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Velloni FG, Cardia PP, Torres UDS, Pereira MAH, Penachim TJ, Favaro LR, Ramalho M, D'Ippolito G. Unenhanced magnetic resonance angiography as an accurate alternative in the preoperative assessment of potential living kidney donors with contraindications to computed tomography angiography and to contrast-enhanced magnetic resonance angiography. Radiol Bras 2020; 53:229-235. [PMID: 32904775 PMCID: PMC7458566 DOI: 10.1590/0100-3984.2019.0013] [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] [Indexed: 11/29/2022] Open
Abstract
Objective To evaluate the accuracy of steady-state free precession (SSFP) unenhanced magnetic resonance angiography (MRA) at 1.5 T for the identification of multiple renal arteries, using computed tomography angiography (CTA) as the reference standard. Materials and Methods This was a prospective study involving 39 patients (26 males; mean age, 62.6 years) who underwent CTA and unenhanced MRA to evaluate the proximal and middle segments of the renal arteries. The analysis was performed in two phases: the quality of unenhanced MRA images was classified as diagnostic or nondiagnostic for the presence of multiple renal arteries by two independent readers; two other independent readers then evaluated the images previously classified as being of diagnostic quality. The sensitivity, specificity, and overall accuracy of unenhanced MRA were calculated, CTA being used as the reference standard. The kappa statistic was used in order to calculate interobserver agreement. Results The image quality of unenhanced MRA was considered diagnostic in 70-90% of the extrarenal arterial segments. The CTA examination revealed 19 multiple renal arteries (8 on the right and 11 on the left). The accuracy of unenhanced MRA for the identification of multiple renal arteries was greater than 90%, with a sensitivity of 72.7-100% and a specificity of 96.3-100%. Conclusion Unenhanced MRA provides high quality imaging of the extrarenal segments of renal arteries. This method may be used as an alternative for the evaluation of the renal arteries, given that it has an accuracy comparable to that of CTA.
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Affiliation(s)
- Fernanda Garozzo Velloni
- Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil.,Diagnósticos da América SA (DASA), São Paulo, SP, Brazil
| | - Patrícia Prando Cardia
- Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil.,Centro Radiológico Campinas, Campinas, SP, Brazil
| | | | - Marco Antonio Haddad Pereira
- Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil.,Diagnósticos da América SA (DASA), São Paulo, SP, Brazil
| | | | - Larissa Rossini Favaro
- Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil
| | | | - Giuseppe D'Ippolito
- Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil.,Grupo Fleury, São Paulo, SP, Brazil
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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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Laurence I, Ariff B, Quest RA, Moser S, Glover A, Taube D, Gishen P, Papalois V, Juli C. Is there a role for free breathing non-contrast steady-state free precession renal MRA imaging for assessing live donors? A preliminary study. Br J Radiol 2012; 85:e448-54. [PMID: 22253354 DOI: 10.1259/bjr/16270927] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE Accurate pre-operative evaluation of renal vascular anatomy is essential for successful renal harvest in live donor transplantation. Non-contrast renal MR angiographic (MRA) techniques are potentially well suited to the screening of donors; however, their restricted imaging field of view (FOV) has previously been an important limitation. We sought to assess whether the addition of a large FOV balanced fast field echo (BFFE) steady-state free precession (SSFP) sequence to non-contrast SSFP MRA could overcome this problem. Comparison with contrast-enhanced MRA (CE MRA) and findings at surgery were performed. METHODS 22 potential renal donors each underwent SSFP and CE MRA. 11 out of 22 potential donors subsequently underwent a donor nephrectomy. RESULTS All images were diagnostic. Both SSFP MRA and CE MRA identified an equal number of arteries. Surgery confirmed two accessory renal arteries, both demonstrated with both imaging techniques. A third accessory vessel was identified with both techniques on a kidney contralateral to the donated organ. 6 out of 11 procured kidneys demonstrated early branch arteries at surgery, 5 out of 6 of which had been depicted on both SSFP and CE MRA. The median grading of image quality for main renal arteries was slightly better for CE MRA (p=0.048), but for accessory vessels it was better for SSFP MRA. CONCLUSION This pilot study indicates that by combining free-breathing SSFP MRA with large-FOV bFFE images, an accurate depiction of renal vascular anatomy without the need for intravenous contrast administration can be obtained, as compared with surgical findings and CE MRA.
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Affiliation(s)
- I Laurence
- Radiology Department, Royal United Hospital, Bath, UK.
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Arvin-Berod A, Bricault I, Terrier N, Skowron O, Cadi P, Boillot B, Thuillier C, Cluze C, Descotes JL, Rambeaud JJ, Long JA. Évaluation préopératoire du nombre de vaisseaux chez le donneur de rein vivant. La TDM est-elle supérieure à l’IRM ? Prog Urol 2011; 21:34-9. [DOI: 10.1016/j.purol.2010.05.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2010] [Revised: 05/14/2010] [Accepted: 05/26/2010] [Indexed: 11/25/2022]
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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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Abstract
Since it first was performed in 1995, laparoscopic donor nephrectomy (LDN) has grown to be the standard of care in most transplant centers in the United States. This article reviews the current indications, selection criteria, surgical approaches, outcomes, and complications of LDN.
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Affiliation(s)
- David A Duchene
- Department of Urology, University of Kansas Medical Center, MS 3016, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA.
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