posing significant intraoperative challenges regarding extraction and subsequent transplantation.
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Affiliation(s)
| | - Atakelet Ferede
- National Kidney Transplant Service (NKTS), Beaumont Hospital, RCSI, Dublin, Ireland
| | - Gordon Smyth
- National Kidney Transplant Service (NKTS), Beaumont Hospital, RCSI, Dublin, Ireland
| | - Dilly Little
- National Kidney Transplant Service (NKTS), Beaumont Hospital, RCSI, Dublin, Ireland
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Abstract
Imaging plays a crucial role in pre-transplant evaluation to enhance the probability of a successful outcome. Its aim is to define kidney and vascular anatomy and to assess potential pathologies. Each modality has advantages and disadvantages. Computed tomography angiography (CTA) is the most commonly used imaging modality, however, magnetic resonance angiography (MRA) can be used in selected cases. The purpose of this review article is to provide an overview of available imaging modalities, their benefits, risks, advantages, and disadvantages. Imaging findings that indicate particular anomalies and pathologies that may affect living renal donor selection will be discussed.
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Affiliation(s)
- Ayaz Aghayev
- Cardiovascular Imaging Program, Departments of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA
| | - Sumit Gupta
- Cardiovascular Imaging Program, Departments of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA
| | - Borna E Dabiri
- Cardiovascular Imaging Program, Departments of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA
| | - Michael L Steigner
- Cardiovascular Imaging Program, Departments of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA
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Majos M, Polguj M, Stefańczyk L, Derlatka-Kochel M, Wachowski M, Majos A. Renal-aortic ratio as an objective measure of renal artery diameter a computed tomography angiography study. BMC Cardiovasc Disord 2019; 19:181. [PMID: 31362712 PMCID: PMC6668124 DOI: 10.1186/s12872-019-1163-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 07/17/2019] [Indexed: 11/24/2022] Open
Abstract
Background Considering vital role of renal arteries in many surgical procedures, diameter of renal arteries seems to be an important measure of kidney perfusion. In this study, we analyzed a new parameter, renal-aortic ratio (R-Ar) as an objective measure of the renal artery diameter. Method The study included CT angiographic images from 254 patients (129 women and 125 men). R-Ar was calculated by dividing the diameter of the main renal artery for each kidney by the aortic diameter. Results R-Ar values for the whole study group ranged between 0.0863 and 0.5083; the ranges of R-Ar values for women and men patients were 0.1150–0.5083 and 0.0863–0.4449, respectively. In 412 cases (81.10%), the kidney was supplied by a single renal artery (RA variant) and in 96 (18.90%) by more than one artery (sRA variant). A significant difference was found in R-Ar values for RA and sRA variants (p = 0.0008). When the anatomical variant of renal perfusion was not considered on statistical analysis, a significant difference was found between the R-Ar values for women and men (p = 0.0259). No statistically significant difference was observed in R-Ar values for the right and left kidneys (p = 0.3123). Spearman’s coefficient of rank correlation between patient age and renal-aortic ratio values for the whole study group equaled − 0.36. Conclusion The analysis of the renal-aortic ratio values demonstrated that the diameter of renal arteries depended primarily on their number, and the relative diameter of renal arteries in women was larger than in men.
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Affiliation(s)
- Marcin Majos
- Department of Radiology and Diagnostic Imaging, Medical University of Łódź, Kopcińskiego 22, 90-153, Łódź, Poland
| | - Michał Polguj
- Department of Angiology, Interfaculty Chair of Anatomy and Histology, Medical University of Lodz, Poland, Żeligowskiego 7/9, 90-752, Łódź, Poland.
| | - Ludomir Stefańczyk
- Department of Radiology and Diagnostic Imaging, Medical University of Łódź, Kopcińskiego 22, 90-153, Łódź, Poland
| | - Magdalena Derlatka-Kochel
- Department of Radiological and Isotopic Diagnosis and Therapy, Medical University of Lodz, Łódź, ul. Pomorska 251, 92-213, Lodz, Poland
| | - Mariusz Wachowski
- Department of Radiological and Isotopic Diagnosis and Therapy, Medical University of Lodz, Łódź, ul. Pomorska 251, 92-213, Lodz, Poland
| | - Agata Majos
- Department of Radiological and Isotopic Diagnosis and Therapy, Medical University of Lodz, Łódź, ul. Pomorska 251, 92-213, Lodz, Poland
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Ferrero A, Takahashi N, Vrtiska TJ, Krambeck AE, Lieske JC, McCollough CH. Understanding, justifying, and optimizing radiation exposure for CT imaging in nephrourology. Nat Rev Urol 2019; 16:231-244. [PMID: 30728476 PMCID: PMC6447446 DOI: 10.1038/s41585-019-0148-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
An estimated 4-5 million CT scans are performed in the USA every year to investigate nephrourological diseases such as urinary stones and renal masses. Despite the clinical benefits of CT imaging, concerns remain regarding the potential risks associated with exposure to ionizing radiation. To assess the potential risk of harmful biological effects from exposure to ionizing radiation, understanding the mechanisms by which radiation damage and repair occur is essential. Although radiation level and cancer risk follow a linear association at high doses, no strong relationship is apparent below 100 mSv, the doses used in diagnostic imaging. Furthermore, the small theoretical increase in risk of cancer incidence must be considered in the context of the clinical benefit derived from a medically indicated CT and the likelihood of cancer occurrence in the general population. Elimination of unnecessary imaging is the most important method to reduce imaging-related radiation; however, technical aspects of medically justified imaging should also be optimized, such that the required diagnostic information is retained while minimizing the dose of radiation. Despite intensive study, evidence to prove an increased cancer risk associated with radiation doses below ~100 mSv is lacking; however, concerns about ionizing radiation in medical imaging remain and can affect patient care. Overall, the principles of justification and optimization must remain the basis of clinical decision-making regarding the use of ionizing radiation in medicine.
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Affiliation(s)
- Andrea Ferrero
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Amy E Krambeck
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - John C Lieske
- Department of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
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Lange D, Helck A, Rominger A, Crispin A, Meiser B, Werner J, Fischereder M, Stangl M, Habicht A. Renal volume assessed by magnetic resonance imaging volumetry correlates with renal function in living kidney donors pre- and postdonation: a retrospective cohort study. Transpl Int 2018; 31:773-780. [PMID: 29575113 DOI: 10.1111/tri.13150] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 09/14/2017] [Accepted: 03/08/2018] [Indexed: 11/29/2022]
Abstract
Renal function of potential living kidney donors is routinely assessed with scintigraphy. Kidney anatomy is evaluated by imaging techniques such as magnetic resonance imaging (MRI). We evaluated if a MRI-based renal volumetry is a good predictor of kidney function pre- and postdonation. We retrospectively analyzed the renal volume (RV) in a MRI of 100 living kidney donors. RV was correlated with the tubular excretion rate (TER) of MAG3-scintigraphy, a measured creatinine clearance (CrCl), and the estimated glomerular filtration rate (eGFR) by Cockcroft-Gault (CG), CKD-EPI, and modification of diet in renal disease (MDRD) formula pre- and postdonation during a follow-up of 3 years. RV correlated significantly with the TER (total: r = 0.6735, P < 0.0001). Correlation between RV and renal function was the highest for eGFR by CG (r = 0.5595, P < 0.0001), in comparison with CrCl, MDRD-GFR, and CKD-EPI-GFR predonation. RV significantly correlated with CG-GFR postdonation and predicted CG-GFR until 3 years after donation. MRI renal volumetry might be an alternative technique for the evaluation of split renal function and prediction of renal function postdonation in living kidney donors.
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Affiliation(s)
- Daniel Lange
- Transplant Center, University Hospital Munich, Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Andreas Helck
- Institute for Clinical Radiology, University Hospital Munich, Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Axel Rominger
- Department of Nuclear Medicine, University Hospital Munich, Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Alexander Crispin
- Chair for Public Health and Health Services Research, Department of Medical Informatics, Biometry and Epidemiology - IBE, University Hospital Munich, Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Bruno Meiser
- Transplant Center, University Hospital Munich, Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Jens Werner
- Clinic of General, Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital Munich, Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Michael Fischereder
- Renal Division, Department of Internal Medicine IV, University Hospital Munich, Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Manfred Stangl
- Clinic of General, Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital Munich, Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Antje Habicht
- Transplant Center, University Hospital Munich, Ludwig-Maximilians-University (LMU), Munich, Germany
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Does the type of renal artery anatomic variant determine the diameter of the main vessel supplying a kidney? A study based on CT data with a particular focus on the presence of multiple renal arteries. Surg Radiol Anat 2017; 40:381-388. [PMID: 28980056 PMCID: PMC5880851 DOI: 10.1007/s00276-017-1930-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 09/19/2017] [Indexed: 11/20/2022]
Abstract
Background An in-depth knowledge of renal vascular anatomy is essential when planning many surgical procedures; however, a few data exists regarding renal artery diameter. The aim of this study was to assess this morphological feature and to investigate whether a correlation exists between renal artery diameter and the type of arterial supply, with a particular emphasis on variant anatomy and the presence of multiple renal arteries. Materials and methods Computed tomography angiography (CTA) studies of 248 patients, i.e., a total of 496 kidneys, were evaluated. The mean age of the patients was 66.4 ± 15.01 years. Renal artery diameter was measured based on the type of arterial blood supply. Results The frequency of occurrence of three anatomic variants of renal arterial supply was established: single renal artery (RA) 43.35%, single artery with prehilar branching (pRA) 37.30%, and multiple renal artery (mRA) 19.35%. The diameter of single renal arteries, with either prehilar or hilar branching, was significantly larger than when multiple arteries were present. A detailed analysis of just the mRA variant demonstrated that the diameter of the renal arteries in men was larger (p = 0.012) than those in women and that there was no difference in diameter with regard to the side of the body (p = 0.219). Conclusions The classification described in our study containing a detailed description of renal artery diameter. It may be helpful in clinical practice, especially for transplantologists, surgeons, and vascular surgeons.
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Çınar C, Türkvatan A. Prevalence of renal vascular variations: Evaluation with MDCT angiography. Diagn Interv Imaging 2016; 97:891-7. [DOI: 10.1016/j.diii.2016.04.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 03/30/2016] [Accepted: 04/05/2016] [Indexed: 01/01/2023]
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Gulati M, Dermendjian H, Gómez AM, Tan N, Margolis DJ, Lu DS, Gritsch HA, Raman SS. 3.0Tesla magnetic resonance angiography (MRA) for comprehensive renal evaluation of living renal donors: pilot study with computerized tomography angiography (CTA) comparison. Clin Imaging 2016; 40:370-7. [PMID: 27133670 DOI: 10.1016/j.clinimag.2016.01.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 01/10/2016] [Accepted: 01/21/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE Most living related donor (LRD) kidneys are harvested laparoscopically. Renal vascular anatomy helps determine donor suitability for laparoscopic nephrectomy. Computed tomography angiography (CTA) is the current gold standard for preoperative imaging; magnetic resonance angiography (MRA) offers advantages including lack of ionizing radiation and lower incidence of contrast reactions. We evaluated 3.0T MRA for assessing renal anatomy of LRDs. MATERIALS AND METHODS Thirty consecutive LRDs underwent CTA followed by 3.0T MRA. Data points included number and branching of vessels, incidental findings, and urothelial opacification. Studies were individually evaluated by three readers blinded to patient data. Studies were reevaluated in consensus with discrepancies revealed, and final consensus results were labeled "truth". RESULTS Compared with consensus "truth", both computed tomography (CT) and magnetic resonance imaging were highly accurate for assessment of arterial and venous anatomy, although CT was superior for detection of late venous confluence as well as detection of renal stones. Both modalities were comparable in opacification of lower ureters and bladder; MRA underperformed CTA for opacification of upper urinary tracts. CONCLUSIONS 3.0T MRA enabled excellent detection of comprehensive renal anatomy compared to CTA in LRDs.
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Affiliation(s)
- Mittul Gulati
- Department of Radiology, University of Southern California Keck School of Medicine, Los Angeles, CA
| | - Harout Dermendjian
- Department of Radiology, University of Southern California Keck School of Medicine, Los Angeles, CA.
| | - Ana M Gómez
- Department of Radiology, David Geffen School of Medicine, University Of California Los Angeles, Los Angeles, CA
| | - Nelly Tan
- Department of Radiology, David Geffen School of Medicine, University Of California Los Angeles, Los Angeles, CA
| | - Daniel J Margolis
- Department of Radiology, David Geffen School of Medicine, University Of California Los Angeles, Los Angeles, CA
| | - David S Lu
- Department of Radiology, David Geffen School of Medicine, University Of California Los Angeles, Los Angeles, CA
| | - H Albin Gritsch
- Department of Urology, David Geffen School of Medicine, University Of California Los Angeles, Los Angeles, CA
| | - Steven S Raman
- Department of Radiology, David Geffen School of Medicine, University Of California Los Angeles, Los Angeles, CA
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Noncontrast-Enhanced Magnetic Resonance Versus Computed Tomography Angiography in Preoperative Evaluation of Potential Living Renal Donors. Acad Radiol 2015; 22:1368-75. [PMID: 26307028 DOI: 10.1016/j.acra.2015.06.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Revised: 06/19/2015] [Accepted: 06/24/2015] [Indexed: 12/26/2022]
Abstract
RATIONALE AND OBJECTIVES Living renal donors undergo an extensive examination program. These examinations should be as safe, gentle, and patient friendly as possible. To compare computed tomography angiography (CTA) and an extensive magnetic resonance imaging (MRI) protocol without contrast agents to observations from nephrectomy in living renal donors and to evaluate whether noncontrast-enhanced MRI can replace CTA for vessel assessment in living renal donors. MATERIAL AND METHODS CTA and MRI results were compared to observations from nephrectomy, which served as the reference standard. Fifty-one potential kidney donors underwent imaging, and 31 donated a kidney. Comparisons in sensitivity, specificity, and accuracy were made with respect to the number of arteries, early branching, and the number of veins. Agreement was assessed using Cohen's kappa. The exact McNemar's test was used to test for statistically significant differences. RESULTS In the assessment of more than one renal artery, the sensitivity and specificity of MRI and CTA were high and in perfect agreement compared to observations from surgery. The results for both MRI and CTA were as follows: (sensitivity 100%/specificity100%/accuracy 100%/Kappa = 1/P = 1). When comparing the ability to test for early branching we found, MRI: (sensitivity 33%/specificity 100%/accuracy 87%/Kappa = 0.45/P = 1) and CTA: (sensitivity 50%/specificity 100%/accuracy 90%/Kappa = 0.62/P = 1). When used to depict supernumerary veins, we found MRI: (sensitivity60%/specifivity100%/accuracy 93%/Kappa = 0.72/P = 1), whereas CTA showed: (sensitivity 40%/specificity 96%/accuracy 87% Kappa = 0.43/P = 1). CONCLUSIONS In conclusion, an optimized MRI protocol that includes noncontrast-enhanced magnetic resonance angiography can be substituted for CTA for preoperative assessment of the renal vessels before living donor nephrectomy.
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Di Carlo HN, Darras FS. Urologic considerations and complications in kidney transplant recipients. Adv Chronic Kidney Dis 2015; 22:306-11. [PMID: 26088075 DOI: 10.1053/j.ackd.2015.04.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 04/03/2015] [Accepted: 04/08/2015] [Indexed: 01/05/2023]
Abstract
Urologic considerations during the kidney transplantation process, starting with initial recipient evaluation and continuing through the post-transplant, long-term follow-up, are critical for minimizing urologic complications and improving graft survival. Appropriate, targeted, preoperative urologic evaluation of the recipient allows for an optimized urinary tract to accept the graft, whereas post-transplant urologic follow-up and monitoring decrease the risk of graft lost secondary to a urologic cause, particularly in patients with a urologic reason for their kidney failure and in those patients with concomitant urologic diagnoses. Urologic complications comprise the second most common adverse post-transplant event, occurring in 2.5% to 14% of patients and are associated with high morbidity, graft loss, and mortality. Early and late urologic complications, including hematuria, hematoma, lymphocele, urine leak, ureteral stricture, nephrolithiasis, and vesicoureteral reflux, and their causes and treatment options are explored. A multidisciplinary team approach to kidney transplantation, including transplant surgery, urology, and nephrology, optimizes outcomes and graft survival. Although the current role of the urologist in kidney transplantation varies greatly by institution, appropriate consultation, participation, and monitoring in select patients is essential.
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Diez A, Powelson J, Sundaram CP, Taber TE, Mujtaba MA, Yaqub MS, Mishler DP, Goggins WC, Sharfuddin AA. Correlation between CT-based measured renal volumes and nuclear-renography-based split renal function in living kidney donors. Clinical diagnostic utility and practice patterns. Clin Transplant 2014; 28:675-82. [PMID: 24654729 DOI: 10.1111/ctr.12365] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2014] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Living donor evaluation involves imaging to determine the choice of kidney for nephrectomy. Our aim was to study the diagnostic accuracy and correlation between CT-based volume measurements and split renal function (SRF) as measured by nuclear renography in potential living donors and its impact on kidney selection decision. METHODS We analyzed 190 CT-based volume measurements in healthy donors, of which 65 donors had a radionuclide study performed to determine SRF. RESULTS There were no differences in demographics, anthropometric measurements, total volumes, eGFR, creatinine clearances between those who required a nuclear scan and those who did not. There was a significant correlation between CT-volume-measurement-based SRF and nuclear-scan-based SRF (Pearson coefficient r 0.59; p < 0.001). Furthermore, selective nuclear-based SRF allowed careful selection of donor nephrectomy, leaving the donor with the higher functioning kidney in most cases. There was also a significantly higher number of right-sided nephrectomies selected after nuclear-based SRF studies. CONCLUSION CT-based volume measurements in living donor imaging have sufficient correlation with nuclear-based SRF. Selective use of nuclear-scan-based SRF allows careful selection for donor nephrectomy.
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Affiliation(s)
- Alejandro Diez
- Division of Nephrology, Indiana University School of Medicine, Indianapolis, IN, USA
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Olin JW, Gornik HL, Bacharach JM, Biller J, Fine LJ, Gray BH, Gray WA, Gupta R, Hamburg NM, Katzen BT, Lookstein RA, Lumsden AB, Newburger JW, Rundek T, Sperati CJ, Stanley JC. Fibromuscular dysplasia: state of the science and critical unanswered questions: a scientific statement from the American Heart Association. Circulation 2014; 129:1048-78. [PMID: 24548843 DOI: 10.1161/01.cir.0000442577.96802.8c] [Citation(s) in RCA: 280] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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A case-control study of intentional occlusion of accessory renal arteries during endovascular aortic aneurysm repair. J Vasc Surg 2013; 58:1467-75. [DOI: 10.1016/j.jvs.2013.06.068] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Revised: 06/20/2013] [Accepted: 06/20/2013] [Indexed: 11/19/2022]
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Coulier B. Ten renal arteries found in a 51-year-old man during multidetector computed tomography (MDCT) angiography. Anat Sci Int 2013; 89:62-3. [DOI: 10.1007/s12565-013-0196-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Accepted: 07/29/2013] [Indexed: 11/28/2022]
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Utility of 16-multidetector CT angiography in the preoperative evaluation of vascular and ureteral anatomy of donor nephrectomy. AFRICAN JOURNAL OF UROLOGY 2013. [DOI: 10.1016/j.afju.2012.10.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Engelken F, Friedersdorff F, Fuller TF, Magheli A, Budde K, Halleck F, Deger S, Liefeldt L, Hamm B, Giessing M, Diederichs G. 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 2013; 31:983-90. [DOI: 10.1007/s00345-012-1022-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2012] [Accepted: 12/27/2012] [Indexed: 11/25/2022] Open
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Liefeldt L, Klüner C, Glander P, Giessing M, Budde K, Taupitz M, Rogalla P, Kroencke TJ. Non-invasive imaging of living kidney donors: intraindividual comparison of multislice computed tomography angiography with magnetic resonance angiography. Clin Transplant 2012; 26:E412-7. [DOI: 10.1111/j.1399-0012.2012.01680.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Lutz Liefeldt
- Department of Nephrology; Campus Charité Mitte; Charité - Universitätsmedizin Berlin; Berlin; Germany
| | - Claudia Klüner
- Department of Radiology; Campus Charité Mitte; Charité - Universitätsmedizin Berlin; Berlin; Germany
| | - Petra Glander
- Department of Nephrology; Campus Charité Mitte; Charité - Universitätsmedizin Berlin; Berlin; Germany
| | - Markus Giessing
- Department of Urology; Universität Düsseldorf; Berlin; Germany
| | - Klemens Budde
- Department of Nephrology; Campus Charité Mitte; Charité - Universitätsmedizin Berlin; Berlin; Germany
| | - Matthias Taupitz
- Department of Radiology; Campus Benjamin Franklin; Charité - Universitätsmedizin Berlin; Berlin; Germany
| | - Patrik Rogalla
- Department of Radiology; Campus Charité Mitte; Charité - Universitätsmedizin Berlin; Berlin; Germany
| | - Thomas J. Kroencke
- Department of Radiology; Campus Charité Mitte; Charité - Universitätsmedizin Berlin; Berlin; Germany
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Hora M, Stránský P, Trávníček I, Ürge T, Eret V, Kreuzberg B, Baxa J, Mírka H, Petersson F, Hes O, Ferda J. Three-tesla MRI biphasic angiography: a method for preoperative assessment of the vascular supply in renal tumours—a surgical perspective. World J Urol 2012; 31:1171-6. [DOI: 10.1007/s00345-012-0870-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2012] [Accepted: 04/03/2012] [Indexed: 12/22/2022] Open
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Li G, Dong J, Lu JS, Zu Q, Yang SX, Li HZ, Ma X, Zhang X. Anatomical variation of the posterior lumbar tributaries of the left renal vein in retroperitoneoscopic left living donor nephrectomy. Int J Urol 2011; 18:503-9. [DOI: 10.1111/j.1442-2042.2011.02778.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Sebastià C, Peri L, Salvador R, Buñesch L, Revuelta I, Alcaraz A, Nicolau C. Multidetector CT of Living Renal Donors: Lessons Learned from Surgeons. Radiographics 2010; 30:1875-90. [DOI: 10.1148/rg.307105032] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Knox MK, Rivers-Bowerman MD, Bardgett HP, Cowan NC. Multidetector computed tomography with triple-bolus contrast medium administration protocol for preoperative anatomical and functional assessment of potential living renal donors. Eur Radiol 2010; 20:2590-9. [PMID: 20582545 DOI: 10.1007/s00330-010-1855-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2009] [Revised: 05/16/2010] [Accepted: 05/20/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To evaluate multidetector computed tomography (MDCT) with a triple-bolus contrast administration protocol for preoperative anatomical and functional assessment of living renal donors. METHODS Fifty-five potential living renal donors underwent MDCT of which 27 proceeded to donor nephrectomy. A triple-bolus contrast administration protocol was used for simultaneous acquisition of arterial, nephrographic, and excretory phases. MDCT images were independently reviewed in random order by two radiologists blinded to surgical anatomy findings. Diagnostic accuracy for anatomical variants was quantified by sensitivity and specificity. Differential renal function (DRF) was derived from MDCT for 54 patients and compared with technetium-99 m dimercaptosuccinic acid renography (Tc-99 m DMSA). RESULTS All triple-bolus MDCT examinations were technically adequate. Accessory renal arteries and veins were identified at surgery in 33% (n = 9/27) and 22% (n = 6/27) of donor kidneys. The mean difference between MDCT-derived DRF and DMSA was 0.8% (95% CI 0.1-1.6) with 95% limits of agreement of -4.6% (95% CI -3.3 to -5.9) to 6.3% (95% CI 5.0-7.6). MDCT delivered a mean (SD, range) radiation dose of 9.5 (3.6, 3.6-17.3) mSv. CONCLUSION MDCT with a triple-bolus contrast administration provides accurate anatomical and functional evaluation of living renal donors.
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Affiliation(s)
- Matthew K Knox
- Faculty of Medicine, UME Office, Health Sciences Centre, University of Calgary, 3330 Hospital Drive NW, Calgary, Alberta, Canada T2N 4N1
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Asgari MA, Dadkhah F, Ghadian AR, Razzaghi MR, Noorbala MH, Amini E. 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 2010; 25:481-5. [DOI: 10.1111/j.1399-0012.2010.01291.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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