Gadolinium-enhanced three-dimensional magnetic resonance angiography versus conventional digital subtraction angiography: which modality is superior in evaluating living kidney donors?1

Abstract

This study evaluates the correlation of magnetic resonance angiography (MRA) and digital subtraction angiography (DSA) with the operative vessel findings in living kidney donors. The intraoperative vessel findings of 52 living renal donors were compared with the preoperative diagnoses of each imaging technique. Sixty-seven arteries were found during explantation. Forty kidneys showed a single arterial blood supply, and 12 kidneys showed a multiple arterial blood supply. No advantage of either imaging method was found for arterial imaging. There were 55 veins identified during organ harvesting. MRA could not determine the venous system in one donor (1.9%) and failed to detect one small pole vein in another. DSA did not yield a venous diagnosis in seven patients (13.5%) and yielded misdiagnoses in four patients. The correct diagnosis of renal donor veins differed significantly in favor of MRA (kappa 0.79 vs. 0.45; P=0.008). MRA is superior to DSA in assessing the renal vasculature in living kidney donors.

Management and Outcome of Living Kidney Grafts with Multiple Arteries

“…Recently, minimally invasive laparoscopic donor nephrectomy has been introduced. In laparoscopic donor nephrectomy, grafts with early branching arteries, as seen in 6.5%-9.6% of the main renal arteries, 19,20 are likely to be MRA grafts because the length of the renal artery has been reduced by the use of vascular staplers. Oh et al 21 reported finding two or more renal arteries in 6 of 62 donors (9.7%), although preoperative imaging indicated only one renal artery, because of the staples fired across the vivisection of the main artery in laparoscopic nephrectomy.…”

Urologic Considerations and Complications in Kidney Transplant Recipients

“…There is an emerging role of magnetic resonance imaging angiography in pre-donation imaging, although recent studies have not demonstrated clear superiority of magnetic resonance imaging over CT angiography. [24][25][26] …”

Magnetic Resonance Angiography of Chest and Abdomen at 3 T

“…In contrast to this, the reliability of MRA is not affected by impaired renal function or the presence of bilateral renovascular disease. 5,12,13 Moreover, it is unnecessary to hydrate the patients or to stop the use of diuretics before the examination. Another suggested advantage of MRA is the possibility of evaluating not only arterial but also venous vasculature.…”